Dental work while on Leflunomide

[Orchid47]

I am taking currently 8mg Predisone and 10mg Leflunomide Arava and feel very well with it.

Now I need to extract the last upper tooth because I have an inflammation under the crown. After 6 months my dentist plans a sinus lift, bone augmentation before he will places an implant.

Has anybody done that kind of dental surgery work while on Predisone and Leflunomide???

In the leaflet of the drug Compagny. SANOFI is nothing mentioned about dental treatments.

Thank you for sharing your experience with me.

Orchid47

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[Hidden]

Hi Orchid47

Presume your dentist knows the Meds you are on?

I've only had a crown done, while on Methotrexate, Steroids & Zolendronic Acid, so nothing like what your having done.

Maybe check with Rheumatology Team?

Good Luck 🍀

[Orchid47 in reply to Hidden]

My dentist is so busy that I have to book an appointment to ask him about the drug and I can see him only on 7th February.

I am seeing my Rheumi on 27th February, but I sent her a mail .

She wrote back that she THINKS that it is OK to undergo these

dental work and to take Antibiotica.

It didn t sound very convincing.

Thank you for your answer.

Orchid

[DorsetLady PMRGCAuk volunteer]

It's usually the Alendronic Acid, or similar they worry about with extractions, but as Mrs Nails says no harm in double checking with doctors.

[Doralouise77]

I'm sorry I can't answer your question but I wanted to ask you something. My rheumy has talked about putting me on Arava and I would like to hear your experience being on it.....side effects?.....has it helped with tapering the Prednisone?.....any information would be appreciated, thank you,

Cheers

[Orchid47 in reply to Doralouise77]

Hi Doralouise77

After 5 flare ups my rheumy said that I have no other choice than to try Arava.

I bought it in November and it took me 6 weeks to start it as I was also very scared

of all the side effects mentionned.

You have to take it for 2 to 3 months until you get a benefit from it, so regarding tapering I can t give an answer yet.

Since I started taking Arava all my pains have gone.

My neck, my shoulders and upper back are no longer stiff and don t hurt any longer.

So far I don t have any side effects,

My blood pressure is normal, no belly aches and no diarrhea.

Hope this information will help you.

Good luck

Orchid47

[Doralouise77 in reply to Orchid47]

Yes, thank you, it does help. I've just read a study trial of its use in PMR/GCA which seems promising

hindawi.com/journals/bmri/2...

Best of luck to you.

[PMRpro Ambassador in reply to Doralouise77]

There was a pilot study in the UK using leflunomide for PMR which claimed 22 out of 23 patients went into remission. I don't know how soon or how long it lasted. One rheumatologist whose opinion I value says it is the only DMARD he would bother trying. The most recent guidelines for managing PMR does not mention it - so there has obviously not been any other good evidence.

But it too has some serious side effects and I do know several people who had to stop it because of that.

[Doralouise77 in reply to PMRpro]

Could you point me to the "most recent guidelines for managing PMR" please? And do you know what the serious side effects were that made people stop it? Thank you.

[PMRpro Ambassador in reply to Doralouise77]

rheumatology.org/Portals/0/...

No, sorry can't remember the details.

[Doralouise77 in reply to PMRpro]

Thank you

[Judigardener in reply to PMRpro]

Hello

I'm on 8mg Pred and 10mg Leflunomide and feel as god as I have done for the last 3 years (except for the evil cough and cold!). I have to have a tooth out and am going to Guys -- if the appointment ever comes through. The surgeon there said the risk with Alendronic Acid is if it is given intravenously rather than oral tablets. I confirmed I was own the tabs and she seemed entirely chilled about it. The only reason for going to a hospital to have the tooth out is that should there be a problem then they can inject some drugs into me-which the would have on its -- which a regular high street dentist would not be able to do. However I have been warned I cannot have an inplant because of the AA and will have to have a bridge instead.

[Orchid47 in reply to Judigardener]

Hi Judigardener,

I was warned by my dentist 5 or 6 years ago regarding all bisphosphonate drugs like Fosomax and also 2 months ago regarding injections of Prolia Denosumab ,

twice a year .

