Dental with osteo on pred

[Spanky2019]

I will call rheumy about this tomorrow. This weeks gastroenterology appt was about same as past. Reflux, dysphagia, esoph dysmotility & ?? Esophagitis again. Stay on dexilant, figure out diet level for dysphagia... (same old stuff). I'm trying to give a little background but get to my point. Haven't had mouth sores since being on pred but got them when reduced last week from 80 to 60 mg. Spent a lot of $$$$$ on teeth past 3 to 4 yrs and am meticulous in dental hygiene. Been very sick with gca and/or pred effects since April. A tooth has been hurting today & just noticed 2 cavities. With gca, high dose pred, osteoporosis, major gastro problems... Can someone share their experience and/or advice. I am hardly mobile from effects of pred/gca. DR's want me to go on boniva but taking poopadoops advice and wait-no hurry approach. I think dental issues are serious business for me right now but difficult to gather information.

[Cally55]

I think my journey is a bit like yours. Have diverticulitis, bowel resection about 8 years ago. I have had GCA PMR since February 2016. Put on omeprazole from the start with the prednisolone, 40 mgs then. Also Alendronic Acid. Immediately noticed that mouth ulcers disappeared! Had been struggling with these all my life but got very much worse in run up to GCA. So prednisolone does have some wanted side effects. I also have osteoporosis, although diagnosis followed the fractures, not the other way round.

I had a filling at the beginning of all this without any problems but now I need a root canal and my dentist won't risk it because of the prednisolone, now around 10 mg, the osteoporosis, the zolendronic acid (instead of Alendronic Acid) etc. There is a long wait for dental hospital on NHS.

Advice from numerous clinicians was that treating the osteoporosis comes first. The risk of jaw necrosis from intrusive dental work is said to be very small, apparently fillings are not a problem. I am waiting for CAT scan of head before referral to dental department though. This is also because of a pain behind right eye when blinking hard for which I was referred to ENT to rule out sinus problems. The ENT doctor said this should cover the whole area.

I have taken bisphonates from the start and haven't had any noticeable side effects, equally they don't seem to have stopped the osteoporosis and fractures, however I might have had osteoporosis before the prednisolone, too late to find out now!

[Spanky2019 in reply to Cally55]

Thank you so much. It always helps to know others story. Best to you.

[PMRpro Ambassador in reply to Cally55]

Oh poo!!! I recently had a root treatment while on 15mg pred. No probs at all - despite having an anaerobic bacterial infection in the tooth. And here in northern Italy you have to be really in a mess before the hospital dentist is available - when I enquired, knowing in the UK what had to be done would probably be "hospital stuff" they looked at me as if I was from outer space. Luckily mine has his practice opposite the hospital ...

[Cally55 in reply to PMRpro]

That's more or less what ROS said, the risk of jaw necrosis was very small and it was far more important to treat the osteoporosis. However my long time, private, dentist won't do it and I don't fancy going as a new patient to one that will! The GP didn't seem surprised. Could it be something to do with insurance?? So far the tooth hasn't died and the painkillers for my back are keeping it at bay.

[PMRpro Ambassador in reply to Cally55]

Jaw necrosis may be rare but poor healing of tissues of all sorts is more likely - and that includes bone. Dentists may be at a higher risk of liability claims perhaps?

[Cally55 in reply to PMRpro]

I suppose the longer they leave it the lower dose of prednisolone I will be on, possibly!

[Janstr]

When on 40 mg of pred my gums bled easily & had areas where they were very sore. My dentist recommended buying hydrogen peroxide 3% & applying it between my teeth & therefore onto my gums with the little inter dental brushes. This worked.

[Spanky2019 in reply to Janstr]

Thank you for tip. Occasionally do use h. Peroxide & baking soda for whitening but not often. Hope you are having a good day.