Where do I start, on the 23rd Dec I got a really bad toothache. My face and neck blew up all down one side, the pain was excruciating. I couldn't speak or sleep. Here in Spain, they celebrate Xmas day on 24th Dec and the 25th Dec is their boxing day. Then everything opens on the 26th, so I went to the dentist and he said that I needed to see the PMR specialist to see if I could change my tablets, RISEDRONATO SEMANAL STADA 35mg. These are the tablets that I take one a week for protection of my bones.
My dentist is not keen on taking out my bad tooth, because of the possible side effects, such as, damage to my jaw bone. I have 2 hours to make a decision whether to let the dentist take it out at my own risk or arrange to see the specialist in January.
Has anyone got any advise for me please.
Regards
Buenavista
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Buenavista
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From my own experience here a great many dentists will not carry out invasive procedures on those patients taking bisphosphonates and if you google alendronic acid which is the most commonly prescribed one you will probably see why.
I would query as to why you are actually taking it - has a need been shown? The thinking on these bone drugs has changed in the last couple of years as the long term side effects have become obvious and although there are still rheumies here who will hand them out with the steroids that is quickly becoming the minority instead of the majority. Myself, I would take the risk, but it is obviously a personal decision. My own dentist has extracted several of my teeth without any problems whatsoever but I guess there is always a first time. The length of time you have been taking it would also have a bearing - obviously the shorter the better in this case.
I promise to answer any further questions you might have, but I have to go out in a short while. Will be back and looking in later.
Oh dear, poor you. Toothache is horrid at any time let alone happening over Christmas.
Many dentists prefer to refer patients on AA drugs to hospital for extractions due to the possible side effects of the medication to the jaw bone. I suppose it depends how much pain you are in as to what decision you make. Perhaps you can have some painkilling medication to tide you over until you get an urgent referral to a dental hospital for removal of the tooth?
Have you been diagnosed with Osteoporosis? If not, then it would be a good idea to request a DEXA scan - if it shows your bones are normal, then you may not need the bone protection, in spite of taking steroids. I took steroids for five and a half years without any bone protection medication, and a DEXA scan towards the end of treatment showed only a very tiny amount of thinning which may be due to advancing years rather than the steroid treatment!
In the short term I can't really advise you about having this tooth taken out as I refused to take a bisphosphonate so a dentist couldn't hold me to ransom over it. I certainly can sympathise with the pain aspect though and I suppose in this case you have to balance out whether you accept this dentist's ultimatum or put up with the pain. Has he said what the cause is? Is there another one for a second opinion?
Bisphosphonates are associated with jawbone problems - but I suspect more in certain cases such as cancer where a much higher dose is used. As polkadot has said - stopping taking it is not too much of a problem and (IMHO) you shouldn't be taking it unless you had a dexascan done which showed you already had some degree of bone density loss. I have been on pred for four and half years, most of the time at 10mg and above, for some of the time well above that, and the dexa done at the beginning and the one done earlier this year are, to all intents and purposes, identical and normal. I took AA for 5 weeks before my GP agreed with me it probably was better not to take it as it is finally slowly being realised it isn't the miracle way of avoiding hip fractures that has no side-effects the manufacturers claimed - it was brilliant marketing by Big Pharma. I have taken calcium and vit D supplements the whole time. Here in Italy bisphosphonates are not offered routinely - you get pred and the supplements alone unless there is evidence of need.
If you stop the bisphosphonate there are other options IF NEEDED. They cost more - needless to say. What dose of pred are you on and how long have you been on it and the risedronato? Because the length of time also has a role to play - if it is just a few months you would probably be fine, a few years is a different question.
Is one allowed to post links here? If so you might be interested in this discussion on the Patient's Experience forum which also illustrates dentist's reluctance to work on patients on bisphosphonates:
My dentist needs a reply from me before 8pm, 7pm UK time. I will make a decision based on your feedback, because this is the second infection on the same tooth within the last 4 weeks.
My history is, PMR for 26 months, but diagnosed since April 20th 2012. Took 30mg of pred, 3 liquid anti-inflammatory, 1 vitamin D tablet, 1 lansoprazol per day and the bone tablet once a week. Stopped anti-inflammatory last April. The longest I would of been on the bone tablets 35mg per week, would be 20 months or less. I checked google as you said, can't understand most of it, what with PMR tablets and antibiotics and 600 mg of ibuprofen pain killers. Which for the 24 and 25 December, did not work at all.
I have never had a Dexa bone scan and I am now on 5mg pred per day, this being the third time of trying.
Best regards
Buenavista
PS. What does alcohol and nuts and Xmas things taste like.
The link I gave you probably has all the info in it you need in easy language. While I remember - what antibiotic? Hopefully not a quinolone - they do NOT mix well with pred as I know to my cost (achilles tendon inflammation), and you'd be better with cocodamol not brufen (also bad with pred).
