I have to have two teeth extracted and have been told to stop Pred the day before and on the day of the treatment. I’m really confused with this instruction because I also had to have teeth extracted whilst I was on 30mg Pred and the same dentist told me not to change my dosage! Apart from wondering why the advice has changed, I’m concerned about the effects of not taking Pred for two days - I’m currently on 5mg a day. I’d really appreciate hearing whether anyone else has been told to stop their Pred in order to have dental treatment.
Thank you. Jan
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Janann25
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Eh? So, apart from potentially causing an adrenal crisis, especially with a stressful procedure for most, what does it achieve? Although the Pred leaves the system somewhere in the 24 hours, it’s effects don’t stop, so I suspect whatever effect they are trying to avoid won’t be totally negated by stopping for a day. Also, depending on when you take it, it could still be in the system anyway. Are they willing to take responsibility if you flare and have an adrenal crisis? A full explanation of the rationale needed I think. I wonder if they are worried about bleeding.
That’s why I’ve questioned this. I’ve never - so far🤞- missed a dose but having read here about the problems caused by missed doses, I decided to ask the advice of other PMR “sufferers.”
Sorry, l’m afraid l can’t agree with your Dentists Plan, you should never stop your Pred at anytime & it is usual to increase Pred when you are at a lower dose to deal with the stress effects of Dental Treatment......
They do have a concern about healing but l’d be more concerned about an Adrenal Crisis to be honest.
The fact he didn’t ask you to stop when you were on 30mg indicated he’s not overly sure of the Protocol.....
Thank you - I knew I would get good advice here. I won’t stop my Pred but I won’t tell him either. It’s stressful enough having dental treatment without “discuss” with the dentist😉
When you were on 30mg you were taking a sufficient dose to ‘cover’ you but now down at 5mg it is a lower dose than our body’s need to function normally, so you’d be putting your body under unnecessary stress......
I’ll add a link about sick day rules for Adrenal Insufficiency, it doesn’t cover dentistry, it was produced for Covid but the principle is the same.
I ‘hate’ going to the dentist so l’m under stress before l begin 😉
Ditto to what Snazzy said! I've never stopped pred for any dental work - and I have had a wisdom tooth out in the last few years. I was terrified after all the doom and gloom you hear in the UK about our dentistry being referred to the hospital but the dentist here was absolutely right. He always is!!!!
Thank you all for your comments - the advice here is invaluable 🙏
Hi, I value the comments made on this site, however I do have some concerns about the advice you are taking here, however well meant. I feel I am becoming familiar to inform my own decisions, but the advice I have read is vey appropriate for the author’s treatment, but not yours.
Couple of points and I know nothing really of the drug, other than I take it; but I do have some knowledge of dentistry. Point 1 is you are taking a different dosage of prednisilone one from the your first procedure, which being lower, allows the clinician to make a judgement on a separate set of parameters. Point 2. It may be a different from your first procedure, and different parameters again considered I.e. and e.g. third molar extractions (wisdom-teeth) are very different teeth to extract in many as often they are healthy teeth but not functioning, with upper and lower presenting different presentation but the same problem: sometimes the submerged lower is infected and the upper not. May as well stick in point 3. A non functioning wisdom tooth in a healthy socket provides a different presentation to that of a tooth which needs to be extracted due to an infection. The list is endless and therefore so is the approach in regards to treatment. I could go on.........
Might I suggest that if you are unsure regarding the advice given from your dentist that you telephone them, express your concerns and seek reassurance. Believe me, their medical legal insurance costs are high, their reputations are easy to damage and no dentist wants to make a mistake in any event and hurt their patient.
If you remain unsure, ask for a second opinion from one of their colleagues, or contact your GP or hospital consultant. In this instance I would only take the advice of a clinician. I have some little knowledge, they have a lot more in their field of speciality and certainly more than most of us on this site in this field.
That is my advice and would be the process I would follow if it were me. The analogy I would consider if you do follow member advice is like following the advice of your mechanic in regard to your hair style!
Possibly - but stopping pred for 2 days at this dose is not a particularly good idea, especially since there is inevitably a degree of stress involved. It is also very likely it would be enough to trigger a PMR flare - any stress will do that at most doses and adding in taking no pred at a point where adrenal function will be, at best, compromised is questionable.
I rest my case I’m afraid. I think the advice that this lady is taking is ill advised and anecdotal, however well informed and based on individual experience.
We have no perception of what the procedure entails, her dental history or what the dentist envisages the outcome. There is a dentist on here, I hope he confirms my advice.
I am sorry but I am concerned for this member’s welfare and her decision as she has suggested.
A simple telephone call is all that is required and I would pursue that avenue, this isn’t about who is right, it’s about your welfare.
I rest my case, but this is not an issue of who is right and who knows best, advice is being taken from those who do not know the case and based on personal experiences of different scenarios. She can sue the dentist if they get it wrong.................the best that she can take from advice freely available here is “sorry, I didn’t know that”
With respect I'd like to point out that people join this well -established group for support from others who are living with PMR/GCA and its consequences. Many of the replies to questions are by no means anecdotal but instead based on years of experience, research and facts to back up advice/suggestions.
