Methotrexate and dental problems.

[Shamrockgirl]

Has anyone else who’s on Methotrexate, had dental problems? I had to have a wisdom tooth out in March & found out that my normal dentist can’t do my extractions, though I had been off it for weeks, due to liver problems. But they said it was “still in my system”. She then referred me to my local hospital (in special measures), to go on a waiting list. I foolishly thought it would be quite fast, as with dental problem, needing a tooth out, you would likely be in a fair amount of pain. The referral was done on the 9 Th of March & tooth removed on 20 Th March. Plus I have to arrange someone to be with me, in case of excess bleeding.

That was over with, but as I have ongoing gum disease (dentists in 1990’s not telling you about this) not long before an issue arises, with few teeth I have left. Another non wisdom tooth, that has been playing up on & off got worse earlier this month. I foolishly hung on for my check up appointment at usual surgery (don’t like it there now, though dentist herself is ok) on the 12 Th September, but she says it needs to come out & I can’t do it, because of the Methotrexate.

But here we are still no appointment & when I contacted the Oral Health Department at the hospital, they didn’t have the referral & I found out that it’s sent to an outside contractor, before it comes to the department to be looked at. I am fuming as I hate all kinds of privatisation within NHS & it mostly doesn’t work. They’ve said today it’s like a “normal waiting list of up to 18 weeks”, unless it was cancer!! I’ve tried the so called emergency community clinic, but they said they are only for people with no regular dentist. But as I’m on Methotrexate they said they would just refer me to the other hospital. Maybe I’d be better of lying about it & why aren’t we told about these things before we go on it???

[Zip1]

I am also having more dental problems but luckily my dentist has not sent me down your route and has taken teeth out for me! Have you thought of getting a second opinion, living with toothache on top of everything else is no fun.

[oldtimer]

This must be specific to your dentist and perhaps others of like mind? My dentist was happy to treat me for extractions and root fillings and everything else while on methotrexate - but he was the one who encouraged me to ask for alternative treatment when he saw what enormous mouth ulcers I had. I suspect that it varies according to their experience and confidence.

[Leviset]

Fortunately we have an NHS Dental Hospital here in Sheffield. I’ve deliberately not spoken about this as I’m not a doctor or dentist but the 22 years I’ve had RA 20 of those have been on MTX, initially 25mg a week and now 10mg a week combined with a number of different biologics and 18 months on a trial drug (which worked brilliantly but was suddenly stopped after a number of European trial patients died!). I’m currently on Abatarcept weekly injections. From about 15 years ago I started to lose teeth one at a time, usually because of an abscess or gum disease - 2 weeks ago I’ve had the last 2½ remaining teeth extracted. I’ve been fitted with NHS dentures, top one is fine but lower is a nightmare and useless for eating with. Implants can only be done privately unless your young and have lost teeth say from a car accident. I’m 70 next month and also a committed socialist and could no way justify spending £25 - £35 thousand having implants top and bottom, I’d sooner just give the money to the NHS - some people go on dental tours of the EU where the treatment costs about ½ of the U.K. prices. I don’t believe my jaw bones are even good enough to retain implants but I’m convinced MTX has contributed to my tooth loss (as do another 40+ patients in clinic I’ve spoken to over the years). What I don’t know is what physical shape I’d be in with NOT taking MTX.

I lost both my ankle joints in the first 5 years because they didn’t want to put me on MTX in 2000 for some unknown reason. My left ankle was fused in 2001 and the right a very early total replacement ankle joint in 2004 - this has just collapsed after 14 years. I suspect it may be Swings and Roundabouts with MTX, yes I suspect it’s caused my tooth loss BUT I’m not permanently in a wheelchair or having to ride a scooter as YET!

Dennis