Tooth Infection Advice

[Paulx222]

Hi all,

And happy New Year to everyone.

Cut a long story short, I've been on pred for PMR since Nov 2023 starting on 35mg and am now tapered down to 4mg.

I have unfortunately now developed a tooth infection that requires either root canal or extraction.

My dentist prescribed Metronidazole 3 times a day. My tooth is still painful to bite on but the pain has subsided a bit. I do, however, I alo feel absolutely grizzly, diabolical in fact. I have been sleeping constantly and feel I have a temperature and am completely run down, drained and exhausted.

Just wondering if this is linked to my PMR or Pred use and if anyone has any advice or thoughts as to what I should do.

At this point I'm thinking of just having the tooth pulled and hopefully bringing all this to a close in terms of the tooth pain bug wondering if that has downsides too.

Anyway, that's me! Off back to bed now!

Paul

[PMRpro Ambassador]

Ouch - sounds like a really severe tooth infection and that alone could cause all that.

HOWEVER - given your dose of pred currently you cannot rule out the possibility of adrenal insufficiency, verging towards and adrenal crisis, and I would suggest you take 10mg of pred asap and call 111 to ask for further advice, saying you are concerned you may be developing an adrenal crisis because you feel so ill.

Are you alone at home? If someone is there, tell them what I have said so someone else knows about the possibility. If 111 is too slow in reacting, call 999 directly and tell them what I'm concerned about. If you are alone - call someone immediately to be sure that someone is aware.

[Paulx222 in reply to PMRpro]

Thank you.

[DorsetLady PMRGCAuk volunteer]

Sounds as if adrenals are really struggling…. Add in tooth issues and no wonder you feel really grotty… PMRpro has given good advice, so please follow that.

[Paulx222]

Just taken an extra 6mg to take me up to 10 for today.

Called 111.....extremely unhelpful but I've pushed for a call back.

Will stay on 10mg until I feel better. Would it be OK to drop back to 4mg then? I've been doing ok on it up until this infection.

Thank you to both of you as always x

[DorsetLady PMRGCAuk volunteer in reply to Paulx222]

Might be okay-but I’d try 5mg initially. Really is no rush and you still might feel a bit yuck so best to err on the side of caution.

[PMRpro Ambassador in reply to Paulx222]

Not impressed by 111 then though they probably thought it was a "worried well" and you couldn't wave the red emergency steroid card at them over the phone. But I feel better about you having done that!

As DL says, probably OK but no harm going via 5mg until you are really better.

[Pixix in reply to PMRpro]

I’ve read that the 111 service is so overwhelmed right now as people are calling it because they can’t get a doctors appointment, or they have read that A&E is overwhelmed. They are employing retired doctors for call backs as they just can’t call back the number that request it/need it, & employing a lot of extra staff to do the first stage. Some people are ringing 5 times or more & the phone call times out (don’t know how long that is) before it’s answered. They are asking people to limit the use of the service if at all possible (but if you can’t go to A&E, & you have not managed to get an urgent dr appointment, or it’s the weekend????!)

[PMRpro Ambassador in reply to Pixix]

Oh I know - but they do admit you should call for "life-threatening" and an adrenal crisis is that if nought else!!!

[Pixix in reply to PMRpro]

I quite agree! But having come a bit closer to adrenal crisis, & just seeing our doctor in time…if I was like that again, I’d be at A&E, I think, 111 could be too slow. When David was sick last year a Dr from 111 phoned within ten minutes…but I think it’s now more like 2 hours. Just not a time to get sick or injured! S xx

[PMRpro Ambassador in reply to Pixix]

The algorithm obviously needs a tweak - but I suspect simply saying long term pred and adrenal crisis straight away might move things. But if you know that, then you should call 999 anyway.

[Pixix in reply to PMRpro]

I think so. Normally, I’d say 111 is excellent, now I’ve used it three times, & each time they called the ambulance for me. But one time they were angry as they weren’t told it was bad chest pains, & they came from Dorset & their satnav took them all through the lanes of the New Forest!! S x

[PMRpro Ambassador in reply to Pixix]

Oh dear - but no doubt their sat nav was set to shortest not quickest? If the paramedics were t'd off, it wasn't at you.

[Pixix in reply to PMRpro]

Oh, no, they were very apologetic,but admitted anger when they saw how much pain David was in. All the crews we had were lovely, & out of six ambulance crew, only 1 man, an Army vet. S x

[PMRpro Ambassador in reply to Pixix]

Not sure on the relative nos these days - was still very male dominated when my daughter started which was still something of a problem for young women going in. Especially the graduates.

[Pixix in reply to PMRpro]

Interesting! Hoping not to find out (you understand it’s not lack of interest, just lack of wanting to need ambulances!)

[CygnusX1 in reply to PMRpro]

The endocrinology nurse added the potential for adrenal insuffiency to my nhs records so that it will come highlighted at the top as a caution if ever I call 999/111 or check in at hospital.

[PMRpro Ambassador in reply to CygnusX1]

Excellent - pays to get an endo involved then.

[Paulx222]

Got it.

Thank you I'll do that 😊

[Paulx222]

Much more energy today.

Tooth pain not great but definitely not as lethargic as yesterday. Will stick with 10mg this week and have told everyone to keep an eye on me.

111 got me a GPs appt at 1130pm last night.....I went.....totally pointless.

I am very grateful to this group for all the help, support and advice.

It's literally a lifesaver at times

[PMRpro Ambassador in reply to Paulx222]

That was what we hoped for. Was that an OOH GP? Usually they are very on the ball. But maybe you were a lot better by the time you encountered them?

[DorsetLady PMRGCAuk volunteer in reply to Paulx222]

Good to hear you are feeling a bit better in yourself…