AA

[Heartache402]

AA been on it 2 yrs and in the last 8mths have had to have 5 teeth removed fed up of this

[DorsetLady PMRGCAuk volunteer]

Do you really need to be on it? Were you DEXA scanned before you started on it, or just put on it regardless?

Some people do need it, but many don't. Suggest you get checked to see if you really need it, and if not then come off it. If you are on VitD & Clacium that may be enough to protect your bones. Talk to your doctor.

[HeronNS]

Actually it is now being considered that two years on bisphosphonates is probably enough - you will have received any benefits and, theoretically at least, not have been put at too much risk for bad side effects. Any longer and bone starts to become brittle, not stronger, even if "density" apparently improves. As well as calcium and Vitamin D3 you also need Vitamin K2 (note: not same as K1) and perhaps a little extra magnesium. Most other essential micronutrients will be available in a balanced healthy diet. And, of course, as much appropriate exercise as you can reasonably manage.

Do you think the tooth problems were because of the AA, or because of some nutritional deficiency or something else?

[polymy in reply to HeronNS]

Good morning Heron s. is there a connection between taking AA and having to have teeth removed? I have been on it for 2 years now. Have always had good teeth and required no dental treatment in years. In the past year I have had 4 fillings as the teeth had small patches of decay or the fillings fell out. Just wondered if AA had anything to do with it.

Liz.

[HeronNS in reply to polymy]

Yes, I have heard that AA can cause tooth problems. You can google alendronic acid and loose teeth and find a number of articles, including research papers. I hope your dentist was aware that you had been on AA as s/he may be able to give you some guidance how to prevent other serious jaw-related side effects.

[Jackoh]

Hi Polymy. I have nothing to substantiate this but suspect that it is the steroids that affect our teeth rather than the AA. I only took AA twice, had a dexascan and the result was good so discontinued the AA. However, I have had numerous problems with my teeth, two extractions, numerous fillings, and two root canal treatments- all without AA. I'm sure we all respond differently to the steroids but from my own personal experience my teeth have deteriorated since being on them. Jackie x

[jevuki in reply to Jackoh]

I too have had teeth issues since on Prednisone.

Lost all my upper crowns and bridges and now have a plate. My bottom teeth are starting to have issues and my dentist and specialist are working hard for me to keep the lowers. Bone loss is the culprit and that is where my Achilles heel is.): This is a cursed disease. My thoughts are with you it can be devasting.

[polymy in reply to Jackoh]

Thank you Jackoh. I asked my dentist if the steroids could be the cause of my sudden dental problems. She categorically said no. According to her, the steroids don't get through to the teeth at all. I'm dubious about that as, if the steroids can cause bone thinning, why not teeth??

Liz.

[HeronNS in reply to polymy]

I think steroids can affect the jaw bone, and this in turn can lead to teeth loosening. I'm sure I felt this effect when I was first on pred, but it went away when I improved my calcium source, and added Vitamin K2, and also most importantly lowered the pred dose.

[jinasc]

I can quote this paragraph from a very long article on AA (extracted from the booklet 'Living with PMR&GCA')

Penultimate paragraph : Restrictions on using AA

Taking AA itself has other downsides. It must not be given to anyone with a history of gastric reflux (heartburn), hiatus hernia, or any surgery for such problems. It can cause musculosketal pain which can be severe (don't we have enough of that already). It must not be used in chronic renal failure, nor if your calcium or vitamin D levels are low - they must be checked and put right. Some dentists will not extract teeth from patients who are on AA because they believe there is a risk of the jaw not healing. All of the PMR forums have threads discussing the side effects patients have suffered.

There are other biosphonates available if you need them, visit the National Osteoporosis website and read up on them.

[PMRpro Ambassador]

Do your dentists think it could be the AA? Some people who have never taken it but have been on pred have also had dental problems.

Something that is rarely emphasised to patients on bisphosphonates is that scrupulous dental hygiene is essential - otherwise you can develop gum disorders which contribute to the loss of teeth. my cousin has several very loose teeth - because her dentists never told her she had gum disease that needed treating.

[Hindags in reply to PMRpro]

My dentists recommended AA over some of the other bisphosphonates, since I is easier to stop. I've taken it for fiv months now. And still find myself,asking the decision whether or not to take the next pill....every week.