As for the alcohol/nuts/xmas stuff is concerned: a pleasure deferred is a pleasure gained Just make sure no one else eats your share!
Sorry to hear of your predicament Buenavista, "ordinary" toothache is bad enough, but yours sounds horrific. I requested a DEXA scan soon after starting Pred and the result being I already had Osteoporosis before starting it ! ! I refused AA after reading mountains of info about it, especially the risk of osteonecrosis of the jaw, this being the reason why many Dentists refuse to do extractions. Before being offered any drug, one of the things I usually do is Google the drug name and Lawsuits and it is amazing what comes up. I hope by the time you read this you are not in pain and things have improved. Take care
I decided to go ahead with extraction. Had to sign a disclaimer. The dentist wanted me to go to the hospital to have it out, because he had never taken a tooth out with a patient taking bone tablets.
He took an x-ray and showed me the infection. Then extracted the tooth. Scrapped the bone and put 4 stitches in. I have to go back Monday for a check up.
I wanted to have an implant done, but he said he doesn't know if it's possible, because of the bone tablets. I have stopped taking them as from now, after reading all the info which I should of done right from the start. The PMR specialist put me on the tablets to protect my bones.
So sorry you have had to deal with this - especially over the holidays. My rheumy put me on AA because of the results of my latest dexa scan. My dentist is aware of both the pred regime and the AA but agrees with the rheumy that jaw probs are rare with low doses of oral bisphosphonates. I hope your dental wounds heal fully and fast
Glad to hear you have managed to get your tooth extracted.
No medication comes without risks and their benefits have to be weighed up against the risks by the patient and prescriber.
I too have had the conversation with my dentist that iforget describes and my dentist is of the same opinion. It is unfortunate that your dentist had no experience in this area.
Perhaps you could have a discussion with your specialist about Alendronic Acid and come to a decision?
Regards
Keyes
The prescription drug Fosamax (the generic is alendronate sodium) is a medication which has been prescribed to hundreds of thousands of postmenopausal women to treat osteoporosis and help increase bone mass thereby reducing the chance of spinal or non-spinal fractures. Fosamax has also been prescribed to increase bone mass in men with osteoporosis. Brand name Fosamax is manufactured in the United States by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. In about 2008-2009, Fosamax became widely available in its generic form (alendronate sodium).
Side effects of Fosamax may include the following:
1. Esophagus problems including irritation, inflammation, or ulcers
2. Low blood calcium levels (hypocalcemia) which may lead to muscle spasms, twitches, or cramps as well as numbness or tingling in the face, fingers, toes, and around the mouth
3. Severe jaw bone problems (osteonecrosis of the jaw often abbreviated as “ONJ”)
4. Bone, joint, or muscle pain
5. Unusual femur (thigh bone) fractures
ABC News ran a story on May 10, 2012 about the dangers of “bone drugs” stating, “In a report published in the New England Journal of Medicine on Wednesday, the U.S. Food and Drug Administration raised concerns about the potential for some serious side effects in women taking bone-building drugs called bisphosphonates, specifically Fosamax, Actonel and Reclast. The published findings are not new. In 2011, the agency voiced concerns that taking the drugs long-term may actually make bones weaker and increase the risk of rare but serious side effects such as atypical fractures of the thigh bone, esophageal cancer and osteonecrosis of the jaw, a rare but painful condition in which the jaw bone crumbles. To investigate, the FDA reviewed data from women who had taken the drugs for six to 10 years.” Underscoring just how commonly these medications are prescribed, ABC News commented, “According to the FDA, doctors wrote more than 150 million prescriptions for bisphosphonates between 2005 and 2009.”
At the end of 2013, Merck settled with about 1,200 plaintiffs alleging that Fosamax caused them to suffer osteonecrosis of the jaw (“ONJ”). ONJ is a rare condition in which the patient suffers degeneration and deterioration of the jaw and often necessitates surgical repair with bone grafting. This recent settlement requires a total of about $27.7 million to be paid by Merck. Before anyone feels bad for Merck, he or she should also know that some researchers estimate that Merck “earned” about $3 billion (with a “b”) in 2007 from Fosamax. There are still many unsettled suits.
While alendronate sodium does have some appropriate indications, there are serious side effects which can occur. Most of the lawsuits focus on one of two harms – femur fractures or osteonecrosis of the jaw. Each is treated differently by many of the lawyers handling these cases. If someone has taken brand name Fosamax and suffered either of these harms, he or she should immediately consult with his or her physician and then consult with an attorney who is experienced in handling such a matter.
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Just make sure no one else eats your share! 
Am I having a relapse?
Do I need to treat PMR?
blurry eyes
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