LOST ONE TOOTH A MOLAR

[calicojoy41]

I am having a debate with my dentist she is pushing for an inplant but I was thinking about a bridge. The implant sounds more like surgery and with PMR, I am now tapering currently on 13 mg. of prednisone I do not want to mess things up. I would like some opinions . I almost feel like doing nothing at this point, I do not want anymore pain.

[PMRpro Ambassador]

I bet she is pushing for an implant - wonder how much extra profit she makes on it!!! I was upset enough about the cost of a ceramic inlay recently - it was replacing a gold inlay that was 50 years old but had developed caries under it. The dental nurse said "But it will last longer ..." Excuse me sweetie - I doubt I will be interested in whether the inlay lasted longer when I'm 120. She didn't get the irony

Have you ever taken bisphosphonates?

[calicojoy41 in reply to PMRpro]

THANK YOU for your reply you gave me a good laugh!!

[Grammy80]

I'll just shoot out my opinion....I would go with the bridge. I worked many years in the dental field and have a mouthful of root canals, crowns and bridges. Recently one of the teeth on a five unit bridge broke off. I went to the same dentist that did my husband's implants last year but told him I did not want and implant and he agreed with me. He didn't advise it with any AI disorder. This is my OH second round with implants at age 79, cost with periodontal work, an outrageous $16,000 for two this time. I don't even like to think about the possibility that there will be infection or any other problem...give me a bridge any day!!!💕

[calicojoy41 in reply to Grammy80]

THANK YOU SO MUCH, MY GIRLFRIEND IN PHOENIX SAID THE SAME THING. SHE WAS A DEATSL ASSITANT IN HER YOUTH. SHE IS 84 NOW! THANKS AGAIN FOR YOUR RAPID REPLY!!😘

[Bridge31 in reply to Grammy80]

Why is it not advisable with any AI disease ?I’m due for an implant in July having already had the bone graft and I’m worried now.

[GCAfiveyearrelapse in reply to Bridge31]

Grammy80 Bridge31 PMRpro Hi I have same question. Am on a taper with GCA diagnosis and am getting an implant. Dental surgeon has not said anything cautionary about avoiding serious dental work while on pred/with an AI condition.

[PMRpro Ambassador in reply to GCAfiveyearrelapse]

Pred isn't so much a problem I suspect. Bisphosphonates are and many dentists won't touch invasive dentistry for a patient on them. Some won't do anything!!

Pred is likely to put you at risk of thrush and if you suffer with a dry mouth then your teeth and gums need particularly good care.

tremandental.com/oral-infla...

drjamrozek.com/autoimmune-d...

Being of a tight disposition (I'm told I can give even Aberdonians a run for their money), I'm rather reluctant to expend that sort of money on something I'm maybe not going to get good value with - if there is a value for money alternative. The performance associated with implant seems rather excessive

[Grammy80 in reply to GCAfiveyearrelapse]

Please see what I wrote to Bridge31, you have to do what is right for you. Take care💕

[Grammy80 in reply to Bridge31]

I believe his statement regarding the AI was specific to me because of the pred I take plus TCZ...I heal slowly. Some folks become more susceptible to infection with TCZ. I've only had one bout of cellulitis but no other infections.

Just because I would be hesitant doesn't mean it isn't the right choice for you. Don't worry! You and your dentist know what is right for you!💕

[Temeraire]

To be honest if its just one molar and it isn’t bothering you I wouldn’t do anything! I certainly wouldn’t have an implant anyway.

[calicojoy41 in reply to Temeraire]

THANK YOU !

[HeronNS in reply to calicojoy41]

One molar? Agreed. I had a molar removed years ago and the gap is not noticeable to anyone else, no trouble at all to me - at least as long as I don't let a whole almond slip into the gap!

[calicojoy41 in reply to HeronNS]

All I keep hearing is your other teeth will move to fill the hole which will change your bite and cause all kinds of problems and I do not need that!!!

[HeronNS in reply to calicojoy41]

That has not happened to me, although some teeth on the other side of my mouth have shifted slightly and are more crooked. They have certainly not been aided by the space on the other side! I can't remember when I had that tooth out but it is a very long time ago now, long before PMR which appeared about eight years ago. If there were going to be any problems they'd have occurred by now, I'm sure.

I do take (a moderate level of) calcium supplements, and Vitamin K2, which I think both help tooth and jaw health.

[PMRpro Ambassador in reply to calicojoy41]

Not usually at our age - I still have the gaps from my 20s in fact. The only teeth that moved much were the ones that the braces encouraged.

[Grammy80 in reply to calicojoy41]

When I was in my 30s, I was working for an orthodontist and at that time I had a few molars missing from early years. He talked to me about my teeth shifting and so he put braces on me...for FREE. After that I had bridges made. One unit of my bridge broke off about 8 years ago...I personally have had no shifting in these golden years. I'm 81 now and that just hasn't been a concern. Tough decision, but you have to do what your 'gut' tells you or you'll never be happy!!💕

[Bcol]

I had a molar out a few years ago and the gap is not a problem at all.

[Exflex]

As PMRPro asked, have you taken [or are you taking] bisphosphonates? And if so for how long? I think I’m due an extraction after paying £600 for root canal surgery that hasn’t worked. I would be extremely cautious about surgery drilling the bone, as it is I’m concerned about the extraction (that’s why I paid for the root canal surgery that sadly didn’t work). I’ve been on Risedronate for 2 1/2 years, part of that was with AA.

[perceptual63 in reply to Exflex]

Do you truly necessitate an extraction considering the possibility of developing ONJ while you are on Risedronate?

