Dental Health , Metronidazole and Compromised Immune System

[Rimmy]

Hello Everyone hope you are all doing as well as possible. Here in Western Australia we have been most fortunate for some time now with no community transmission of Covid for ages- although the Delta variant is running wild in other parts of Australia - and causing havoc with still relatively low immunisation rates - it has all become a 'race' to up these numbers asap !

In the meantime I have managed to develop my own 'new' issues relating to long term Pred (still at 12mg) which I have been unable to taper due to my ongoing (5 years now) PMR/GCA. While I was recently (fatally) 'congratulating' myself on NOT developing many of the long term side effects of Pred (although I have had some - cataracts/weight gain/osteopenia) my dental health was covertly fast deteriorating. In one year I have gone from a relatively stable mouth to having a bridge 'fail' (mind you it was decades old) some decay and two other abcesses. A real PAIN to say the least and hard to get fast attention even in the less pressured health system we have here. I ended up taking antibiotics - and the Metronidazole component made me violently ill for 48 hours . Worth noting (I discovered later) is that if you have low Neutrophils it isn't a good idea to take this drug). Anyway my dentist was surprised at the rapidity of the changes in x-rays from 1 year to the next. Now I am wondering what I will do with my remaining noshers for the longer term - as I DREAD hours in the dental chair - and the thought of (let alone expense) many implants etc etc. Wondering how others have done/doing with their teeth and if they have experienced any rather sudden changes and the decisions they have made !?

Nothing cheery here I'm afraid - but in light of so much suffering in the world at present I feel indulgent in this personal 'protest' against my 'wee' challenges' - just hope most of you are currently 'OK' !! All the best

Rimmy

PS. our constantly rain drenched garden is looking lush this year - although the weeds also abound !

[SheffieldJane]

Lush is the word Rimmy! Your garden looks like paradise. I can just hear your adorable birds. So sorry to hear about your poor teeth. Mine are often tender and one is loose in the socket, so I guess my teeth are lining up to be the next plague of Job for me too. False teeth have crossed my mind fleetingly. My very pretty granny had all her perfectly ok teeth out to celebrate the advent of free dental care , under the NHS when she was in her early 30s. I think she regretted it a lot. I will hang on to mine as long as I can and have treatments done as they arise, expensive though it now is. My family are in lockdown in NSW. Sorry that antibiotic had such a horrible effect, thanks for the heads up about Neutrophils. Will be careful. Keep safe! Xx

[Rimmy in reply to SheffieldJane]

Thanks Jane - I am in agreeance with you re teeth - false ones would be the last straw BUT there is always that balance thing about what I am prepared to go through if the outcome is either way far less than 'ideal'. My partner who grew up in Scotland in the early 1960s recounted teeth extractions (all of the teeth that is) were often given as birthday 'presents' - clearly in fearful avoidance of all the terrible possibilities - mainly expenses and pain - and an expedient way for the government to save money as well. Not much education about dental 'hygiene' it seems. I feel fortunate the teeth I have - have survived until my nearly 7th decade - although my milk teeth were pulled 'early' apparently having little enamel - so dentistry and me got off to a pretty 'bad start' anyway and although not 'phobic' I still don't 'like' them much (ha ha !) Sorry your family in NSW are locked down and have been for ages of course - it is quite tough (if vital) especially on those with young families I reckon and if people don't have a big back yard - to me it would be unimaginable. WA has avoided all that except for a couple of short periods and look at our 'border closures' as having worked well for us to date. Still that Delta variant seems to sneak through so readily - and now in Auckland as well !

Yes my reaction to that particular antibiotic was incredible - I was almost at the ER as I started to faint - it felt literally like I was poisoned - so I will be very cautious with those kinds of drugs now.

Hope all is going well with you at present

XX

[Bcol]

Morning Tommy, beautiful garden, thanks got the antibiotics information as SJ says worth bearing in mind. Sorry to about the gnashers and can't help there as I'm not long term yet and so far so good. Again though, a problem worth bearing in mind for future knowledge. I'm sure others will be along later with more knowledgeable insights. Good luck and stay safe.

[Bcol]

Apologies just noticed my error, I'll blame predicted text and have now corrected it.

