Rux and IFN, risks of Dental Complications

[EPguy]

I just got a possible Dx of tooth resorption on a tooth. Simplified this is when the immune system dissolves tooth materials from inside or outside. Usually a root canal or implant is required. I will post updates. In searching info I came across this report implicating both Peg and Rux for different oral risks:

pmc.ncbi.nlm.nih.gov/articl...

This para summarizes the findings:

"In a multivariate analysis including all parameters described above,treatment with Peg‐Ifn (OR = 11.4) or ruxolitinib (OR = 14.77) are the most significant parameters associated with need for oral care (P < .0001 each). Peg‐Ifn use was highly associated with gingival abscess (OR = 5.8, P = 0.004) and to a lesser degree to tooth loss (OR = 3.93, P = 0.053), whereas there was a nonsignificant trend toward association of ruxolitinib with tooth cracks (OR = 2.34, P = 0.097)"

Those are huge odds ratios. The plots show these effects I think before the multivariate analysis. HU and other MPN drugs were not a risk in this study.

I had a couple tooth cracks last year early in my Rux Tx, one on a cherry pit, reasonable, and another during teeth cleaning. Lately none.

Have any other members on IFN or Rux had tooth issues that might be part of this risk?

[MCW22]

I've had a couple of teeth break over the last few years but never gave it a thought it could be connected to rux. I've also had 5 spinal fractures which I considered to be related to the blood cancer.

Carol

[EPguy in reply to MCW22]

I didn't connect it either, but maybe there is something to it. If I get another I'll be more convinced.

[PhysAssist in reply to MCW22]

The article mentioned some effect of JAK on tooth structure and enamel development [and presumably maintenance] as relates to this side-effect.

[RoundTheWorld]

I’ve a hairline crack on a tooth and a small missing bit of enamel on another but the crack predated diagnosis and the chip was near diagnosis so can’t blame the Peg. in my case.

[EPguy in reply to RoundTheWorld]

According to this report Rux was the connection to tooth cracks. So Peg should be doubly innocent in your case.

[RoundTheWorld in reply to EPguy]

Good point!

[ainslie]

interesting paper, thanks for posting, I will run by my expert when I see him next.

I’ve been on Rux since 2017 and no dental issues of any kind, I get 6-12 month checks.

I don’t doubt the data necessarily but for example there was data posted recently I think on this forum or was it MPN list about a paper stating that us with MPN have a huge risk of dementia, I cant remember the exact stats but I think if we were diagnosed before age 65 we had something like 70-80% chance of getting dementia , last week I had a consult with my expert at Mount Sinai and asked him about the dementia stats quoted and he pulled a bit of a face and said in his decades of clinical experience he has not noticed or heard of anything about the increased dementia risk , these guys are super smart and I think they will have noticed if something like 70% of MPN patients were getting dementia. Food for thought.

[EPguy in reply to ainslie]

Any study of dementia is an even longer term outcome than MPNs. It would also be polluted by the improved MPN treatments thru any relevant time period.

80% chance is odds ratio of 4:1. I agree with your Dr anything at that level would be hard to miss anecdotally, while dental troubles might not be so obvious.

If you can find that report it would be interesting reading.

[jon1972]

Hi EPguy, been a while. I've actually been meaning to post my progress on Rux after finally giving up on Peg and IFN in general. I feel like IFN was literally killing me. Among other things, I also experienced tooth "resorption". That's exactly what my dentist called it. She said there's no known cause and that the IFN is as good of reason as any. Prior to the resorption I spent 2-3 years in and out of dentists and specialists for serious gum infections. It seemed to all start when I attempted to switch to Besremi which I found I was highly sensitive to. It caused my throat and tongue to become raw and painful and that's when the issue with my gums started. I tried switch back but it was too late. It seemed the Bes started something that couldn't be stopped till I finally quit IFN altogether. I ended up having multiple Osseous procedures to try and repair the gum damage before ultimately having 2 molars extracted. One was completed hollow (resorption) the one above had a really bad cavity, both of which they had attempted the osseous repair on. This entire past summer has been a nightmare. My neut-white counts were bottoming out when all this came to a head at around .5 to .6, well bellow the safe limit. The nurse told me that this is a known complication due to white counts being unsafely low. Apparently, bacteria that are already there, when left uncontrolled make a mess of your teeth and gums if your immune system is weakened? Anyway not sure of the exact reasons, but did want to confirm your suspicion about IFN.

I should add that the gum problems completely went away since switching to Rux. My quality of life has actually improved all around as many others here have mentioned.

[EPguy in reply to jon1972]

Your observation on the low WBC matches the note in the report "This may be explained by the decrease in circulating neutrophils often observed in Peg‐Ifn‐treated patients ".