[9lives]

Hi I have had PMR almost a year now and last November I lost a gold crown that I had for about 30 years. Actually It was a bit embarrassing as we were on holiday in the Far East having a lovely meal wth friends when suddenly i bit on something solid, which was strange as was eating a Chinese dumpling . Any way spat out this tiny lump of gold called waiter over . We were both horrified by this in the food, thought it was an earring or piece of jewellery . Waiter went off to investigate mean while I could feel an area in my mouth that felt rough, then I figured out what it was. Waiter came back very opologetic . But he also realised what it was. We did al laugh though x

Anyway more recently, funnily enough another holiday in March, skiing to France, (not me I hasten to add,) I just do loads of walking with the ladies, whilst the men ski. !!

Sorry I digress, well I had a really bad toothache which turned to be a route canal filling that was the problem. An X-ray showed the tooth has a slight crack in it and bacteria had gotten in. Luckily antibiotics seem to have sorted it, otherwise will have to have it replaced.

I've never taken AA at all so just commenting really .

Don't think I'll plan any holidays just yet, they things come in threes don't they xxx

Carole

[Tonylynn]

How on earth could bisphosphonates or steroids cause damage to teeth. Once formed they are just that, they do not undergo further change in the same way as bone which is a dynamic system. What damages teeth is acid dissolution caused by bacteria metabolising refined carbohydrates and producing acid which demineralises teeth. Tooth decay in other words, and this only occurs if "sugar" is consumed too frequently. Acid erosion can occur as a result of gastric reflux or acid foods such as apples and lemons if consumed to often.

Periodontal (gum) disease is multifactorial and there are genetic elements along with factors such as smoking and diabetes. Good oral hygiene is essential in the prevention of gum disease along with the regular removal of deposits on the teeth by dentists / hygienists.

Dentists are advised to treat patients taking oral bisphosphonates the same as those who do not but to warn that there is a very very slight risk of osteonecrosis following extractions.

[PMRpro Ambassador in reply to Tonylynn]

I don't think anyone said they affected the teeth themselves - but the bone and soft tissue surrounding them.

While they do not affect the teeth themselves both of them can lead to a change in the turnover of bone. Bone is a living substance which is constantly being resorbed and renewed. If the bone in the jaw around the roots of the teeth is affected - the teeth become loosened. Both can also lead to gum disease - with the same effect.

dentistryiq.com/articles/rd...

But you are also wrong about teeth being "permanent" - the roots can be resorbed in pathological situations:

dentalcarematters.com/tooth...

[Tonylynn in reply to PMRpro]

I did not say they are permanent. Tooth decay causes loss of tooth substance as can idiopathic resorption. (Root resorption occurs naturally with deciduous (baby) teeth but is uncommon in permanent teeth.)

If you are suggesting taking prednisalone and or bisphosphonates is a factor in periodontal disease then quote a reputable peer reviewed article that says so. Periodontal (Gum) disease leads to bone loss not the other way around as you suggest. There is no evidence that I am aware of that demonstrates that changes in bone metabolism is a cause of periodontal disease. How can you possibly reach the conclusion that gum disease is caused by changes in bone metabolism? Have you properly examined the aetiology of periodontal disease? What do you think the cause is?

[PMRpro Ambassador in reply to Tonylynn]

I didn't say that - they are two different factors that can cause loosening of teeth.

[Tonylynn in reply to PMRpro]

Oh, so you think osteoporosis is a cause of loose teeth. Quote a reputable source.

Neither bisphosphonates nor prednisalone cause tooth loss. There is insufficient evidence to link osteoporosis to periodontal disease but it may be that in compromised patients periodontal disease could cause faster bone loss in patients with osteoporosis. (There is nothing to suggest osteoporosis is a cause of periodontal disease or loose teeth). Clearly good oral hygiene is essential in patients who have a propensity for periodontal disease. As most people do not know their risk of periodontal disease it makes sense for everyone to practice good oral hygiene.

It also makes sense to reduce the bone loss brought about by high doses of prednisalone by taking bisphosphonates.

[PMRpro Ambassador in reply to Tonylynn]

Nor did I say that osteoporosis is a cause of loose teeth. I do wish you would read what I write properly.