Tooth extraction and AA

[Suffererc]

I have been to the dentist and he has advised to have a wisdom tooth extracted. He knows I am taking AA but assured me he has extracted teeth from patients talking AA hundreds of times with no dire consequences. I am always dubious of claims like that but would like your thoughts on it please 😊

[PMRpro Ambassador]

Hmmm - I agree, hundreds of extractions in patients on AA does seem a tad incredible!!!

Which wisdom tooth is it? Are you on AA tablets - and how long have you been on it?

[Suffererc in reply to PMRpro]

The tooth is top right. Been on AA on and off but since last flare since September. Dr put me on 15 mg but I dropped to 10 within days. Now on 6 mg. The dentist says there is no problem with folks on AA 😊

[PMRpro Ambassador in reply to Suffererc]

I think it is stretching it to say NO problem - but it isn't anything like as major as some dentists seem to think. Maybe he is just better educated. It's the claim of "hundreds on AA" that makes me say what??

I had an upper wisdom tooth out a few years ago as it had always grown squint and was catching my cheek badly. I was terrified, being on pred and the fuss made in the UK by some dentists and expected to need it done in hospital, but they were very laid back about it here and my dentist was right - probably one of the easiest extractions I had had although to be fair, the previous ones had been for orthodontics. I wasn't on AA though. I have since had a bisphosphonate infusion which has a slightly higher level of risk but I saw the dentist first, he did an x-ray to be sure there was nothing lurking and insists on hygienist sessions as really good oral hygiene is essential. and isn't worried about future dental work. The main risk for jaw necrosis is in oncology patients who get bisphosphonate infusions every month - not once a year.

[tempusfugi]

Hi Suffererc, my dentist wanted to extract a couple of my teeth recently but, because I'd finally started taking AA, I said I would come off it for approx 3 months and then go back to have them out. There seems to be a variety of views on the subject. I keep meaning to contact theros.org.uk (Royal Osteoporosis Society) about it, to get their views. It's on the dreaded 'to do' list!

You could try that...tempus f

[PMRpro Ambassador in reply to tempusfugi]

Stopping it short term is unlikely to make any difference.

[Katiecatweazel]

while this topic is being aired, could I ask for a comment on Risedronate Sodium 35mg weekly tablets, which I have just started. I believe they have a similar function to AA and my dentist was similarly unworried about this. Grateful thanks.

[PMRpro Ambassador in reply to Katiecatweazel]

Not sure what comment you want? What you should have done before starting it is have a dental checkup, preferably with an x-ray, to be sure there is nothing lurking and any potential invasive work done before starting the bisphosphonate. And impeccable oral hygiene is required while on the bisphosphonate. Oral bisphosphonates are very low risk - the main risk for jaw necrosis is in oncology patients who get bisphosphonate infusions every month - not once a year.

[Katiecatweazel in reply to PMRpro]

Dear PMR Pro, Looking at my enquiry I see it was misleading. The Rheumatologist was keen I should start on a biphosphenate and my dental procedure was scheduled a couple of days before I started on it. The dentist was able to do an X-ray and advise on dental hygiene. The state of my teeth currently shows no need for concern but if anything arises I would be referred to the RUH in Bath for treatment.

I’m grateful you took time to reply that oral biphosphenates are low risk, thanks for this reassurance.

[Suffererc in reply to Katiecatweazel]

😊

[SheffieldJane]

I would not be reassured. Do you have a dental hospital in your location for another opinion?

[Noraflorence]

My dentist was very clear that he would not extract a tooth while I was on AA , he was very alarmist saying that it could bring Life Changing consequences for me. He was especially concerned that being on AA and steriods was particularly risky for an extraction.Perhaps too much the other way from your dentist. Sorry not much help or reassurance for you.

[PMRpro Ambassador in reply to Noraflorence]

The main risk for jaw necrosis is in oncology patients who get bisphosphonate infusions every month - not once a year. I think your dentist is being OTT and it is this scare story attitude that has brought such a bad reputation for bone protection medications. The risk with oral bisphosphonates is very low. Good technique and post-extraction monitoring is required - maybe he isn't that good?

[Noraflorence in reply to PMRpro]

Thank you for some reassurance. It has caused me lots of anxiety over the years and a row between Rheumy and dentist. Not helped by having rubbish teeth all my life. I wonder if the dentist is concerned about litigation. He probably prefers less risky and more lucrative procedures majoring on inplants, tooth whitening etc.

[PMRpro Ambassador in reply to Noraflorence]

I do get the impression that UK dentists are getting more and more averse to anything difficult or requiring more care! I had a local dentist in Durham until he decided he wasn't taking NHS patients any more and sent us a "Plan" to join. My husband was quite ready to pay up - I wasn't, and went on the search to find someone still taking NHS patients - this was 20 years ago so there were plenty if you looked. In the end I found a practice in an impoverished former mining village in the country who ONLY took NHS! One of the dentists was a lecturer at the Dental Hospital who was there part time to keep his hand in with patients. The practice owner was also superb, More interested in a good job than making money - even when I said I only expected a checkup on the NHS, if a job could be done better private, I didn't mind paying. And after being there a couple of times, I realised just how bad the previous guy had been!

[Noraflorence in reply to PMRpro]

I would agree with you now impossible to find an NHS dentist even for children. Happy days 20 years ago, we did not always appreciate what we had. Perhaps I need to move on but I too am risk averse!!!.

[PMRpro Ambassador in reply to Noraflorence]

I now live in northern Italy where there is no such thing as an "NHS dentist" though apparently there are some who are a lot cheaper than my current guy - which wouldn't be difficult although I was assured the other day he is by no means the most expensive locally!!!! But he IS absolutely superb and I trust him. He is also immediately opposite the hospital so if anything DID go wrong, they are handy!!!

[Orange_2022]

Speak to the Royal Osteoporosis Society as suggested. I'm on AA too and my dentist said he'd undertake most treatments but hospital surgery might be an issue. Necrosis of the jaw is rare but of course you need to be sure.

[Suffererc in reply to Orange_2022]

😊

[Kafkaontheshore]

I’ve had three teeth extracted over the last 2-3 years, two in hospital and one at my dentist. I carried on with AA and Pred with no consequences. All dentists assured me it was OK. Perhaps I was just lucky.

[Sophiestree]

I have had extractions with bone meds and it was fine but I was given antibiotics as a prophylactic and was vigorous with salt mouth washes.