Hello all. I have to have a back molar extracted tomorrow and apparently there is a non-emerged wisdom tooth underneath. I don't know if the dentist plans to remove the wisdom tooth or not. I think the molar will come out fairy easily (touch wood). Do you think I need to increase pred today? I am just back down to 4mg after a few up and down weeks following a trip over and resulting broken hip, Covid etc. Stabilised for the last couple of weeks but my last cortisol test showed insufficiency. My rheumatologist doesn't think my adrenal glands are working, or ever will. Do I need to up my pred to compensate do you think?
Marion
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marionofnorwich
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I had insufficiency at 4mg but very slow reduction over another 2 years helped them recover. I don’t know in your case but I’m just saying that it isn’t necessarily hopeless if there’s some activity there.
I’d be surprised if the dentist went ahead and extracted a buried wisdom tooth unless they were absolutely sure of the situation. A few people I know who have had this procedure went to the hospital for it for a general anaesthetic. Also, if he is super confident you don’t have to have it done that day either.
As for Pred, I never upped my dose just in case for anything but saw how I went unless I was really anxious before and feeling weak. Everyone is different and some might say, double it on the day or add a couple of mg. See what they say.
Thanks SnazzyD . No I haven't abandoned my adrenals either as I don't feel bad enough on 4mg. I think they will come back bit by bit which is what I told Max
At 4mg it is likely that any testing will show insufficiency. Loads of room for improvement as you get lower.
I think my superb dentist would remove the molar and wait and see what the unerrupted wisdom tooth does. Like Snazzy, not sure I would want anyone messing about with that sort of thing outside a hospital dental unit. I have had a molar with a broken root taken out and a wisdom tooth while on pred - though at noticeably higher doses. No problems.
Great thank you. I think he will take out the molar and probably see. he is a periodontal and implant specialist rather than my regular dentist though I have seen him a number of times before. I think he should be a good jsudge and he knows I have PMR and steroids. I might just up the pred to 5mg tomorrow
Unlikely to hurt - the pred, not the extraction!!!! Though I was surprised how little discomfort I had when he excavated the broken root which of course didn't come out with the main tooth.
If he is an implant specialist, you are probably in the safest hands for an extraction of the molar. They are usually pretty keen not to disturb the socket to give the implant the best chance of success and from my own experience of 6 implants, have the skills to be very careful. I've never had any problems with mine and no pain after extraction.
Having had two badly impacted wisdom teeth taken out in the dentist chair, I would personally want to have that done under general anaesthesia. Thankfully, I wont need to endure that another time.
I’m on 3mg and had a dental implant earlier this year, which included an extraction. All went well. The dental surgeon suggested upping my prednisolone to 5mg just for one day which I did. I have also had full knee replacement surgery this year with no increase in pred, and that was significantly more complex, and that is repairing nicely. Good luck tomorrow.
I saw somewhere about upping the dosage before dental treatment. Sorry, Marion, I can’t remember where. I would bounce up to 10mg just for the one day. I am currently on 5 ½ but have twice bounced up when I have been working and it didn’t seem to do me any harm. Oh, and I also had two cataract ops while on 15 - 20mg, at The Spire in Norwich. NB, check with the dentist beforehand. Another thought, I am due to have root canal work in Norwich and have been putting it off because I'm a wimp, but the dentist isn’t worried about the steroids at all.
Thanks ChrisBeeLoop glad to meet another Norwich person . I am upping a bit. Took 4mg at 3am and will take another 2mg in a little while, mainly because I am not 100% certain that I took yesterday's dose! I know I sat down with a cup of tea to do it but felt quite weird later on and then started to doubt whether I had actually taken them so I think a bit of compensation is probably a wide idea
Not your decision - you need to discuss your long term use of pred with the anaesthetist caring for you during the operation and they will provide intraoperative cover for your adrenal function. In terms of the possibility of a postoperative flare, you should discuss with your rheumatologist or GP what they would want you to do.
Really interesting thread this....thank you for sharing.....
I've currently got down to 6mg and am due a full top set of implants in November when I will hopefully be down to 4mg......
I am also seeing a dentist on Friday to look at replacing a crown and possibly doing a root canal......
What is the issue with being on a lower dose of pred and dental work?
Sorry for the stupid question.....
Plus .....as part of the dental implant work in November I will be having 9 teeth extracted while on 4mg of pred and then 4 implants put in......would I be better delaying all that?
The stress of dental work may be too much if you have adrenal insufficiency at a low dose of pred. That may simply need a bit extra on top of your normal dose.
As for the major excavations for the implants - that is something to discuss with the dentist and how he feels it should be dealt with.
Yes, I did take a couple of extra mg that day but it was all fine. Dentist was very considerate and applied anaesthesia in two doses and it was no issue in the end
I asked the question because any kind of operation including dental work, the body can perceive as an attack and a shock to the system. When the body isn't producing its own cortisol and you are giving it less than approx 7.5mg dose of artificial cortisol then it can, in theory, react but that is really what I was asking about - and the answer in my case was, not really. You should be OK - just ask your dentist beforehand and make sure that they do know what dose you are on
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