A tooth with a life of it's own!

[orangemax]

Hi, all. I wrote in several months ago about a painful tooth. My dentist couldn't find anything wrong with it. He finally referred me to an endodontist, and he did a root canal. Found several issues. Would have been nice if that had been the end of it, but no! The pain would not go away, and I knew something just wasn't right. My general dentist did a temporary crown, and when I came back for the permanent one weeks later, I told him the pain was still there. Soooo, enter Dentist #3!! The periodontist. I saw him the other day, and he says the tooth must come out, that there is still infection in both the bone and the tissue.

Here is the crux of the matter. Due to several health plans and doctor changes, I was on bisphosphonates for way to many years. I ended up taking myself off of alendronate after about 6 or 7 years of that. But I had been on other ones - Evista, Actonel, Fosamax before the alendronate. Further I am currently on a proton pump inhibitor and H2 blockers, which aren't great either for the bones. But this very young oral surgeon from UCLA, says since I've been off the bisphosphonates for 5 + years, the surgery, bone graft, and an implant should be no problem.

I'm currently tapering from 3.5 to 3.0 on my pred.

I'm very nervous about all this. I have visions of my jaw falling in my lap. 😶 Your thoughts, friends?

[SheffieldJane]

I doubt that anyone has the expertise of your young orthodontist to advise you in an informed way on here. We can just sympathise with the potential risk. Toothache is one of the most lowering pains. Can you seek one more opinion before you take the plunge?

[orangemax in reply to SheffieldJane]

Hi, Jane, Thank you for your reply. One thing I have learned by going to 3 different dentists, is that dentists apparently learn very little about bisphosphonates, prednisone's side effects, and nothing about PMR. So they don't seem to understand the risks involved. I'm thinking I'll try to get a phone appointment with my rheumy and maybe she can give me some insight as to how bad the risks are, and what the alternatives might be.

[SheffieldJane in reply to orangemax]

My young dentist was really up on biophosphonates and would probable refer me to the dental hospital for complex treatments. He gave me hope for the future of dentistry. By the look of him, he is not long qualified.

[orangemax in reply to SheffieldJane]

Well, both the endo and the general as much as said they don't know much about it, although bisphosphonates were on the endo's questionaire. The periodontist asked what seemed like the right questions, but didn't instill a lot of confidence in his responses. I'm praying I'm wrong. There is a more experienced dental surgeon in the office, and I'm hoping mine will consult with him. In the meantime, I'm hoping my rheumy can make me feel better about all this. Surely she's had other patients with similar situations??

[SheffieldJane in reply to orangemax]

I wonder if a pharmacist could shed some light on this, it is their specialism after all? Best wishes!

[orangemax in reply to SheffieldJane]

Sorry, S Jane, I missed this message. Thank you for your suggestions and your good wishes. I'm told it will be months before they would proceed with the implant. So that gives me time to do some research. I could still go with a bridge, but the surgeon really tried to discourage that, because then 3 teeth are ruined and vulnerable. This could get interesting.

[PMRpro Ambassador]

However - SJ's comment of the YOUNG orthodontist, reminds me that MAYBE he doesn't have the life exerperience.

Deep in the bone the bisphosphonate is still there - the question is does it have an effect when uncovered by the extraction or not? It all depends how risk averse you are ...

[orangemax in reply to PMRpro]

Hi, Pro, Thank you for your reply. You have hit the nail right on the head. I don't think he's had enough time and experience to realize that there IS a risk. So many different things are involved in my case. I'm sure he's a good oral surgeon "for his age, and ability". Just hasn't seen it all yet. I've never been known for staring risk in the eye, so I'm between a rock and a hard spot. I'm going to talk to my rheumy and see. But to top it off, when I asked for a prednisone protocol, she told me to take 5mg just before and after the procedure, which would include extraction and bone and tissue grafts. Doesn't sound like enough to me. I'm already on 3.5 to 3 mg. I might just bump that up on my own. I'm going to have nitrous oxide during the procedure, as I'm such a coward in the first place. I'll update you guys when I figure it out (if).

[PMRpro Ambassador in reply to orangemax]

I'd at least double it in line with Sick Day Rules. A bit more is preferable to a bit less ...

[orangemax in reply to PMRpro]

After all the hours I've spent reading the conversations in this forum, if I learned nothing else, I learned about Sick Day Rules. They have served me well. I will at LEAST double it!! Thank you so much for what you and some of the others do here on this site. You're all amazing!!

[PMRpro Ambassador in reply to orangemax]

Thank you.