Dental work SURPRISE - mtx -rituximab - Prolia - prednisone

[irishponies]

I recently asked for and received great support from the group concerning getting medical clearance for dental work, a crown/cleaning due to mtx, rituximab, prednisone. Rheumy said to get clearance from GP. Two DIFFERENT doctors from the clinic responded. One prescribed amoxicillin prior to dental work. One said not necessary. Dentist said get med clearance in writing. Went to GP clinic with dentist's medical clearance form. This GP said NO dental work other than cleaning and to take amoxicillin prior. (I fully understand the need for antibiotics.) SURPRISE: No cavity filling could be done due to Prolia shot given by rheumy Oct 2021 - the same day prescribed prednisone 20 mg. A DEXA Scan done later the same week scored no osteoporosis. No Prolia or osteoporosis medication prescribed since the Oct 2021 shot/DEXA scan. Have others experienced this Prolia/jaw issue? How long before dental work can be done? It has been since Oct 2021, are the Prolia effects gone? (Prednisone 5 mg since March 2022. Today is dose #30 mtx 20 mg, had two rituximab infusions in June. Trying to achieve remission.) Thanks for your help!

[PMRpro]

It is usually INVASIVE dental work that is regarded as a problem for patients on bisphosphonates or denosumab. It has nothing to do with osteoporosis per se but with healing of sockets and development of osteonecrosis of the jaw.

ncbi.nlm.nih.gov/pmc/articl....

provides advice on timing of dental work.

[irishponies in reply to PMRpro]

Thank you for your response and sharing your expertise. I had no idea that one Prolia shot 8+ months ago would be an issue at all, the dentist never said it was. Her concern was the rituximab which she stated she is very familiar with (because her brother is having infusions due to lymphoma.)

The dentist requested prophylactic antibiotics and medical clearance from a GP. One doctor in the clinic prescribed antibiotics via phone consult. A second doctor (I did not ask for a second opinion) contacted me and requested an in-person visit. Then he refused to give me written medical clearance (the dentist's form to be faxed to her) based solely on the Prolia history. I told him the Prolia was Oct 2021 and the DEXA exam was in my chart. I told him there was no Prolia scheduled and I am not on any osteoporosis meds. I literally begged him to let me have my tooth repaired. He read the written treatment plan from the dentist. He flatly refused to give medical clearance for a crown. He patted me on the arm and said, "I am here to help you." I was told to return in 3 months and he left the office.

When I returned home from the GP visit last week, I did read that report that you forwarded (thank you - I read it again). I read other reports and comments from people on this site. Many of them have had very successful dental work even while on Prolia for long term.

I do not understand why he is refusing to give me medical clearance due to one shot of Prolia. The shot was Oct 11, 2021. Today is almost 9 months post-injection and well out of the time frame in report of dental work being done 4 weeks after and 6 weeks prior to any future Prolia injection (there is none scheduled).

Meanwhile, my poor tooth...

[PMRpro in reply to irishponies]

At a guess, CMA dentistry! Doing all they can to avoid being sued ...

[irishponies in reply to PMRpro]

That is exactly what it appears to be! I am going to have to see another dentist and leave the Prolia off the med list. They have left me no choice but lying to get dental care. And paying for another dentist. I called the original dentist. Her office told me no medical clearance, no appointment. I already had and paid for the x-rays, etc. What a hit to the pocketbook, ouch. I did get the antibiotics though! Thank you for your support. The perfect emoji for my situation: 😁

[PMRpro in reply to irishponies]

If you paid for them - surely the x-rays are yours? Get copies ...

It will be all about timing - so do your homework. Ask the specialist in charge of the rituximab.

[irishponies in reply to PMRpro]

I will try to get the x-rays from the dentist. When the dentist requested medical clearance for the rituximab (and that med only), I contacted the specialist/rheumy that prescribes the mtx, prednisone, rituximab, and the Prolia. The specialist that prescribes all of those medications said he did not deal with medical clearances and to get the medical clearance from the GP. The GP said NO medical clearance due to the Rheumy Giving the Prolia Shot Heard Round the World October 2021.

The dentist is and was aware of the Prolia Oct 2021 shot. The dentist did not believe the Prolia to be an issue with just a cleaning and a crown.It is the 7th Circle of Hell of Dental Care and that does not even include the pain of the dental care and the kick to the wallet.

The hours spent trying to get dental care is incredible, office visits, phone calls, etc. Wow.

[Johndeeregreen]

Do you think your tooth issues might be contributed to vasculitis drugs?

[irishponies in reply to Johndeeregreen]

at this point, any drug can cause ANY side effect! - so - Maybe!