Having a tooth out

[notnice]

Hi everyone

Hope you are all well or as well as can be expected. I have GCA and currently on 22.5mg of preds. I am going to have a back double tooth out next Wednesday, would Anyone know if I need to take extra preds just for that day?

[bowler]

I assume your dentist has a list of meds. you are taking, and should know the problems with taking prednisolone, My dentist wanted the OK from my DR before he would take my tooth out, so just call your surgery for advice,

[notnice in reply to bowler]

Hi Bowler

Thank you very much for your information. Yes my dentist does have a list of my meds but did not say anything and I forgot to mention it to him. I do have to see my doctor this Friday so I will ask him. Thanks again I very much appreciate it.

Sue

[Celtic PMRGCAuk volunteer]

As that is quite a high steroid dose you are taking, I doubt you would need to increase it for the tooth extraction. It might be worth considering if you were having the extraction whilst at the lower doses around 7.5 where the adrenal glands are trying to kick back in again with their natural steroid (cortisol) production. I assume your dentist is aware that you are taking steroids - it is always worth seeking your dentist's advice.

It is those patients on Alendronic Acid that dentists feel more concerned about with extractions, very often referring the patient to hospital.

[notnice in reply to Celtic]

Hi Celtic

Yes my dentist has a list of my medication but did not say anything to me and i forgot to ask, I do take Alendronic Acid and Adcal, can I ask why the dentist would be concerned if you take Alendronic Acid?

Sue

[DorsetLady PMRGCAuk volunteer in reply to notnice]

Hi notnice,

Sure Celtic will come back with a fuller explanation re AA and dental work, but I think because AA can affect teeth and your jaw, you, and your dentist, just need to be more aware that an extraction could be more difficult for the patient. It could be more painful or cause more swelling etc than if you weren't on it. This doesn't mean it will, just it could! That's why everybody needs to be aware, and that's why the dentist, if he's/she's not entirely happy will refer to Maxiliofillial (spelling?) clinic.

[notnice in reply to DorsetLady]

Hi DorsetLady

Yes I am sure Celtic will come beck to me. Thank you for that information it is very useful and I am most greatful, as I mentioned I have to see my doctor on Friday and was going to ask him but now with the question of AA I am now wondering if I should give my rhumie a call and get it clarified with him.

Sue

[Celtic PMRGCAuk volunteer]

Here I am!

Ah, now that you say you are taking Alendronic Acid, as Dorset Lady has said, you need to be aware that the class of medicines that alendronic acid belongs to (bisphosphonates) has been associated with a rare condition called osteonecrosis of the jaw. It is generally recommended that people who are about to start treatment with AA should visit their dentist for any invasive dental procedures such as tooth extraction or surgery before embarking on AA if at all possible. It is also very important to be extra thorough with oral hygiene whilst taking AA, and it is recommended that patients have a break from it after 5 years. This is the reason that many dentists prefer to refer their patients on AA to hospital for dental surgery including extractions. As I said previously, do just discuss this with your dentist beforehand. Only he can assess your situation and decide whether he feels there is any risk in your case.

[notnice]

Hi there

Thanks for coming back to me and explaining things I very much appreciate it. I will speak to my dentist tomorrow and see what he says, so on that basis if my dentist is happy with everything there would be no reason to phone my rheumie at the hospital?

I am so greatful for this forum the information is very quick and good, I do not know what I would do without it.

Sue

[Celtic PMRGCAuk volunteer in reply to notnice]

Sue, I assume you have had a DEXA scan? If not, then do request one - if you have no signs of bone thinning (osteoporosis/osteopenia) you may not need Alendronic Acid. Just the usual calcium + Vit D should suffice, plus plenty of dietary calcium contained in such foods as yoghurt, milk, cheese and plenty of oily fish. And as much weight-bearing exercise, such as walking, as you can comfortably manage.

[notnice in reply to Celtic]

Hi there

No I do not think I have had DEXA scan, when I was not well at the beginning of the year, I had headaches that would not go and a chest infection, after going to the docs he sent me for blood tests and the next day phoned me up and asked me to pick up a prescription for steroids and antibiotics then mentioned I would be getting an appointment to see a Rheumatologist at the hospital. When I saw the rheumie I had a chest x-ray and blood tests he spoke of temporal arteritis, of which i did not have all the symptoms, the x-ray came back with a shadow on it. I went away with steroids, to rule out temporal arteritis, and another appointment, in the mean time I went back for a skeleton x-ray and a scan of all my organs. When I went back to see him he confirmed I had temporal arteritis and gave me a steroid reduction plan, all my tests came back clear. I left the hospital with a prescription for steroids, Alendronic Acid, Calcium and vit D and another appointment. I so far cannot get past 25mg of preds so now have started a plan which DL gave me to try which fits in more or less with what stage my rheumie would like me to be at the next time I see him.

I assumed he gave me the AA and Cal +D to prevent the bone loss starting.

Sue

[notnice in reply to Celtic]

Hi Celtic

I forgot to mention that I love walking and try and walk as much as I can each day. Where the food is concerned I have a hieatal hernia (spelling) so l have to eat small amounts and I try to avoid foods that bring my belly up yoghurt and cheese being some of them, its a shame as I love yoghurt.

Sue

[poppetpain]

Hi notnice. I notice that you too are in the "eager to please your rheumy" club. Why do we feel this pressure to reduce even though our body might be saying "no way hosay" (spelling). I don't feel that they know as much as I have learnt from this forum. If they do then they are not sharing it with me. I appreciate that they're busy and have much worse cases than me but I have never been given advice on how to reduce which is sooo important. Again I have learnt this from this forum. I pity those folk out there with no access to it. I had a dexa scan by coincidence at the start of my steroid journey and it was good, so my doctor (not my rheumy) agrees that I don't need AA and I will have another scan in 18 months to check. Please insist on one. Good luck at the dentist x Mary.

[notnice in reply to poppetpain]

Hi Poppet

Thanks for your reply. Yes I do tend to please my rheumie, I read somewhere that a rheumie discharged someone because they said the patient was doing everything themselves, I do not really want that put on my medical record so yes I will aim to please until I get discharged then go my own way.

I will ask about the dexa scan and see what they say.

I must say this forum has been a god send to me as my rheumie did not explain anything he just give me a steroid reduction plan, I have learned everything from here.

Sue

[notnice in reply to poppetpain]

Hi Poppet again

Thank you for your kind wishes at the dentist.

Sue

[greenheath]

Speaking from my own experience, my molar tooth removal was very easy as the root had become soft due to prednisolone and other PMR drugs. The tooth just slid out and I felt nothing. Pred (plus Alendronic Acid) is a pretty lethal combination, as many of us have discovered, and I wonder how many more of my teeth are going to disappear!

Good luck

Greenheath

[notnice in reply to greenheath]

Hi Greenheath

That sounds a bit more reassuring, thanks for your info and good wishes.

Sue