My Endocrinalog doctor wanted me to start with them. But

I have a few implants and my dentist said that they would all fall out if I should take any of the above mentioned medications for my Osteoporesis.

I took for 3 years Evista from Lili and

during 2 years Forteo

Injections every day.

I also have a little cough from time to time.

Maybe it is from Arava.

How long have you been on Arava?

How much Predisone did you take 3 months ago?

Good luck with the extraction of your tooth.

Orchid47

[Judigardener in reply to Orchid47]

Hello is Arava the same as Leflunomide? If so I have been on it since last summer.

[PMRpro Ambassador in reply to Judigardener]

Leflunomide is the substance name, Arava is the brand name.

[PMRpro Ambassador in reply to Judigardener]

AA can cause problems even with tablets, I have no idea what grounds she had for saying that. The vast majority of patients take it orally - and some of them have problems.

[Robert17 in reply to PMRpro]

I realise that this thread relates to dental matters but I was particularly interested in the comments about Leflunomide. I have been on this drug for about 3 months now but I have started to suffer from diarrhoea. My GP has prescribed Loperamide which apparently is the same sort of thing as Immodium. She says to take it when ever I feel the need which so far has been every day! Has anyone had this experience.? Does it diminish as the body gets used to the Lef?

I know that diarrhoea is a common side effect of Leflunomide but are there any adverse side effects of taking Loperamide on a daily basis? I am particularly concerned because we are going on a 3 week coach trip across America shortly and I cannot imagine the potential problems of frequently being caught short on a coach!!

[Orchid47 in reply to Robert17]

Hi Robert

During the 3 months that you are on Leflunomide,

how many mgs of Cortisone were you able to taper.

from......to......

I suffered all the years before from constipation and !eflunomide has solved this problem for me.

Hope you will feel better by the time you are going on the coach trip, but all modern buses have nowadays a loo/WC

at the back of the coach.

Good luck

Orchid

[Robert17 in reply to Orchid47]

Orchid

I'm glad the Leflunomide has had a positive side effect for you! I started this medication on 4 Nov when I was on 12 mg Prednisolone. I am now down to 7.5mg as from the beginning if this week. I'm sure you are right about modern coaches but it could be a bit of a problem if there are two of us!

[Judigardener in reply to Robert17]

My tum is very uneven on Leflunomide. Some days are better than others and I can't work out what makes the difference. I should have shares in Immodium!

[Robert17 in reply to Judigardener]

judigardener

I can't work it out either. I just hope you cant overdose on immodium by taking it every day - I seem to be taking enough tablets as things are already!

[November_rain in reply to Doralouise77]

I take avara and it has helped me the most after several failed meds. No side effects at all for me. I also had all my teeth removed while on it. Both dentist, rheumatologist and pain dr said it was ok.

[polymy]

Hi Orchid,

I have had a tooth implant whilst on Pred 20mg. No problem whatsoever. I didn't need bone augmentation. I was also on methotrextate at the time. My implant is fine too.

[Orchid47 in reply to polymy]

Hi polymy,

Thank you so much.

That is the answer I was waiting for and hoping to get.

I couldn t take Methotrexate but both are DMARD drugs.

Orchid

[kulina]

Be very careful, sometimes sinus lifts don't work even when you are healthy. That is a tough area to place an implant, I hope your dentist mentioned that. My husband, who isn't on any medication had the sinus lift done twice and it didn't work. He went through a lot of pain, and not to mention the expense, eventually, he gave up on the implant. Good luck. I truly hope it works for you.

[Orchid47 in reply to kulina]

I know and my dentist told me to wait with the extraction as long as I can, but now

I get tooth ache from time to time.

It is the upper last back tooth. I had done the tooth next to it four years ago. I know what to expect. I had sinus lift, bone grafiti before getting the implant. It took a long time to heal, a lot of pain and an expensive business, but at the end, it feels like your own

tooth and not like a denture of false teeth.

Thank you, hope it will be successful also this time.

Orchid

[tgca in reply to Orchid47]

I have just had my very back lower tooth removed in the chair. My dentist insisted I double my pred dose from 10 to 20 mgs for that day... touching wood, I'm ok. I also had a crown a few months ago with the same advice but I just upped the dose to 15... survived! Good luck