Dental Treatment

 

Introduction

People living with Myalgic Encephalomyelitis (ME), particularly those with severe or very severe disease, can face profound and often underestimated barriers to accessing dental care. These issues arise from the underlying neurological, sensory, and systemic dysfunction that defines the disease.

Energy limitation is a central feature of ME. Patients often have almost no usable energy, and attending an appointment - travel, interaction, sensory exposure - can lead to Post-Exertional Neuro-Immune Exhaustion (PENE, also referred to as PEM), a worsening of all symptoms that can last days, weeks, or longer. This means that even a short dental visit may result in significant and prolonged deterioration.

For some individuals, those in the more severe ranges, for example, even the presence of another person in the same room can be overwhelming. 

Physical contact, which is unavoidable in dentistry, may be intolerable due to hyperesthesia and touch sensitivity, where even light contact can trigger severe pain or distress. This is compounded by pressure intolerance, meaning the dental chair, headrest, or even routine positioning can become a source of significant suffering.

The dental environment itself can be unmanageable. Bright overhead lights may worsen light sensitivity and headaches, while the sound of instruments can provoke extreme noise sensitivity. 

Many living with ME experience confusion, disorientation, and cognitive dysfunction, making it difficult to process instructions, give consent, or communicate needs effectively. These are not mild impairments; they can fluctuate rapidly and worsen with exertion.

Basic aspects of dental treatment may also be physically impossible for some individual:

Chewing and swallowing difficulties, along with gagging or problems managing secretions, can make procedures unsafe without careful adaptation. 

Muscle weakness, fatigue, spasms, or even periodic paralysis can limit a patient’s ability to keep their mouth open or remain in position. 

Breathlessness may be exacerbated when reclined, and movement or motion sensitivity can make even small adjustments intolerable.

Additional barriers include chemical sensitivities, where exposure to perfumes, cleaning agents, or dental materials may trigger severe reactions. 

Sleep disruption further reduces resilience, and cumulative symptom burden means that what might seem like small stressors can become overwhelming when combined.

 

Precautions

Ultimately, people with ME are patients whose condition demands a different standard of care. Recognising the realities of severe ME is the first step toward making dental treatment safe, humane, and accessible. Because of all the above, appropriate dental care for people with ME, especially severe ME, requires knowledgeable, flexible, and patient-centred approaches. 

This may include:

• Careful risk assessment before any intervention

• Minimising sensory input (dim lighting, quiet environment)

• Avoiding unnecessary physical contact and explaining each step in advance

• Allowing extra time, rest breaks, or even splitting treatment into shorter visits

• Considering alternative locations, including domiciliary (home-based) care or seeing the individual when admitted to hospital for another reason

• Awareness of sensitivities when selecting materials, medications, or anaesthetics

• Close collaboration with carers, who often understand the patient’s needs best

For some, conventional dental attendance may simply not be feasible. In these cases, access to specialist or community-based services is essential to prevent neglect of oral health.

Dental Leaflet 

 

We are currently working on our own Dental Leaflet to include risk assessment details and more.

Until we have completed our leaflet we are sharing a leaflet by the Grace Charity for ME.

Please see information for ME sufferers and their dentists in their leaflet which can be printed on both sides, then folded into thirds, with the tooth image to the front.

Dental Leaflet by Grace Charity for ME  

Tips:  print landscape; both sides of paper; PDF may need you to ‘shrink to fit’.

(The leaflet was produced by The Grace Charity for M.E. with grateful thanks to members of the 25% ME Group)