Chronic musculoskeletal disorders: dental considerations

For the medical management of chronic musculoskeletal disorders, see the Rheumatology Guidelines.

Pain and restricted mobility are common symptoms of musculoskeletal disorders. Chronic musculoskeletal disorders encompass a range of conditions affecting:

• muscles (eg sarcopenia)
• joints (eg osteoarthritis, rheumatoid arthritis)
• bones (eg osteoporosis, traumatic fractures)
• spine (eg back and neck pain)
• multiple body systems and locations (eg widespread and regional pain disorders, inflammatory connective tissue diseases, systemic vasculitides, fibromyalgia).

Patients with pain and restricted mobility due to a musculoskeletal disorder may find extended dental treatment uncomfortable. Modify treatment to minimise the time spent in the dental chair, and consider changing the chair configuration or using filler pillows to support the neck, hips or knees.

Patients with chronic musculoskeletal disorders may be prescribed immunomodulatory drugs, which can cause immunosuppression (see here). If corticosteroids are used, also see here.

Some patients with chronic musculoskeletal disorders take large doses of over-the-counter or prescription analgesics, including opioids. Opioids can cause dry mouth and consequently dental decay and periodontal disease, particularly if taken with other drugs that can cause dry mouth. Consult the patient’s medical practitioner if pain management is required for a dental indication.

Patients with chronic musculoskeletal disorders may have prosthetic joints; this is not a specific indication for surgical antibiotic prophylaxis before dental procedures (see Surgical antibiotic prophylaxis for patients with a pre-existing joint prosthesis).