Dental problem?

[Mstiles]

Hello everyone

Oh boy, I’m worried this morning as I try to figure out what’s going on. I’ve been taking 40 mg of pred for PMR/GCA for 2 months and recently posted about trying to decipher prednisone side effects from a flare. My rheumy wants me to start tapering down. I had blood tests for inflammation Monday and am waiting for results.

Well I woke up this morning with a sore gum, looks a little swollen, (hard to see, upper gum). It’s near a crown I had a year ago which has never felt right. I have has some facial pain in that area when I press on my face there. X-ray last summer showed nothing. I’m going to call my dentist to see if he can take a look. Of course it’s worrisome if it’s an infection knowing that prednisone suppresses immune function. Is there anything I need to be aware of at the dentist? I can’t take novacaine, they give me something else. Are there any precautions I need to be aware of at the dentist?

[DorsetLady PMRGCAuk volunteer]

Hi,

No more than the usual with dentists..we all seem to have a fear of them!

Just make sure he/she is aware you are on Pred and what dose. I think the main concern is people on Alendronic Acid or similar with dentistry and the possible extraction of a tooth! Hope it won’t come to that!

PS - stop worrying, that won’t do your illness any good!

[SnazzyD]

Being on 40mg Pred doesn’t help the worry gland, I remember well! Just pop along, tell them you’re on Pred, no more to it. X-rays don’t always pick up very early problems, and it doesn’t take much inflammation in such a tight place with nerves so close by to cause discomfort long before it is visible. I know that from my own dental experience.

[Mstiles in reply to SnazzyD]

Thanks Snazzy. I’ll see what the dentist says.

[PMRpro Ambassador]

And just a thought - but COULD this potentially be the cause of your GCA-type symptoms?

However - if you have an abcess, or even just an infection, your blood markers will be meaningless.

[Jackoh]

I've just been to the dentist Mstiles as I had to go up with pred because of a cold virus and a tooth that winges every so often was hurting again. The dentist did an X-ray and said it didn't look like there was any infection as such but I needed a root canal filling as it was probably causing low grade inflammation- which we don't want!! The dentist knows I have GCA/PMR, he knows I'm concerned re infection and inflammation. He is very supportive and let's me choose appointments to fit in with doses and tapering. Just explain everything and I'm sure they will put you at your ease.

Best wishes Jackie

[Mstiles in reply to Jackoh]

Thanks Jackoh

I didn’t find my dentist very supportive. He didn’t act concerned about the GCA and prednisone, etc. just wrote the prescription and referred me to an endodontist.

Glad you have a good one.

Is it usual to up the pred with an infection? Im waiting to hear back from my rheumy.

[PMRpro Ambassador in reply to Mstiles]

Only really if you have symptoms of the PMR/GCA - if you have an infection you might need more pred if you are below 10mg to help deal with the stress (adrenal function) but OTOH it may not help your immune system fight the infection. Depends a lot on your doctor's views.

[Mstiles in reply to PMRpro]

I’ll see what he says, thank you. I have just read that prednisone can make you MORE susceptible to infection... confusing like everything about this disease. What is OTOH PMRpro?

[Soraya_PMR in reply to Mstiles]

On the other hand =OTOH

[PMRpro Ambassador in reply to Mstiles]

Sorry - I tend to assume everyone knows the shorthands in these days of texts and tweets! Sorry...

[Mstiles in reply to PMRpro]

❤️

[Reeceregan]

Hi,

Definitely get the crown checked first. I have PMR and GCA and am on prednisone and tapering down from 50, now at 8. Recently had my first Prolia injection for severe osteoporosis as well. Prior to the Prolia I had to have a dental check resulting in a crown on the bottom left side. It never felt right but it wasn’t too bad all in all, I thought I’d get used to it. Two weeks after the injection all PMR and GCA symptoms started to return, headache, jaw pain, neck and shoulders aching, hips and legs. It could have been side effects of the Prolia or reducing too low on the pred HOWEVER....the one difference was the pain in my temple, where I’d had the biopsy, I could touch it and it was very tender, my top tooth ached if I wiggled it, etc. Back to the dentist who took the crown down slightly...temple pain gone. Such a relief because I was so scared of a return of GCA, the worst case scenario. The other symptoms are still there in the background so it’s the side effects of the Prolia but such a simple way to “eliminate” the more serious scenario. ....and get ride of the temple pain.

[Reeceregan]

PS:

Should have mentioned that I also had to have a tooth out prior to the Prolia. After advising the dentist of my PMR/GCA and prednisone history, she rang the dr, he advised increasing the pred from the current dose at the time of 10mg, up to 35mg for two days, the day before the extraction and the day of the extraction, and if all good then drop straight back to 10mg on the day after extraction. This was to afford adrenal shock, but the extraction went brilliantly albeit I did bleed for 7 hours and ended up using dried (unused) tea bags for plugs after running out of dental swabs. 🤣