Coming off Pred for tooth extraction?: I have to... - PMRGCAuk

PMRGCAuk

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Coming off Pred for tooth extraction?

braininjurythepits profile image

I have to have a back tooth out, the dentist has advised me that I have to come off Prednisolone a week beforehand to aid healing. Is this common practice? I seem to be successfully tapering (down to 8mg at the moment) and am worried that I’ll be back to square one again....

29 Replies

Hi

No I’m afraid that this is an unreasonable request, as to reduce so quickly will cause you problems & without wanting to frighten you the stress of the removal of the tooth could cause a collapse.

How essential is it to have this tooth out? Many of us on here have had dental surgery or extensive treatment, root canals etc & many actually increase the Pred on the day to take you through the stress of the treatment.

This kind of information is in the Patient Information Leaflet. Yes there is a possibility healing may be slower but far better than the effects of suddenly stopping the Prednisolone.

Personally, l’d get a second opinion from another Dentist.

Good Luck 🍀

MrsN

jinasc profile image
jinasc

I would not be worried about going back up,,,,,,,,,,,I would be worried about being told to stop it abruptly. I would be checking this out with my medics. An adrenal crisis is not anything you even want to contemplate.

I had an abcess and was referred to the Dental Hospital (part of the University) and they drained it and then took out the tooth about 5 days later. I was on 40mg of pred at the time with GCA. The only difference was they had someone to monitor me whilst they extracted the tooth.

I wonder why he wants you off pred........and anyway you should never stop it abruptly - as far I understand your adrenal glands have shut down because of the pred you are taking and when you stop pred it can take up to one year for them to become fully functional.

I had a synacthen test before my Rheumy would let me stop - just to see if they had woken up they had.

SnazzyD profile image
SnazzyD

Others have said about the risk of adrenal insufficiency and potential collapse. Even if you have a Synacthen test it doesn’t say whether your adrenal axis is fully functional 100% of the time, just that the adrenal glands would work if they got the signal. I also doubt that the reduced healing effect of Pred stops the moment you come off it. It is not as if you are on a high dose. What’s wrong with just covering you with antibiotics?

YuliK profile image
YuliK

Oh dear.

I've had two implants about 6-8 months ago and my dentist said it was ok to continue with the prednisone.

Seems to me that you dentist is either very young and not experienced or old and just covering himself.

Is it a wisdom tooth he is extracting ?

My friend was on exceptionally high doses of pred and had her cataract done. Some doctors say no and others yes. Go and know who's right.

Megams profile image
Megams in reply to YuliK

Yulik - please tell me how your implants went and if they settled down fairly quickly? I would be grateful to know.

Also was the bone density of your jaw checked prior.

I am due to have a front fractured crown removed September replacing with implant - hope it will still be OK as my Dexa scan now showing noticeable signs of bone loss which addressing tomorrow with Rheumie.

Thanks in advance ~

PMRpro profile image
PMRproAmbassador

You MUSTN'T stop pred suddenly to do that sort of thing and the dentist should know that. What a ridiculous thing to tell a patient on long term pred - it could make you seriously ill.

I had a wisdom tooth out a couple of years ago, still on pred and definitely more than 8mg, and I also take anticoagulants. I was terrified, knowing in the UK it would most likely be done in hospital. The hospital looked at me as if I was crackers and my dentist was totally blasee about it. He was right. I didn't bleed much and it healed fine.

I think you need a more experienced dentist.

keepfitdoll profile image
keepfitdoll in reply to PMRpro

Hi general enquiry. What happens if you stop taking the Alendronic acid suddenly. Will it have any bad effect? I mean if it is temporary.

PMRpro profile image
PMRproAmbassador in reply to keepfitdoll

It's perfectly OK to stop AA suddenly. Personally I don't think it would have a bad effect if you stopped it permanently - but why would you stop it temporarily?

keepfitdoll profile image
keepfitdoll in reply to PMRpro

Thanks for reply. I was reading the other posts and was thinking if you needed a tooth extraction or any other treatment. I am on this drug for the bones so need to know this. The GP does not tell you these things, so this site is very useful information.

PMRpro profile image
PMRproAmbassador in reply to keepfitdoll

Tell your dentist - and many will refuse to do invasive procedures if you are on AA. But stopping it temporarily won't make any difference - it remains in your body. At last count they admitted it was still there after 10 years - but that is only because it has only been in widespread use for about 12 years.

SheffieldJane profile image
SheffieldJane

This is irresponsible advice in my view, it is dangerous to stop Prednisalone suddenly. I am afraid that I would have lost faith in this dentist. I have had two crowns fitted ( extensive drilling and filing) if anything I needed more to help me get over the stress of invasive dental work. My dentist is knowledgeable about PMR and about Prednisalone. Are you on any other meds. like Alendronic Acid? That is a real no,no for tooth extraction.

We are vulnerable to infection though - not sure if penicillin- as a precaution would be useful ( if you aren’t allergic that is).

I know NHS dentists are as rare as hen’s teeth these days, so if you are in the UK it might be hard to find another one, but oh dear.

in reply to SheffieldJane

Re Alendronic Acid or any other Bisphosphonates - you are always advised to have any Dental Work completed before you start taking them.

If however, you really did need an extraction you would be sent to the dental hospital & other options would be considered first, including temporarily stopping the bisphosphonate.

