I have just developed an abscess on the gum of a tooth that had a root canal and crown done 2 years ago. I saw a different person in my dentist’s practice today who confirmed the abscess and said I should go back asap to the endodontist who did the original root canal for either a second root canal or an extraction.
My concern is the effect the prednisone may be having on my ability to fight this infection. The endodontist couldn’t see me until Monday and I’m worried the infection may take off over the weekend. After 17 months of PMR, I am now down to 5mg of prednisone and wonder if I should be on an antibiotic while my gum issue is assessed and treated by the endodontist.
Has anyone in the community experienced a dental infection while on prednisone and if so, how was it handled? Did you need to up the dose while the infection was being treated? This is new territory for me and any relevant input would be appreciated.
Thanks!
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Donna5658
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I think when you see a reputable orthodontist they will carefully consider balancing all of these options. In my case the dentist proceeded to do a root canal. He didn’t advise an increase in my Pred dose but I was given 5 days of Penicillin as a precaution against infection. It was all fine and I had been using Pred for much longer that you have.
Yes I did under my upper gum, caused by powdery dry mouth tablets and loose gums. If I remember correctly I was on about 7 mgs where I was stuck for a year or more.
Thanks for the helpful reply! My rheumatologist confirmed that I don’t need to increase the prednisone but that taking an antibiotic would be a good idea.
This happened to me years ago long before Pred. I had had a root canal and then during pregnancy (lowered immune system?) it became an abscess. An x-ray showed it had tracked to the bone which had initially all been painless. The original (private dentist) suddenly became unavailable and the investigating dentist decided to remove it with my whole- hearted permission, under the cover of a couple of weeks of antibiotics. They said this can be a problem with root canals. I wanted it gone because of having nursed patients with systemic problems due to chronic dental infection. It was the best thing it did, aalbeit losing a tooth. A close friend had the same issue and decided on extraction after a couple of antibiotic courses first didn’t resolve it fully. My husband has always been fine.
That was the solution for me but hopefully the dentist will assess it properly for your situation and that is only tomorrow now. The good news is that 5mg is a low dose and it’s not as if you are on 15mg. If it were me I wouldn’t be upping Pred unless I was having a flare or intolerable adrenal insufficiency, because of the immunosuppressant effect. Hang in there for tomorrow but if you become unwell in your body elsewhere, seek medical help for possible antibiotics.
Did you have an implant after your extraction? I am leaning against, but the dentist said I might lose the tooth above the extracted tooth due to nothing there to chew against.
Nothing. I didn’t want anything going back in there. I have had no problems with the tooth below, but I know you said above. My lower tooth isn’t looser with its missing counterpart. Is that true even? I have a couple of friends who had a lower tooth removed and they haven’t appeared to have had issues. I have an odd bite such that only 2 molars on each side can meet their counterparts. I’m not getting loose teeth because they don’t get pressed in all the time by food. I do have to say that it is annoying having one side that takes ages to chew anything. I try to even up the work my jaw needs to do by using both sides. Might be worth questioning further elsewhere unless you want an implant that is.
update - I stand partially corrected. It depends. This explains it, though it is from a private dentist website.
I am a bit surprised they didn't consider abx in the meantime but 5mg is a very low dose really and probably not making much difference - except maybe making it less inflamed around it. As Snazzy says, it is only tomorrow now but if you feel unwell or it gets worse, I would go to the ER (I'm assuming you are in the USA? Please could you add that to your bio on the profile page, it makes such a difference to what we can suggest)
Thanks PMRpro. I am in the US and that info has been on my profile page since I first joined. I just checked again and it’s still there. I appreciate your ability to tailor advice depending on country.
I think my experience is somewhat similar to those already discussed.
I experienced two infections followed by extractions whilst on pred. On both occasions I was prescribed antibiotics as soon as the infection appeared. After the extractions, I was prescribed a further week on antibiotics.
No adjustment was made to my pred dose - in fact I don’t remember it even being mentioned. All went well on both occasions.
Good morning, I had your experience last year. I kept getting tooth infections over a four year period. A private dentist diagnosed it as coming from as it turned out the wrong tooth. I was booked in for two long treatments of an hour and a half each both with a huge bill at the end. Covid struck and luckily the tooth behaved itself. The infections kept ocuring until last year I developed a round lump on my gum which I bathed with salty water. My NHS dentist x-rayed it and said it was the tooth next to the one the private chap had diagnosed and the infection was tracking along the gum to get out. She advised me to have an extraction which went perfectly and healed well. I did up my pred dose before and after the procedure. Both suspect teeth had crowns. The private dentist did try to drill into the wrong crowned tooth and that was the one that was going to have the expensive under magnification procedure. Having the extraction has made a lot of difference thankfully.
Thanks for your reply! What dose of prednisone were you on when you upped it for the extraction and how much did you up it by? Also wondering if you were put on an antibiotic for the extraction?
I didnt have antibiotics for the extraction as the infection had calmed down. I always had them when it was getting going. I think I upped the pred by 5. for a few days.
I had an abscess when I was on 40mg pred. I was given antibiotics and the dentist did a root canal treatment. XRAYS showed the abscess had eaten into the bone above the tooth but had been draining on its own so no pain. I now get yearly XRAYS and the bone is healing very slowly. It's now 2 years 5 months since the first treatment.
I have my 7th infection in sane tooth, & now admit it has to come out! Various health reasons have meant it wasn’t a good solution in past four years. I’m phoning dentist tomorrow, but expecting yet more antibiotics first, then extraction. I’m on 2mg. I may go to 5mg for 2 days before & a after extraction, but only because I have a problem getting my adrenals to wake up & behave!
Thanks for your reply! Were you given antibiotics for each of your 7 infections? What antibiotic did they put you on? I’m allergic to quite a few so that limits their options.
Hope all goes well for you! I think an extraction is probably in my future too. I’d rather wait for warmer weather as Covid seems to be raging here in the US, but I suspect they will want to do it sooner rather than later.
Yes, each time! I’m allergic to penicillin so sometimes have to have a couple if one doesn’t work…same as you by sounds of it! Covid growing/increased a lot here in UK right now, judging by number of people we know who have it, or have had it recently! Weare shielding, not due to PMR, I’m only on 2mg, but I have lung issues & we shield each winter. Metronidazole, Clarithromycin, doxycycline are all OK for me to take, depends on where the infection is!! I am on antibiotics as a preventative throughout each winter, it’s called azithromycin. It not going to prevent a tooth infection, though!! Good luck with your extraction! I didn’t increase pred for any infection. I haven’t done so now, either. It’s such localised pain & infection. I’m only on 2mg.
Just wanted to thank everyone who replied to my query. I had one further question. Did any of you have implants after your extractions? I am leaning against due to cost and issues with my MS. Thanks!
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