Prednisone and dental surgery?: I have a tooth with... - PMRGCAuk

PMRGCAuk
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Prednisone and dental surgery?

OutdoorsyGal
OutdoorsyGal

I have a tooth with a broken root and an extraction is scheduled for April 1. The oral surgeon has requested I NOT go back on prednisone (for a suspected PMR flare) until AFTER the extraction/bone graft.

Anyone know why? Bleeding risk or something else?

39 Replies
oldestnewest

Probably potential immune suppression?

Hidden
Hidden

It’s healing that mainly concerns them, are you having a local or general anaesthetic?

How long have you been off Pred?

MrsN

OutdoorsyGal
OutdoorsyGal in reply to Hidden

Off prednisone since Dec 31.

IV sedation. I’ll sleep right through it!

Hidden
Hidden in reply to OutdoorsyGal

Good Luck with your procedure 🍀

PMRpro
PMRproAmbassador

I suppose if you are currently not taking pred another week or so won't make much difference - but reading your profile suggests to me you aren't flaring, the PMR hasn't gone away and now you are off pred, it is making its presence felt. No cure - just management.

OutdoorsyGal
OutdoorsyGal in reply to PMRpro

So PMRpro, you are thinking I should still be on a maintenance level of Prednisone? Any idea what that might be? I felt fine on 1mg, and for a few weeks post-prednisone. Do I have to start high and taper again, or start low and increase till the symptoms disappear?

PMRpro
PMRproAmbassador in reply to OutdoorsyGal

No idea at all I fear: you are never reducing relentlessly to zero, you are looking for the lowest dose that gives the same result as the starting dose did. That is why you need to stay at each new dose for at least a month and why pushing through a return of symptoms is pointless. When symptoms reappear it is a sign you are too low. You have to go back to the last dose that worked and be patient.

OutdoorsyGal
OutdoorsyGal in reply to PMRpro

So, if I have been at zero for the past 2 1/2 months, but felt fine through the end of the taper and beyond, I should just try 1 mg a day for awhile, and if that doesn’t work, inch up to 2?

My taper was a month each of 15,10,9,8,7,6,5,4,3,2,1. No symptoms at all while tapering and for a few weeks after ending.

PMRpro
PMRproAmbassador in reply to OutdoorsyGal

1mg may turn out to be enough - but it may not be enough to clear the accumulated inflammation that is causing the symptoms. If it were me I would try maybe a week of 5mg to be sure that pred is going to help and then drop to 1mg and see if that holds it. That is perfectly safe. You might even get away with 3mg for a week - worth trying.

Suzan62
Suzan62 in reply to PMRpro

How long do you give it on new dose before returning to old one? I’m on 3.5 but thighs ache when I walk. Just wondering how long I should stay on 3.5 to see if aches go before returning to 4 if they don’t?

PMRpro
PMRproAmbassador in reply to Suzan62

When did the pain reappear? The day after you dropped or only after a while at the new dose?

Suzan62
Suzan62 in reply to PMRpro

Not straight away, about a week maybe. It’s not too painful, just aches when I walk.

PMRpro
PMRproAmbassador in reply to Suzan62

That is a typical sign that you are on just slightly too low a dose to mop up all the inflammation each day. It builds up, like a dripping tap fills a bucket, and finally overflows. I'd go back to 4mg - wait a month or 6 weeks and try again. Often it will work after 2 or 3 tries but maybe you have reached what you are looking for: the lowest dose that manages the inflammation as welll as the starting dose did.

OutdoorsyGal
OutdoorsyGal in reply to PMRpro

So when you find this target “lowest dose”, do you stay on it forever?

Or do you test periodically to see if your PMR is in remission? HOW do you test? And after how long?

Hidden
HiddenAmbassador in reply to OutdoorsyGal

I stayed at each drop for 4 to six weeks then I had to only drop 0.5mg. if I was symptom free after 4 to 6 weeks I dropped again. That said I have been at 6mg for 6 or 7 months.

It's important that you try and take note of what your body does the first few days after Drop. Often that is steroid withdrawal. OTC painkillers can help with that. My right shoulder always hurt with withdrawal. If my thighs and arms started to hurt after 7 to 14 days I knew PMR still active and bumped back up to previous dose. I have been one of those whose inflammatory markers shift up in line with symptoms. Whether this will always be the case I don't know.

PMRpro
PMRproAmbassador in reply to OutdoorsyGal

No, you keep trying a small drop every so often - don't push it but try it and if it works, try the next one. Some people find it takes them 2 or 3 goes to get to the next level down. You test by seeing if you get a bit lower. Again and again. If you can't get lower, don't panic/worry/get depressed/force it. Wait a month or two and try again.

I had an extraction on Friday. Currently on 25 mg prednisone for GCA. The dental surgeon gave me 8 mg prednisone just prior to surgery. Great result. I feel great. No pain.

Hidden
Hidden in reply to alvertta

Well Done that man or woman ⭐️

alvertta
alvertta in reply to Hidden

Man dentist.