We know from here WBCs are often dose limiting for IFN. Ignoring a bigger detail, it was for me.

Gum infection does match the IFN association of the report. I see reverting to PEG still left you with high RBCs.

[jon1972 in reply to EPguy]

Yes the whites kept going lower and the reds kept going higher. IFN just seemed to stop working altogether after about 5 yrs and the sides got worse and worse. I think I remember reading that most people don't stay on IFN more than roughly 5 yrs due to complications. So this wasn't too surprising.

[PhysAssist in reply to jon1972]

Hi Jon,

I'm sorry to hear that you had these issues with IFN.

Now, you''ll have to watch out for your teeth cracking instead.

Best,

PA

[Cja1956]

I started Ruxo in January 1923, and since then I’ve had four tooth extractions. The teeth that were extracted had very old crowns on them. Even though they are in the back, I was really upset to lose them. My dentist told me that he thinks because I have cancer, any bacteria or infection in the mouth is not gonna heal as quickly as if i didn’t have cancer. He does think it’s all connected.

[EPguy in reply to Cja1956]

With that timing there could be something to the Rux connection. But it seems you had infection rather than cracks, is that right?

[Cja1956 in reply to EPguy]

No cracks

[Ovidess]

I had your experience with resorption years before my diagnosis, back in the good old decades when I had high platelets but no doctors worried too much about 'em. So in my case it would be the disease or inflammation or lousy genes/luck, not the Besremi to blame. I also wondered about osteoporosis, but didn't hear that was involved. There seems to be so much we don't know, a sea of ignorance out there.

[EPguy in reply to Ovidess]

My dentist said my version is rare and agree that I am full of that sort of thing. I will learn more next week. I understand it's more common in younger pts.

[Ovidess]

Alas, "rare" used to be something to aspire to, no more it seems! Good luck with your appointment. In my case I passed on that implant because the (mis)alignment of my teeth meant that the resorbed far molar would not be as useful as one would want.

[EPguy in reply to Ovidess]

I'd likely leave that tooth alone too. Mine is lower front center. So form and function point to needing something there.

[william-Indo in reply to Ovidess]

Good decision.

I my self never saw dentists got implant for themselves

[william-Indo]

Thx for the info.

No wonder my teeth always broken, specially when eat hard food

[EPguy in reply to william-Indo]

You indicate the breaking started after using IFN and/or Rux, is that right?

[william-Indo in reply to EPguy]

Yes, it was about 3-4 months after Rux

[EPguy in reply to william-Indo]

Has cracking continued same rate for you? I had it within the 1st 6 months of Rux but not lately even as I expected more.

[william-Indo in reply to EPguy]

Yes, but rate still continue, but slow rate.Every 6 month I must go to dentist for repairing 2-3 teethes

Recently, i stop using tooth paste and replace with baking soda.

Just experiment to see if it could help.

Baking soda work very effective to clean yeast on the tongue too

[RedCardRob]

In my 70 years worth I have probably self inflicted most of my teeth "repairs" through either sport or bike accidents...but since you brought the subject up, peg from this Feb 24, I haven't had any inner pain from one particular nemesis tooth.Just a thought, perhaps the improved blood flow has also improved the rehab of this tooth as it has done with other physical symptoms I have felt i.e short periods of cramp like pain, but not cramp, in legs, arms, etc.

[EPguy in reply to RedCardRob]

Could be the MPN condition was causing it and IFN improved that part. But of course we can never know for certain.

[DiveGoddess]

Good Morning EPGuy,

I started Besremi Jan 2023, lost a tooth late 2023, March 2024 experienced this again, tooth reabsorption. I am 59. I have always had dental issues, many crowns and root canals. So for me, may speed things up, but probably was on horizon. Sorry this happened. It is expensive buying a new tooth! Besremi only drug for MPN I have taken, besides daily aspirin 81mg.

[DiveGoddess]

EPguy,

I started Besremi Jan 2022. Lost a molar one year later. 2024 lost a front tooth and had implant. Told front tooth had reabsorption. Caveat- about ten years ago had sinus surgery and had been on medication that caused dry mouth prior to surgery. In hindsight, should have had the sinus surgery about a decade prior. I have PreFibrotic Myelofibrosis. (ET) my platelets rising for years while anemic. Still surprised to loose two teeth after starting Besremi. Don’t know I would blame the drug, certainly could have sped up a chronic issue for me.

Best of Luck

Christy

[EPguy in reply to DiveGoddess]

Normally one would expect the dental troubles to be close to the time of a long term dryness. This is my impression from Sjogren's that is inherently long term. But either way, it could be additive as you say.