[PMRpro Ambassador]

Love it - I wouldn't mind a garden like that but I wouldn't fancy the work!

One thing that pred does is affect gum health - and that can have a disastrous effect on tooth health. My mother had all her teeth out at 21 because of gum disease - before antibiotics. Her sister still had almost all her teeth when she died at over 70. Genes? OTOH, my cousin is furious that her previous dentists never told her she had gum disease - despite knowing as proven by the investigation that awarded her a lot of money for treatment. Almost all her teeth had quite deep gingival pockets and he'd measured them but not mentioned them to her. The result is they are very loose and she is trying some form of treatment at his insurance's expense in the hope of stabilising them. So it isn't just pred.

You haven't been on bisphosphonates as well have you? You require scrupulous dental hygiene with then as well.

I hate to say it to you - after 12 years of pred my gnashers are still pretty good. I put it down to restricting my dental work to essentials - apart from a dollop of gold work done by a finals student at the Dundee dental school 40-odd years ago. OH was the same, got more gold than me though as a presentation patient, and despite 15 years being nowhere near a dentist he also has no trouble. Wonderful stuff gold - natural antibacterial! My very good dentist here did some work last year on a tooth towards the back of my mouth - the technician got the colour match not quite right and the fitting of the inlay was delayed. I really couldn't have cared but he said it was important in case I decided to REPLACE the golds!!! Pay all that money for a tooth no-one can see???????

[Rimmy]

Thanks PMRpro - the garden was initially quite hard work to establish (only white sand 10 yrs ago) but is pretty self-sufficient now - but it's our larger garden - a small orchard 50kms away and an acre and a half which is still very hard work and worse lately when I tore a meniscus - but that has now recovered pretty well - so back to lots of bending and weeding !

Interesting about your durable gold fillings - I have none of those but lots of the old much maligned amalgam (and vintage NZ dentistry) whereas my partner has one she got 40 years ago and it is fine. No dx exactly of gum disease but I have had touchy gums for quite awhile so despite my best efforts they are never great, I haven't ever taken bisphosphonates however. It is the rapidity of the deterioration which puzzled my dentist. Not sure if having GCA as well as PMR is significant in our varying situations - who knows ! ? but can't do much about that either !

[PMRpro Ambassador in reply to Rimmy]

I suspect there is a vasculitis component in there somewhere ...

[Devoid in reply to Rimmy]

Hi I went through a period when several of my teeth became loose and I did have to have one extracted but rather surprisingly they have settled down. My dentist felt it was a combination of vasculitis and medication. I thought at the time it was yet another thing to contend with and also hated the thought of false teeth

[Ineedsleep2]

I sympathise. My teeth too have deteriorated over the last few years. I have a very painful infection right now and I'm taking metronidazole. So far no side effects, but they haven't really kicked in yet.I wanted tooth implants, but my dentist says due to osteoporosis, my gums are not strong enough. So I have to have my teeth removed and wear dentures. This is horrifying to me. I had such beautiful teeth. But my family has a 'bad gene' which causes serious tooth decay.

Right now I won't go out, but if I do I happily wear masks! It has a double plus in my case. I guess I'm lucky enough to have a regular dentist, but I'm so down about losing my teeth.

[Rimmy in reply to Ineedsleep2]

That sounds very difficult and horrid for you and of course I can well sympathise. I did not realise that there could be a 'genetic' cause for rapid tooth decay and ascribed it to my long term Prednisone use and eating (probably) too much sugar when I went through a particularly 'low' phase with fatigue. But regardless of 'causes' I am very sorry you are having to get dentures and I also was aghast at that thought although my teeth were never really wonderful and I did not have a wide 'flashing' smile. I suppose I am fortunate that my teeth have just passed muster this time and my clever dentist managed to replace the bridge which just fell out one day - after 25 years without a problem. But I am sure the worst will soon be over for you and I did hear a man saying to someone in a surgery once that he had dentures for many years and that listening to the dental dramas of others he was pleased he didn't have those problems anymore and was 'happy' with his situation. Maybe not much to cheer you up - but at least something positive ... BTW - yes 'masks' they have many purposes - ha ha !!