Dental work or not on Prednisolone.

[Rue9]

I had an appointment with a private dentist, as have troublesome tooth and wanted to check up of viability of implant. He advised that cyst on tooth may erupt once i started steroid, as suppressed immne system, and therefore would not want to extract, post starting treatment. He had, however, no issues with continuing with implant work once the gum had healed. I have paid up front, and extraction due in Thursday. ( he scured his extraction before mine). Any comments much appreciated.

[Hidden]

Hi rue9. I had an abscess last summer in a troublesome tooth and it came out 'itself'. I would say it took a bit longer to heal than a tooth I had out a few years ago. That said I have diabetes and am on pred and a dmard that suppresses the immune system even more. It was a joy that it was out after multiple abscesses and wobbliness. I had no problems at all after it came out. 🌻😁

[Rue9 in reply to Hidden]

Thank you, Poopadoop. Glad your tooth came out unhindered! And in that respect you are feeling better. Does being on pred make an eruption of latent abscess more likely, i wonder? It’s a worry. Rue.

[Hidden in reply to Rue9]

I did wonder that. The tooth had been wobbly as it was initially part of a bridge. One thing I do know is that in the first year of PMR the pred shot my blood sugar sky high and I had boils and infections everywhere that took ages To heal. It's controlled now. Any idea how your blood sugar is?

[Rue9 in reply to Hidden]

Not sure. I thnk it’s okay. Not on pred as yet. I understand that bone density can be affected, so presume this also means dental issues. Double bind, really, isn’t it? What stregnth pred are you taking?

[Hidden in reply to Rue9]

I am down to 6mg now but was on at least 9mg when tooth played up.

[YuliK]

I had two implants 6 months ago whilst I was 15mg Prednisone. Didn't bother me ( or the dentist). It was fine. I had an extraction too, but it wasn't infected.

Good luck.

Btw did your dentist advise you any anti-biotics ...

[Rue9 in reply to YuliK]

Hello, Yulik. You were brave to have implants!

Given antibiotic a couple of days before. I just thought he was perhaps spinnng me a line about the tooth eruption when on steroids How do you fnd the 15mg?

[HeronNS in reply to Rue9]

Just so you are clear on this, if you are taking pred for PMR you will be started at a dose like 15 mg or so, but you will not stay at that level. The idea is, after a month or so, to start very slowly tapering down to find a level which continues to control the symptoms as well as the initial dose did, so after six months on pred, all being well, your dose would more likely be closer to 10 than 15 (we are all different so don't take this as gospel, just to give you an idea) and after a year you might be much lower and approaching a very low maintenance dose. There is a big difference between the moderate to low dosage used for PMR and higher doses used in other conditions. There are also lots of things one can do to mitigate potential side effects (careful attention to diet to control weight gain or increased blood sugar as well as avoiding bone-thinning effects). As for the immune system I did find myself a bit more susceptible to colds and small injuries, like a cut, bruise or abrasion took a little longer to heal when I was at my highest dosage of pred, but it was nothing serious at all. I'd recommend you take care of dental issues asap as that will in all probability help your recovery overall.

[Rue9 in reply to HeronNS]

Thank you so much, HeronNS. I am about to start 15mg. This clears up things in my mind, whch is crowded with all manner of imaginings, paranoid thoughts, etc.

I thnk maybe The pmr is making me hypersensitive to any tiny change. I guess we have to stand back and put things in perspectve, and realise that with this ( what i have found) oddly introspectve inclining condition, life can look muddled, when in fact it is more straightforward. X

[HeronNS in reply to Rue9]

It is daunting. I hope you feel so much better when you start the medication! And this is a great forum - always someone here who's had similar experiences and can help with good advice.

[YuliK in reply to Rue9]

I don't think your dentist was spinning you a line Rue..

A seriously infected tooth ( abscess) on a patient who is taking steroids , can be compromised if neglected.

👍 I started on 25mg about 12 months ago.

[PMRpro Ambassador]

You are not on alendronic acid I assume?

[Rue9 in reply to PMRpro]

Hello. No, not sure what that is?

[PMRpro Ambassador in reply to Rue9]

A drug commonly given alongside pred to "protect" you from loss of bone density. Should not be given without a dexascan to establish if you really need it.

[Rue9 in reply to PMRpro]

No, PMRpro. Nothing like that. GP is gong to arrange bone density scan, though.

[PMRpro Ambassador in reply to Rue9]

Excellent!

[alvertta]

I had an extraction on Friday. Dental surgeon gave me 8 mg prednisone prior to extraction. I am on 25mg prednisone for GCA. Will take til June 1 to completely heal. Then start bone protector drug. No pain. Not much bleeding.

[Rue9 in reply to alvertta]

Thank you, Alvertta. Hope all progresses well for you, and healing sooner than you think. Rue

[SheffieldJane]

Are you taking anything like Alendronic Acid for your bone density? That would worry me more. I have had two crowns fitted whilst on Prednisalone with no issues. Are you taking antibiotics for the cyst?

