Tooth extraction

[Holycow2]

Hi all. I had a flare and had to go up to 7mg from 1 which seems to be working. My question is I am having a tooth extraction soon. Is there anything I need to do before hand as I have heard some horror stories

[SnazzyD]

Do you mean horror stories of dentistry going wrong or adrenal issues? How are you feeling generally now?

[Holycow2 in reply to SnazzyD]

I don’t know just dangerous to have teeth removed while on Pred . I’m feeling ok now

[SnazzyD in reply to Holycow2]

Dose wise you are not going to be highly immunosupressed, but the dentist can make that decision. The other issue that can bring horror stories is if people are taking drugs like Alendronic Acid for bone thinning. Again, the dentist will certainly know about that and make a judgement about risk. As for dental procedures, from reading about people’s experiences here there doesn’t seem to be any worse outcomes than usual from our small sample, me included. Also, you do need to balance it up with the risk from a pocket of infection in a tooth that is defective. Serious issues can arise from this eg heart inflammation.

[Holycow2 in reply to SnazzyD]

I am supposed to be taking alendronic acid but I must admit I’ve been very hit and miss with it

[PMRpro Ambassador in reply to Holycow2]

And to add to Snazzy's post, some people claim you might bleed more or not heal as well - I certainly didn't bleed despite being on anticoagulant therapy too and have always healed fine.

[123-go]

Your dentist should have your health details recorded but best to speak to him /her for reassurance before your appointment stating your concerns. Your dentist will have come across similar situations as yours so try not to worry.

This was posted in 'Related Posts':

healthunlocked.com/pmrgcauk...

[PMRpro Ambassador]

I have had a couple of teeth removed while on pred - one wisdom tooth that was growing squint, unopposed and cutting into my cheek, and one molar with a fractured root and unsalvageable. Absolutely no problem at all. The first was at a dose above 10mg, the second was at a dose well above 10mg AND Actemra as well. I had also had root treatment done while on pred. Also fine.

I live in northern Italy and was somewhat concerned about the first extraction - but extractions in hospital as seems common in the UK are very rare here. My dentist had no concerns whatsoever - and he was right. I'm also on anticoagulant therapy as another complication. All he needs to know is the full list of medications. He was all set to whip the tooth out immediately last time but when I mentioned Actemra I was sent home with a large dose of antibiotic and told to come back 2 hours after taking it.

Of much more concern to most dentists is a history of alendronic acid.

[MiniSpec in reply to PMRpro]

Oops! During the last five years I've had two molars removed. The first was an upper molar that was perfectly fine, but my upper jaw was disintegrating round it, so it had to come out to prevent on-going infections under the gum.

The second molar was the one opposite the first one. It slowly rose out of my lower jaw as there was nothing for it to bite against. So it became uncomfortable and painful after a while, and my dentist suggested removing it to alleviate the pain and discomfort.

I've been on Alendronic Acid for the last 12 years, and didn't know it had anything to do with my teeth, so although I may have told my dentist at some time in the past that I was on Pred and AA, I don't know if he was even aware of my history at the time of the extractions. As it is, I've suffered no problems with either extraction and both have healed over successfully.

However, now that I know there is some problem with AA and dentistry, if I have to have any other procedures in the future, I'll be sure to remind him of it.

[PMRpro Ambassador in reply to MiniSpec]

The disintegration with the first molar could have been associated with that.

It is also recommended that a drug holiday be taken with bisphosphonates - after 3 to 5 years the sort of bone formed my have microcracks which makes the bone weaker not stronger and atypical spontaneous fractures can occur.

[MiniSpec in reply to PMRpro]

Thanks for the information. Now I'm worried about possible bone fractures as well as osteoporosis!

The only time I stopped taking AA my fingernails became very thin and weak, so I started taking it regularly again, and continue to do so every Sunday morning. However, now that you've warned me about it, I may try reducing the dosage to once every two weeks, or even once every three weeks and see how I get on.

As well as the AA I also have chewable calcium tablets with D3 that I take two of every day, so I may rely on those more and less on the AA for the future.

Bearing in mind that I am now on 3mg of Pred per day and reducing to 2mg as we speak, I'm hoping that the AA won't be needed for much longer anyway. With luck and a following wind, I won't need any more dental procedures for a while, and by the time I do I hope to be Pred and AA free.

[Purpleazalia]

I had 2 tooth extraction procedures at the dentist earlier this year.

The first when on 5mg pred - not asked to increase dose and no problems PMR-wise during or after.

The second on 4mg - dentist asked me to take 5mg on the day of the procedure only. Again, no problems during or after.

Hope you feel reassured after reading your replies.

[Holycow2 in reply to Purpleazalia]

Thank you! I don’t really know much about PMR so this is really helpful.

[DorsetLady PMRGCAuk volunteer in reply to Holycow2]

Well you've come to the right place then... there's plenty of information in the FAQs section...that's why they are there....

[Koalajane]

I think the main thing is you tell him about your meds particularly the alendronic acid