I joined this group after seeing a notice pinned up on my rheumatology clinic's notice board. There is constant monitoring of messages to ensure soundness.
Of course and I have benefited from advice myself in the very short time I have been a member.
May I ask you to consider, which of these advisors are a dentist, preferably who know her medical history and the treatment plan? Who can prescribe? Who will take responsibility. I sense that answers will not be forthcoming.
My stance remains exactly the same. Seek the advice of those who are treating you, hearsay based on personal experience and lack of qualified knowledge is dangerous. To be absolutely honest, i wished I hadn’t commented on this thread and I have only continued as I am worried about the lady’s welfare and treatment prognosis if she follows well intended, but uninformed advice: her choice was to ignore professional advice after reading the responses.
She has my advice, it is simple. Not one of the “experts” has any knowledge of her case and I hope that she doesn’t heed it.
My last post on this topic, in summary if a duck quacks then it is a duck, in this particularly instance the emphasis is not on the duck.
Having just read all the replies again, no-one said to ignore the dentist but that it should be discussed/queried. One of the early instructions for anyone on longterm pred is not to stop taking it suddenly FOR ANY REASON. And THAT comes from doctors and pharmacists who are probably far more aware of the risks of doing so than most dentists. So who do you take notice of: your doctor or the dentist who probably isn't aware of how long you have been on pred, just that you are currently taking it?
I see this as pointless. The lady said that she was likely to ignore a qualified professional who was conducting the procedure in regard to advice from members here, who however well intentioned, have no idea of the full picture. I am observing a duty of care. Recheck her comments if you want.
Nobody has professed to be a dentist or an expert. Questions are asked to gain support through shared experiences and people reply in that vein. I am pleased that you have had some benefit in being a member.
The first time 7mg (my gp even said I could continue to reduce the week before but I played safe and stayed where I was) and the second I think I was on about 3 or 4mg. Luckily I had no problems. And I'm a real scaredy cat at the dentist so was apprehensive beforehand. But all was well.
According to the Sick Day rule leaflet for steroid users it's the opposite. Your dose should be doubled 24 hour before extraction and then return to normal. The leaflet can be downloaded if you haven't got it already.
Interested in this leaflet. Please can you tell me where to download it? Thanks, I’m following this thread with interest, as I am fighting a tooth infection with antibiotics at the moment, & it may lead to extraction (bad history with this particular tooth)! Thanks, S x
I’ve been reading the various responses this morning, my advice would be as someone else suggested to ring your Consultant & ask for their opinion, also l would insist your Dentist gave you this advice in Writing so there is so possibility of back tracking......
Are you in the U.K.? As many Dentist here will send you to the Dental Hospital for extractions.......
Yes, I’m in the Uk and the dentist is a consultant surgeon. He worked in the hospital previously but now has his own specialist clinic. I would never normally question him because he’s excellent. My only reason for querying this was because he has previously taken out several teeth - steroids have played havoc with them😡 - without asking to to change my dosage at all. Very confusing 🤷♂️
Ever grateful for the measured, well balanced and well informed responses from the vast majority of this community, based on decades of experience with pmr, gca and steroid treatment. Always dispensed with a good dollop of common sense as well as the latest research!
Tooth extraction can be stressful and as such the body responds by excreting more cortisol. Given that the adrenals are often compromised in patients on long term steroids the advice to dentists is to contact the GP and discuss whether the patient should INCREASE the dose at and around the time of the extraction. I was never advised that the patient should reduce the dose.
I've recently had two teeth extracted. I stayed on my same dose of 10mg for both. After the first extraction I flared and had to take more prednisolone for a week but was able to go back to my lower dose straight away. I don't understand why your dentist would risk you stopping your steroids. Seems a bit odd to me. Good luck with the extractions x
Have been on Pred for 8yrs and never been told to stop ,even have had extractions and implants done .Only pill not to take is any blood thinning tablet
I had a tooth extracted last year on 15 mg. A few weeks ago I had one extracted at 10 mg. I agree to seek advice of GP or rheumatologist rather than have it done and not mention to him that you hadn’t stopped. I really can’t see why he would ask you to stop all medication but I would agree with Mrs Nails to ask him why and have him confirm in writing.
Not knowing the full details it appears on the surface to be very foolhardy to stop your medication for 2 days and then have a stressful procedure.
Would be interested in hearing the result of what happens as I feel I personally will be frequently at my dentist. I have been 6 times since lockdown!! An expensive hobby!😬
Yes, I’ll contact him on Monday. I did actually ask the receptionist to check with him and she then phoned me back to confirm he wanted me to stop for the day before and also the actual day of the extraction but that I should at least stop on the actual day. All very confusing.
I had work done on my teeth, and my dentist wasn't concerned about the Pred, just glad to know what meds I was on. I had an extraction, a filling and some bonding done.
Not worth the risk to stop your Pred that way IMO.
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A bit gutted 😞 