[calicojoy41 in reply to perceptual63]

I have not taken Risedronate, my tooth broke at the gum, it was already at risk as it broke in half the year before and it was secured by a post and filling material, it did g to last a year!

[Exflex in reply to perceptual63]

I’m seeing the dentist on Tuesday, but sadly all the good work she did - a total of 2 hours in the chair, and quite a bit of that was painful even though I had a local - hasn’t cured the problem. She’s suggested cutting the tooth in half and repairing, new crown etc, or extraction.

[perceptual63 in reply to Exflex]

I’m sorry that you are experiencing such dental problems. Hopefully you can avoid an extract but if you need one then keep up with regular appointments to monitor for ONJ as that is not something to play with. All the best to you. 🙂

[Exflex in reply to perceptual63]

Thank you. Having looked up osteonecrosis following tooth extraction I’m a bit worried now. 😳

[perceptual63 in reply to Exflex]

There was a talk I had with my dentist that if I did indeed had to go on a bone med then I could never again get an implant and that going forward the goal would be to just maintain my existing teeth, but if I would ever need a tooth extracted then there is a greater chance to develop ONJ. The dentist also stated that if I did develop ONJ then the treatment for that would be hyperbaric treatments.

I haven’t taken a bone med. but this is the conversation my dentist and I had if I were to take a bone med.

I hope this helps in some way.

[Exflex in reply to perceptual63]

Very helpful and thank you so much for taking the trouble. I will not have it extracted without exhausting methods to save the tooth.

[calicojoy41 in reply to Exflex]

Thank you for your reply. No I have not taken bisphosphonates.

[Daylily2000]

I have three implants. They are so much like your own teeth…don’t notice the difference. I had two of them installed a year ago while taking 10mg prednisone. I recommend them.

[HeronNS in reply to Daylily2000]

I think there are instances where an implant, or several, are important. Front, visible teeth, for example, or if you have several gaps. It sounds to me like Calicojoy's situation is very similar to mine, and no one else would know I had lost a tooth, nor has the gap given me any trouble. I fell about twenty years ago and broke a couple of my front teeth, one of which twisted, so needed a root canal and is "dead". It was successfully restored, and the other only needed repair. Had I lost either or both of them I'd have been having implants, believe me!

[Exflex]

Do you know whether the implant has to be done fairly soon after the extraction (before the gum recedes I guess) or can it be done retrospectively? This thread is great because it’s important for people like us taking Pred, and if like me taking Risedronate as well. PS my GP consulted a Rheumy on my behalf and was told I should keep taking the bisphosphonate for as long as I’m taking Pred ... even 1mg. Sounds daft to have to do this whilst on low dosage (I’m currently taking 3 1/2mg). Thanks for reading.

[HeronNS in reply to Exflex]

I believe you have to wait for the gums to heal, and also for any infection that might be a result of the damaged tooth to clear up, several months, so not something which happens right away.

This: 918dentist.com/blog/dental-...

[PMRpro Ambassador in reply to Exflex]

Heaven help you if your journey with pred is as long as mine!!! Been on pred for 13 years nearly - and my bone density hasn't changed much. I refused to take bisphosphonates - and I'm so glad I did. But more than a few years of them is not good for you without a holiday from the drug.

[Exflex in reply to PMRpro]

I would have thought 3 1/2mg of Pred was low risk but my GP, having consulted a Rheumatologist, thinks otherwise. But it’s not their bones and potential complications with dental surgery.

[PMRpro Ambassador in reply to Exflex]

Not everybody loses bone density when on pred - quite a few on the forum who didn't. It seems there is some recent work showing even 5mg isn't a "safe" dose - however - I really don't regret taking the risk. Maybe it will come but in the meantime, I;ve had a reasonable life!

[phebamom in reply to PMRpro]

I am also stuck at 5mg. Been on pred 12 years. My rheum. is satisfied with 5 and says I may be on it the rest of my life. It is what it is at this point. Attempts to go lower have met with disaster.

[HeronNS in reply to Exflex]

I improved my bone density during my first year on pred through diet and exercise. In 2020 I a bad fall which hurt my knee, but I didn't break anything. I'm such a klutz, generally speaking, if I had fragile bones I would be in pieces now. Been on pred, mostly very low dose, since mid 2015.

[Exflex in reply to PMRpro]

Been on Bisphosphonates for 2 1/2 years, as I said earlier, how long a holiday from them would you suggest? Thanks.

[PMRpro Ambassador in reply to Exflex]

The medical literature suggests at least a year after 5 years on them although a lot of experts say that is too long, 3 years is preferable.

[Exflex in reply to PMRpro]

Thank you PMR. As I’m going to phone the Doctor’s surgery I will question him or her, saying I’d like a break. Come July it will be 2 years since my Dexa scan so I’ll mention that as well.

[phebamom]

Personally, I would not get an implant. My old dentist, now retired, advised against it. He was familiar with auto-immune issues. His wife had a liver transplant and a sensitive immune system. He told me to never get an implant as my body was very sensitive to anything foreign. I have bridge work on one side. I hate it. It is hard to keep clean, and I am now having sleep apnea, waking with a bad taste in my mouth I regret having it done.

[Karenjaninaz]

I want an implant soon. I had one for a long time in the far back which needed to be removed. I’ve had teeth removed for orthodontics because I had not enough space in my jaw for all my teeth(buck teeth).So every molar matters. The space where the implant was is empty and it’s a pain in the neck just to chew on that side because there’s not enough chewing teeth. So I’m looking forward to get my new implant when my prednisone dose is lower.