[alvertta in reply to SheffieldJane]

Not starting bone protector until all dental work done. Then wait til June 1.

[SheffieldJane in reply to alvertta]

Has the need for it been highlighted by osteoporosis showing in a Dexa Scan? I would only take it if that was the case. They are powerful drugs.

[alvertta in reply to SheffieldJane]

My rheumatologist is adamant I have to take this drug even though my bone density results are good.

[GOOD_GRIEF in reply to alvertta]

Let your rheumy stew. You don't have to take it if you don't want to since your bone density is good.

What you do need is a calcium supplement and Vitamin D3.

[alvertta in reply to GOOD_GRIEF]

Yes taking those.

[HeronNS in reply to alvertta]

Don't take bone medication if you don't need it. And if your DXA scan is good there is absolutely no reason to take it. Do what you can to maintain you bone density. Even more important than calcium, which most of us get quite a lot of in our diet, is weight bearing exercise (even just walking), and some micronutrients, like Vitamin K2 (not K1) and magnesium. These get calcium into the bones where you want it.

[alvertta in reply to HeronNS]

Take magnesium, D and calcium.

[HeronNS in reply to alvertta]

Has he explained why?

[alvertta in reply to HeronNS]

She is adamant I need it. I see my family doctor once a month and will talk to her.

[HeronNS in reply to alvertta]

Some doctor seems to be working from an outdated playbook which prescribes bisphosphonates to people taking pred as a preventative measure. They do not take into account that these are very dangerous drugs and should never be taken "just in case" - especially when there are so many ways to maintain good bone density, or even to improve those which are not so great without using any of these drugs at all!

Furthermore, bone thinning is not inevitable with pred.

[GOOD_GRIEF in reply to HeronNS]

Heck, on this side of the ocean they were prescribing it to every woman entering peri-menopause.

[HeronNS in reply to GOOD_GRIEF]

Not where I live in Canada. Although the one rheumatologist I had the misfortune to meet (at a "bones" workshop for people at risk like me) came across as a pill pusher, even referring to the AA as "her" medication, like she owned this wonderful thing. 🙄

[Rue9 in reply to SheffieldJane]

Hi, Sheffield Jane. Start taking antibiotcs two days before extraction. No actual pan. Not like an abscess. This tooth has a long history. Root canal nonsense years ago, the back and forth with the threat of eruptions and then when knew be taking pred, decided to check the condition. I couldn’t get my own dentist for two weeks, so have gone private, someone who did another implant. He said there was a cyst, so he’d be happier taking out before starting pred. It’s an upper prom canine. Tooth loss is never good for self esteem, and now with the pmr i feel i’m really falling apart. But what can you do? Guess best out and be gappy, or wear a false one. Worse things happen at sea! X PS, i wonder if that would raise the ESR?

[SheffieldJane in reply to Rue9]

I know what you mean. Health first, vanity a close second.

[alvertta in reply to SheffieldJane]

My drug is alendronate sodium 10 mg. The way the pharmacist described when I picked it up ... sounds dreadful.

[SheffieldJane in reply to alvertta]

I am afraid that I wouldn’t take it. The side effects scare me and I’ve had 2 good bone scans in 3 years, so it would be pointless. Other opinions are available, alvertta. Why do they push it so hard?

[alvertta in reply to SheffieldJane]

My rheumatologist and family doctor disagree. Family doc says no rush. Rheumatologist says take it now. Neurologist says take it now. Yikes!!! Rheumatologist thinks I will fall and break a leg.

[SheffieldJane in reply to alvertta]

Oh dear!

[PMRpro Ambassador in reply to alvertta]

Have you had a dexascan? I wouldn't take it without having had one done first. And only then if the t-scores suggested it were required. It should NOT be taken if your bone density is normal. Mine was - and after over 7 years of pred still was, without alendronic acid, just calcium and vit D.

[alvertta in reply to PMRpro]

I had a bone density test. Which was good. Not sure what a dexascan is. Seeing my family doctor in April and will Discuss. I really do not want to take any more drugs. Enough.

[PMRpro Ambassador in reply to alvertta]

It is the proper name for the bone density scan. You need to know your t-scores - and then you can decide about taking the AA. You won't crumble without it before seeing your GP!!

[Rue9]

Does it have even more side effects? Drugs for the drugs, and so on.

[alvertta in reply to Rue9]

Have to take in morning before food with 8 ounces of water. Then stay upright for 30 minutes so pill goes down. Danger if it sticks in esophagus it burns a hole in skin. Lovely.

[YuliK]

nhs.uk/medicines/alendronic...

This link may help.

But I think as the others, if you don't have problems of osteoporosis then why subject your body to more unnecessary drugs.

Most of us here have been subjected to controversial treatments by both our GPs and rheumatologists. Nobody is infallible, even those in the medical business .

Remember the saying..."If it ain't broken, don't fix it "

Your decision, but if it me, i would wait until the test results come back.

Have a nice day

Yulik

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