My Dentist actually x-rayed my teeth before l started AA & again with the ZA but no work was necessary.

Gosh! Thank you all! I’m so glad for this forum, I’m not on Alendronic Acid fortunately, but I will definitely change my dentist!

piglette profile image
piglette

I am not sure your dentist is that knowledgable about long term pred. I think a lot of doctors and dentists do panic about stories they read rather than actual knowledge they have. There is no way anyone should tell you to stop taking pred for a week unless they wanted you to have an adrenal crisis.

alvertta profile image
alvertta

When I had a tooth extracted this year the dental surgeon gave me 8 extra mg at the time of surgery. I had no bad side effects and my gum healed well. I was on 25 mg at the time. GCA.

Purplecrow profile image
Purplecrow

Recently, I had a wisdom tooth extracted, on 7 mg pred. No problem. Healed promptly.

Jerri

PMR diagnosed 2013

GOOD_GRIEF profile image
GOOD_GRIEF

Well, this makes no sense at all.

Besides all of the above comments on the dangers of abruptly ceasing pred, and the potential of inspiring a relapse caused by the extraction, it just makes no sense.

Transplant patients are given massive doses of steroids before, during and after transplant surgery, for heaven's sake. They seem to heal up just fine.

Brantuk profile image
Brantuk

It is well known that stopping pred suddenly can cause a stroke. I tapered down to 8mg when major surgery became necessary. They stopped my methatrexate the week before the surgery, but raised the pred back up to 10mg. After the surgery I stayed on 10mg (logical) and it's taken ages to get it down to 9mg/day. Like pmrpro I'm also on blood thinners (warfarin, clopidogrel) and a bunch of other drugs (alendronic/folic acids, bisoprolol, etc).

My dentist is the same - he'll only do minor work on me now and insists any extractions are done by the hospital in case of excessive bleeding or other problems. Personaly I think he's a whimp, plus it's a pain getting the hospital to do any dental work at all - they won't touch me without a heap of justifications, letters from gp/surgeon, and making a fuss. There's a big gap in the NHS where folks with complex conditions and prescriptions struggle to get dental treatment. Heaven help us if we get a dental emergency.

mcbouchon profile image
mcbouchon

Just to give you my recent experience, hope it helps - I've had PMR since Oct 2017, unfortuneatly diagnosed with GCA early June, so had to increase pred to 50mg - a top molar broke mid June, my dentist liaised with rheumatologist re procedure, his concern was the alendronic acid (which I have stopped because I had bad side effects). However I had the extraction last Friday, reducing pred this week from 50 to 40mg, neither the rheumie nor the dentist at any point suggested stopping pred, and the extraction was quick and painless and seems to be recovering well. I am following all the guidance re what (not) to eat, etc.

MaryA_ profile image
MaryA_

I had to have a tooth extracted and was 7mg. I had to stop the blood thinner but not the prednisone. Good luck with this. Maryanne. 🤐

mtrafter profile image
mtrafter

I have had 3 extractions in last 4 mths while on 6.5 mg of Pred. Neither my Rheumy nor Dentist said that I needed to stop or increase pred. The extractions were straight forward and I healed quickly.

Cross-stitcher profile image
Cross-stitcher

I had my two implants fitted (including bone-grafting) pre-PMR and pre-Pred. Then PMR struck and my dentist advised waiting longer than usual for the bone-grafts to "take" before fitting the final crowns. 6 months of healing later, and by then on 11mg Pred, the implants were surgically exposed and the final crowns were fitted. Healing of the gums was slow and painful, but complete within a month. So I believe that, for some people, Pred does slow the healing process. It had also given me very thin skin which cuts, bruises and bleeds easily.

Thank you for all your comments which have been really helpful! I saw a different dentist today, who absolutely agreed that it was vital to stay on Pred, so I am much relieved 🙂

PMRpro profile image
PMRproAmbassador in reply to braininjurythepits

Hope someone educates the other one!!!!

Suet3942 profile image
Suet3942

On the contrary. You should be doubling your dose on the day itself. You can’t just stop the pred. Its dangerous.

damselinarap profile image
damselinarap

I had two teeth out 10days ago and some gum contouring for building up my lower teeth my dentist is aware of me taking preds and methotrexate and was not duly worried l did bleed a little longer which was explained l would but he stitched up the gum and l salt watered rinsed for a week and all’s fine.

Blackcat1M profile image
Blackcat1M

Hi have had two teeth taken out while on pred, and my dentist never told me to stop taking pred. But maybe different dentist have different ideas.

Lonsdalelass profile image
Lonsdalelass

Hi, I had a bad root canal tooth extracted in May. My dentist thought I may have to increase my dose of pred. But my Dr said there was no need, and I could in fact continue to reduce (I was on 8mg at the time, and due to go down to 7). However, I decided not to reduce but to stay at 8, to play safe. I stayed there for the week before and week after my extraction, and everything was fine. Healing maybe took a little longer, but the dentist had packed the socket with dressing to avoid dry socket, so I think this was why. Anyway, am glad to say all is now well. I'm feeling the best I've ever felt since getting PMR (diagnosed Oct 18) and currently slow tapering to 5mg. All the best!

Carrollee profile image
Carrollee

Hi. Had a tooth out on 7mg. Barely bled and healed pretty quick. No problem at all. Cc 🤗

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