tooth extraction

[AlfredRose]

I’m having a tooth out next Wednesday. I’m taking 3mg of prednisolone. I’ve been off AA for nearly a year. What is the advice for this procedure please?

[123-go]

Hi. I’ve no personal experience of your situation but I know there will be other members along soon to advise. I will say that if you haven’t had a conversation with your dentist regarding your current and past medications you should do so now. Best wishes.

[SnazzyD]

if it were me and I felt fine on 3mg regards adrenal function (no weak wobblies or fatigue) I would not increase my dose unless I felt all over the place afterwards and then I’d take a one off 1-2mg and rest all day. If it is going to be a complicated and protracted procedure, 1-2mg extra will do no harm as this is such a low dose. Let the dentist know. Regards the AA, your dentist needs to know in advance so they can make a clinical judgement.

[Kendrew]

Hi Alfred Rose,

I've just had a molar extraction and I am currently on 2½mgs of prednisolone. I didn't take any extra pred and I experienced no adverse effects from continuing with my same dose.

I ensured the dentist was up to speed on everything PMR and steroid related and 5wks on everything has healed up well.

Obviously we're all individuals and must make our own decisions based on our own personal circumstances. Hope this has helped though.

[PMRpro Ambassador]

Make sure your dentist is aware NOW that you were on AA because they need to make decisions, not least whether they are willing to continue doing it in the practice. Some may not. Over and above that, they need to monitor the socket after the extraction to be sure it is healing properly,

Otherwise - an extraction is no big deal because of pred although they do need to know what medications you are on.

[SheffieldJane]

This is one for your dentist. Mine was helpful over the Prednisalone. No extra ( infection) and anesthetic without Adrenaline. A A is tricky and you need qualified dental advice.

[Yorksman]

Whilst I'm aware that you no longer take AA I suggest as others have that you inform your dentist that you used to take it.

Last year I needed a back tooth extracting so my dentist called in a specialist dentist who was qualified to treat patients with reduced immune systems. He explained that whilst Alendronic Acid increases blood supply to your bones to prevent Osteoporosis (reduced bone density), Prednisolone on the other hand reduces blood clotting and healing of wounds. An unfortunate contradiction! This means that when a tooth is extracted there is a risk of bleeding that could be difficult to stop. There is also the risk of infection of the empty socket.

He advised me not to take AA in the week before the extraction but to continue to take Pred as usual. The tooth came out with no problems and almost no bleeding. I was then prescribed a weeks supply of an antibiotic to prevent infection and a mouth wash to be used four times a day. Also to avoid solid food for two days. All very satisfactory and no ongoing problems.

Wish you well with your extraction.

[PMRpro Ambassador in reply to Yorksman]

I have to say, I would be less than keen to have that dentist involved in MY dental work. He apparently doesn't understand how AA works - it doesn't increase blood supply, it increases the calcium being retained in bone tissue. The risk of bleeding is not particularly high and easy to deal with and that isn't the problem in a patient on bisphosphonates. Stopping the dose the week before will achieve nothing useful.

[Yorksman]

Thank you for your reply.

The reference in my post to an increase in blood flow was my understanding of how Alendronic Acid works and not that of my dentist. I was under the impression that calcium is transferred to bones by the blood.

When you say that bleeding is not particularly high and easy to deal with and isn't the problem, can you explain what the problem is with AA and extractions please?

It seems to me that your reply is a personal view of my treatment and implies criticism of my dentist who is qualified and experienced in dealing with extractions on patients taking AA.

As you will be aware Health Unlocked advises that the information you supply 'does not replace the relationship between you and doctors or other health care professionals nor the advice you receive from them'. Consequently I wouId politely like to say that I think your comments are a little out of order and you are not in a position to make personal views about my dentist and his treatment of me which I thought was excellent.

[PMRpro Ambassador in reply to Yorksman]

I beg your pardon - it appeared that the dentist had given increased blood flow as the mechanism - it is the drug's effect on the osteoclasts that makes calcium retention increase, I automatically mistrust professionals who don't have the correct view of such things. If the dentist didn't say it - then I don't hold anything against him.

The effect of AA on the bones is explained here - it is the increase in risk of osteonecrosis that is the problem and potentially could lead to the empty socket where the tooth has been removed not closing up after the extraction. It is a similar situation to a leg bone not healing after a fracture - but using your jaw becomes impossible.

ncbi.nlm.nih.gov/books/NBK5....

[Yorksman]

Thank you for your reply and the information. Good to know all the details.