Hi. I had a tooth taken out last sept with just a local anaesthetic. I was on 71/2 mg at the time. The tooth had broken down to the bone so was considered complicated and possibly needing stitches etc. It only took her minutes, no stitches, no bleeding to speak of and it healed nicely although I had to be careful with eating and drinking etc. I went in nervous and came out relieved. All the best cc 🤗

re: "extraction/bone graft"

It appears low dose pred, would probably be safe for bone graft/implant; 5-10mg or less. see:

"Prednisone: Contraindication for Implants?"

osseonews.com/prednisone-co...

But I would ask the dentist the reason. I presume the bone graft is needed for an implant.

Adding another link:

osseonews.com/patient/will-...

"ONE THOUGHT ON: WILL STEROIDS PREVENT A SUCCESSFUL BONE GRAFT?"

"This means that long term use of glucocorticoids can adversely affect the mineralization of a bone graft and postoperative healing including a higher risk of infection.

Patients taking long term glucocorticoids should consult with their physician before undergoing bone grafting or implant surgery."

Yes the bone graft is for an implant. Though I am prone to periodontal disease, and an old pocket is next to the tooth that is coming out. Don’t know if that adds to the need for graft. My oral surgeon draws blood from my arm, spins out the platelets and mixes it with the cadaver bone that he pumps into the extraction site. Being an upper tooth, he may also perform a sinus lift, elevating the sinus membrane from below so he can increase the thickness of the bone graft.

Sounds icky, and the healing and implant and more healing and impressions and finally getting a crown placed on the implant are a LONG process, but so worth it in the end.

Hidden
Hidden

Best of Luck 🍀

Extraction is day after tomorrow. Yesterday I wondered if I should be taking NSAIDS if I’m having a dental surgery. In the absence of prednisone, I’d gone back to 2 Aleve (naprosyn) per day to manage aches and pains, but as it’s a blood-thinner, I stopped that too.

Now I’ll find out how much pain is left after stopping pred at the New Year...

Thanks for the well wishes for my extraction/bone graft!

Tomorrow’s the day.

Yesterday I wrecked while cross-country skiing and have a sore shoulder & wrist (and collarbone?). Needed some pain relief, so switched to Tylenol (acetaminophen) which ISNT a blood thinner.

(After the extraction, I get REAL pain-killers!)

I am having an implant and was not told or advised to stop prednisone which is not really possible or practical. Both rheumatologist and dentist are aware i take steroids.

(I was already off prednisone, but considering going back on. Asked the oral surgeon and he said let’s try to get the extraction done before you go back on. Not a big deal.)

So the surgery went well, except it took 4 tries to get a needle in a vein to draw blood for platelets to mix with the cadaver bone for the graft. They got an IV in (smaller needle) and were able to find a vein while I was sleeping and not whimpering!

Ate a late lunch and started my antibiotics. And nausea set in 2 hours later. A rough night, vomited 3 times and diarrhea set in 2 am.

I have posted separately about this, to see if others have had issues with antibiotics and PMR.

Otherwise, no pain, no pain pills. I did ice for the first few hours.

Waiting for the oral surgeon’s check in call to find out what to do next.

PMRpro
PMRproAmbassador in reply to OutdoorsyGal

It COULD be reaction to lack of cortisol if your adrenal function isn't keeping up. It is felt to take up to a year for full response to return. You may be fine for day to day functioning - but it was a heavy duty performance if they struggled to get a needle in a vein, even that can be quite upsetting.

Hidden
Hidden

What antibiotics have they prescribed?

OutdoorsyGal
OutdoorsyGal in reply to Hidden

Generic “Augmentin” which is 500 mg amoxicillin (penicillin) + 125 mg of Clavulanate. I’ve taken it before w/o problems. (Though the generics were made by different companies.)

Hidden
Hidden in reply to OutdoorsyGal

Augmenting jack be tough on the bowels, have you been in touch with the Dental Surgeon as you’ll need antibiotic cover really.

Hope you feel better soon 🌸

MrsN

OutdoorsyGal
OutdoorsyGal in reply to Hidden

I called, he’s in surgery. Receptionist asked two good questions: did I take with a meal? (yes, though small), and what pain med was I taking (none). Hope to hear from him soon. I have a bottle of amoxicillin (without Clavulanate) on hand - got it in case my cracked tooth started to ache while traveling, before I had seen the oral surgeon for a consult. So I could switch as soon as I get the go-ahead.

And that’s what I did. No more stomach upset.

Hidden
Hidden in reply to OutdoorsyGal

Great, hope all’s good now 🌸

OutdoorsyGal
OutdoorsyGal in reply to Hidden

As long as the puking and spitting didn’t disrupt the surgical site, I think I’m good to go. Checkup in 10 days.

Passed checkup with flying colors. Another follow up in a month.

Upside. Might be coincidence, but since the abcessed tooth is gone, my aches and pains are far less. I’m feeling almost normal again. Except when I overdo it. Then I suffer the next day.

But many days I forget to take 1 or both of the Aleves in my pill tray, there’s so little pain. Still very stiff in hips getting up from sitting though. What’s up with that?

I’m now almost 4 months pred-free. (When do I qualify for Club Zero?)

Dental patients with a history of corticosteroid use may require special consideration before receiving any dental treatment. Currently, the misuse of steroids is its overdosage as it is prescribed even before minor dental procedures. The risks associated with excess glucocorticoid administration are relatively small.

Probably potential immune suppression?

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