Invasive Dental Treatment

[Pebble-Sue55]

Hi I posted a few months ago as Pebble, started Pred 10mg in October, had a good 4 months but now beginning to get pains in Left shoulder and buttocks again. Pain in right buttock is moving down lower than it was before. Seeing GP next week and Rheumy appt. in April. Slightly worried about a dental appt. to have gum planing due to gum disease, this means scouring underneath the gums to clean them which can cause after pain and bleeding. My concern on doing the research, is that it is possible for the bacteria to get into the blood stream and travel through the system and antibiotics may be necessary before the treatment. Have spoken to dental nurse who doesn't think there will be a problem. Anyone have any thoughts on this?

[Celtic PMRGCAuk volunteer]

Pebble, I think the dental surgeon is the best person to advise you, not the dental nurse. As you know antibiotics are not given out lightly these days, and I was advised just this week that in spite of on-and-off bleeding from my gum following a difficult extraction nine days ago, requiring a return to the dentist for packing of the cavity and stitches, they would prefer to only prescribe antibiotics if an infection arises, not before. I am doing frequent salt water rinses in the hope of warding off infection, so my advice to you would be to stock up on the salt just in case!

With regard to the shoulder and buttock pain, it is beginning to sound as though your 10mg steroid starting dose has not been sufficient to get on top of the original inflammation and keep control of it. Although I have heard a rheumatologist say that it is possible for PMR to respond successfully to a 10mg starting dose, I feel that it is insufficient for most of us - in fact even some patients who have started on 15mg have later had to increase the dose to 20mg to get their symptoms under control.

[Pebble-Sue55 in reply to Celtic]

Thank you Celtic I will brace myself for the treatment and use the salt water. I always wondered whether the 10mg would work in the long term, the reason for the low dose was that I already have type 2 diabetes and my GP was really reluctant to start me on steroids at all. It was the Rheumy who eventually prescribed them.

[PMRpro Ambassador]

Ditto what Celtic has said. Especially asking the dentist not the nurse. Remember to tell him all the medication you are on.

The new pain lower down in your buttock could be piriformis syndrome and that can be helped with physiotherapy.

I appreciate that if you already have type 2 diabetes your GP will be leary of pred but being even more vigilant with regard to carbohydrates will help there. Ask your GP to look for the work done in Newcastle about low calorie and low carb diets for Type 2 diabetes. It is beginning to get accepted now.