SharonY

[WaltzG]

Wondering if anyone has had dental extraction while on Actemra. I was told by my dentist that it affects the jaw and I would need to see a specialist since an extraction would be problematic? I am in the UK and have weekly Actemra injections. Thx

[SheffieldJane]

If you Google your query, you will find a research article about rare instances of jaw necrosis with the use of Tocilizumab/ Actemra. Entitled “ Another Drug that leads to Necrosis of the jaw. I cannot attach without registering with the organisation.

Persistent dry socket and failure to heal sounds like a horrible side effect albeit a rare one.

[PMRpro Ambassador in reply to SheffieldJane]

What was your problem SJ? I got a free-to-air version with no problem.

[SheffieldJane in reply to PMRpro]

I didn’t try because it wanted a third party registration via Google or similar and I thought it would deny me access without. You just go the extra mile my friend.xx

[PMRpro Ambassador in reply to SheffieldJane]

Don't remember registering with them - if it was it was a long time ago.

[PMRpro Ambassador]

ncbi.nlm.nih.gov/pmc/articl...

is a link to the entire paper SJ refers to. I think it is important to note the patient had SEVERAL teeth removed at one time and, like the other cases, had been on other medications, in this case methotrexate, and reading the full text the patient's dental health was pretty poor. They emphasise the need for close examination of the patient's dental health and follow-up in patients who are on Actemra. I have noticed that UK dentists are extremely risk-averse and will look for any excuse to get out of treating patients on certain medications including pred.

Is there a dental hospital within reach of where you live? They are always worth a try.

[WaltzG]

Hi thanks to you both for answering....I looked at the article and I do have a dental hospital near ...I suppose I was wondering if anyone on here had actually had experience of problems....

[PMRpro Ambassador in reply to WaltzG]

Not that many here on Actemra as it isn't approved for PMR and no-one has ever mentioned it, no.

[WaltzG]

Thanks very much

[HelenDaisy]

I have been on Alendronic acid for 3.5 years and had extraction and an implant with a specialist dentist. My usual dentist refers all implant patients, not just me! He explained the risks and I was comfortable to go ahead. He noted that there were changes to the bone but I had no problems with healing.

[WaltzG in reply to HelenDaisy]

Aah how reassuring and so glad it went well for you .....thx

[Pixix]

I’m not on actemra, but was on alendronic acid when my dentist refused to take my tooth out in the local surgery because I may go into adrenal shock. The hospital dental surgeon then told me that she didn’t think it a good idea as I was at high risk of getting MRONJ…necrosis if the jaw, but that it was really my decision. I discussed it with my doctor & read a lot on Google, & decided to do nothing. I had had 7 or 8 infections by that time. But in the past year I’ve had no infections, just a bit of toothache & swelling that resolved over two days with salt water. I’m waiting another year, if all goes well, then I will have it removed if I have further problems! I also have hypermobility & don’t always heal well.

[WaltzG in reply to Pixix]

Thx for answer hope continues to go well.

[Bfp1]

hi - I am not on actemra but am on a lot of other meds. So I have had to have tooth extractions and the dentist wouldn’t do them. so I have had to have them done in a maxilla facial department of the hospital with an icu in case. I am high risk for necrosis too and am going for check ups following the extraction. This last one isn’t healing properly I think so a worry. The only upside is I have had all the work done on the national health and very good care. It is what it is I suppose. So much going wrong still! Hope you are ok- don’t fret - just go with the flow. Hopefully we will be fine xxx

[WaltzG in reply to Bfp1]

Yes hopefully 🙏 just one more thing added to the list!! Thx

[Devoid]

Hi. I have had an extraction while on Actemera, my dentist contacted my consultant rheumatologist to discuss prior to the appointment, I think the biggest concern was bleeding? It went very well, no problems at all. I was expecting to bruise badly because I was on pred but not a bit .

Hope this helps

[WaltzG in reply to Devoid]

Oh yes really helps !! Thx

[PMRpro Ambassador in reply to Devoid]

I'm still trying to work out why bleeding??? It is mentioned - but as a rare adverse effect. Maybe it isn't as rare as the manufacturers want to admit. Must be a liver effect.

[Devoid in reply to PMRpro]

she didn’t elaborate and I certainly didn’t have a problem with it, but she rang me 2 hours after and the following day!

[Grammy80]

I just saw this~~~ I have been on Actemra for three years and have not had an extraction, but had dental work. I've had two crowns made and the usual cleanings every six months.

I've not heard about an issue and from the sounds of Jane and Pro....rather rare unless their are extenuating circumstance. I think you should do whatever gives you peace of mind.

Just a little side story....I'll be honest....my GCA was raging but they didn't want to give me Actemra because I had diverticulitis, a history of bleeding ulcers and an stomach bleed from Ibuprofen. But, I'd already lost the sight in one eye. I have never read the side-effects of Actemra and I get pages of them with every shipment. I figured I knew I was going to take it....regardless.

By all means...be at peace with the treatment and it sounds like you have a facility nearby.💞