Dental work, while on steroids

[allykat]

I am a year into GCA and after one flare am back to reducing from 10 mg. Yesterday I thought I had lost a filling but it turns out I have lost the entire back of one of my top incisors and there doesn't seem to be much tooth left. I hope to see a dentist tomorrow but want to be prepared. I am assuming it is okay to have the tooth reinforced externally if that is possible. My concern is what if I need drilling into the bone, or if the tooth needs to come out. Should I even consider a tooth implant if it is one of the options. I am probably jumping the gun but my own GP is on compassionate leave so can't even talk it over with him.

Besides taking prednisolone, I am on AA, lansoprazole, Adcal and low dose aspirin. 

Any advice would be much appreciated.

Thanks

[DorsetLady PMRGCAuk volunteer]

Hi allykat,

I'm sure your dentist will go through all the options with you, most understand the problems that Pred and AA can cause. I had a similar problem a few months ago, i.e the rear of the tooth disintegrating. Fortunately the front of the tooth was intact and it was stable enough to fill and shape so that I have no rough edges, and it looks no different than usual. If it needs to come out, he/she may refer you to local hospital for the extraction.  

I've had no problems since - touch wood.

[allykat in reply to DorsetLady]

Thanks Sue, I am really hoping the dentist can just build it up again even if it only lasts for a while. Can't face anything more major than that just now.

Cheers

Kathryn

[shella in reply to allykat]

I am on low dose steroids and had to have tooth extraction while on holiday in Spain!  I checked back home with doc and he suggested I double dose on the day.  So far so good even with antibiotics that I am usually very bad with... good luck with everything 

[piglette]

Let the dentist know you are on AA as well as pred so they are aware. Good luck.

[PMRpro Ambassador]

I think it is far less the steroids you have to worry about than the AA but as DL says - you may also find your dentist is far more aware of any constraints than a GP. 

Before starting AA it is advised that any major dental work should be anticipated and completed - so I wouldn't think an implant or whatever is advisable. I wouldn't have one done, I have to say!

I'm seeing my dentist tomorrow too - there I was, eating my lunch on Friday and there was this rather hard bit in my salad! Part of a lower molar that really is a filling with a bit of tooth and has been for about 40 years - hope he is gentle! I don't like to think about the cost - no state funded dentistry here and the last time I saw him about a similar event in the top he suggested a part crown. I declined and it is no worse 3 years on...

[allykat in reply to PMRpro]

Thanks for that. I am a real wimp when it comes to dentists and and an implant seems a step too far so fingers crossed a patch job may do the trick!

Cheers

Kathryn

[PMRpro Ambassador in reply to allykat]

It'd be a cheque too far for me...

[lesley2015]

Hi,

As we are talking about teeth, I have been on steroids since June 15, AA then Risonodrate,  my teeth have become more sensitive, being sensitive to cold, I now use a toothpaste specific for this. I have a dental appointment for check up this week and have routine hygienist. My hygienist generally causes a fair amount of discomfort and bleeding should this bbe avoided? 

Thanks

[PMRpro Ambassador in reply to lesley2015]

Certainly with most bisphosphonates you need to indulge yourself in VERY good dental hygiene on a daily basis. I'd be very reticent about a hygienist who made my gums bleed and it is something I would ask the dentist about. 

I can't remember the last time I had a "deep clean" - but this morning the dentist was quite complimentary about the state of my teeth and gums - the truth being I've been to a dentist only 3 times in the last 6 years and once was to have a rogue wisdom tooth removed which got rid of 90% of my back problems! 

Just as well my teeth are happy really given the price for the ceramic filling: about £500. I comfort myself it would cost as much in the UK even with state supported dentistry. Several years ago my dentist there made me an offer I found easy to refuse: £120 per year for 2 checks and 10% off dental work. Well, I've saved that and the dental work still would have been on top. 

Under the circumstances a good decision - because he told me a load of lies about that wisdom tooth being too complicated to remove (read as, I'm not going to earn enough...) and condemned me to probably 10 years of back pain I needn't have had. 

Hope you enjoy your visit to the dentist!

[lesley2015 in reply to PMRpro]

Thanks I doubt I willenjot it! I brush and floss regularly but bottom teeth close and those are the ones that she generally tries to squeeze impossibly large brushes and tape through!  Not pleasant when normal but don't want to causes a problem etc 

Thanks for your advice- I am the one paying monthly for my two checkups and hygienist! 

[PMRpro Ambassador in reply to lesley2015]

I was lucky at the time, there was a very good dentist about 8 miles away in an area where, as he said, he'd go bust if he expected private patients so was quite happy to take on NHS work. He was good himself but one of his part-time staff was actually a lecturer at the local dental hospital who liked to keep his hand in. Win-win - I was sorry to lose that practice when we moved here.

[Judigardener]

Hi Allykat. I have had a few dental problems while on Pred for PMR. The general advice is (from a dentist who teaches dentistry and a rheumy) is to get to 6mg and below before going for an extraction if possible. Also to go to a dental hospital where they will be all geared up for anything that might happen and can lay their hands on drugs, which a local dentist may not be able to do.Hygienists are necessary to keep the teeth and gums as good as possible to avoid more major work. Floss floss and more floss I am told. I have got a tooth that will have to come out -- root canal years ago has now failed and cannot be patched up. So the plan is get to 6mg. Have tooth out in hospital and then wait 4 months for it to heal up and then consider what options I have -- I will probably go for a bridge.

[PMRpro Ambassador in reply to Judigardener]

Actually I discussed this with the dentist this morning - no such concerns here and my wisdom tooth was removed at about 10mg/day I think. No problems at all and it healed quickly. I was also on anti-coagulants - also not regarded as a problem here. I'd investigated having it done in hospital - and was greeted with total incomprehension.

In fact, if you think about it, having an extraction at above 6mg pred is probably safer than at 6mg where you are hoping that your adrenal glands are functioning. They don't really need to at 10mg. In fact the practice is across the road from the hospital - and that was my comfort blanket for the first time. Now I really don't feel any concerns.

And when it comes to AA - one would have to wait a very long time to "get it out of your system". It has only been in widespread use for about 15 years or so. The most recent assessment, done a few years ago, is that it is still to be found in the bones after 10 years. The next one will very likely find it is still present after 15 years - it is a fixed component of the bone and not very likely to get removed in any way.

[susanspurs]

Dear allykat

I've been on steroids for two years for PMR and AA for most of that time. I have been plagued with tooth problems and I have lost three teeth over that period  

My dentist was concerned about the extractions but they all went well each time and he monitored my healing. I wanted implants too but he will not consider them until I have been off the  AA for several years as it stays in the system for a long  time and affects the bones in the mouth. I have had a small plate made for the two on the top but the gap on the bottom is half way to the back  and mostly can't be seen.  I do believe that the medication has contributed to all this. Could the PMR?

Good luck.

Sue

[PMRpro Ambassador in reply to susanspurs]

See my reply to Judi above

[Mgt1234]

Hi,

I had a failed root canal treatment (rear tooth) which resulted in the tooth being extracted. I have been on steroids for about 9 years for PMR and GCA as well as AA. I was extremely fortunate as an Oral and Maxillofacial Surgeon does a weekly clinic at my dental practice, so I didn't need to go to my local hospital. (It is a private dental practice). The only problem I had was it took a little longer to heal. Hope this helps.

Margaret

[allykat]

Thanks everyone for your help. I visited the dentist today armed with "the knowledge" and thankfully there is enough tooth left to support a crown so nothing invasive required.

[DragonFly100]

Hi, what is AA

[Bcol in reply to DragonFly100]

Alendronic Acid