Dentist and vasculitis

[Wegeners88]

Hi

looking for advice. I am currently waiting on confirmed diagnosis of anca vasculitis but based on my symptoms and anti-mpo test it looks like I have it.

I am on prednisolone but also rivaroxiban as I had a pulmonary embolism recently. I have had a bad reaction to iron infusion that caused calcium and phosphate to leach out of my bones and caused secondary hyperparathyroidism. This can cause your bones to soften and crack.

I have suddenly got a filling fall out and I beleive its due to the tooth below it becoming weak from the low calcium and hyperparathyroidism.

My question is for anybody with vasculitis who has needed dental treatment whilst on steroids- how did it go? Were you warned to wait and not have dental work until active vasculitis flareup is over? I am in an active phase with high neutrophils and rashes and ent problems at the moment.

Did anyone have complications caused by dental work?

I did see a lady on youtube whose son needed a lung transplant for GPA and he flared up after having dental treatment and he was on a ventilator and she though the dental treatment caused the GPA flare.

Any advice would be appreciated. I do not know if I can keep the tooth as it is (small bits of enamel with old filling in it) or if it could become infected.

[GPAC]

These are all great questions to which I don't think there are many good answers! Prednisone is well known to cause a long list of side effects and thinning bones and/or osteoporosis is definitely on the list. In Canada, there was a survey last fall of about 100 GPA and MPA patients to report any of their dental problems and the results should be available this spring. However, I think it highly likely that treatment with prednisone and other GPA/MPA treatments are causing various dental problems. Until there is good reported data I think the best thing to do is follow the advice of your dentist. In any event, I don't think it is wise to delay dental fillings as decay may be more rapid in teeth which are already under stress from the effects of steroids. Good luck and I hope this helps.

[DogHospiceMom in reply to GPAC]

I know I have been told by my doctor to call him anytime I am going to a dentist so he can prescribe an antibiotic to take before I go to the dentist.

[Investigator1]

Hi Wegeners88, I understand your concerns and sympathise however I am from Yorkshire and will just say “get it done” the possibilities from infection are much worse, your immune system is low so any infection could be difficult to fend off. Nick.

[Obscureclouds]

At the start of last year I was on 40mg of Predisnolone and had been advised against having dental treatment. However a tooth broke so I sought advice from the dentist who confirmed I needed to avoid invasive treatment. However she was able to remove the remains of an old filling, scrape around the area and cover it with a temporary filling. I was told if the tooth started becoming to painful and an X-ray revealed decay (increasing) then I might need to risk a full filling. Fortunately the temporary filling stayed in place and I was down to 10mg of steroid before I had it filled properly a stage at which both GP and dentist felt comfortable with. Their main concern seemed to be infection and/or excessive bleeding. I can’t remember if I opted to have the filling without a jab to lower the risk but know there were no ill effects . Good luck

[Wegeners88 in reply to Obscureclouds]

I think a temporary filling would be best for me if it is a possibility. Unfortunately there is not much of the original tooth left as it was overfilled in the past by a dentist trying to save it.

I think my plan is wait until I see a dr this wednesday coming who is in charge of my steroids and I am possibly getting input from haematology as I also have ITP so i can ask them for advice re dental treatment then get 111 on the job for emergency dental appt as my NHS dentist has fully closed down!!

[Obscureclouds in reply to Wegeners88]

I was surprised the temporary filling did the trick as I had lost a big chunk of tooth and apparently had the remains of three different fillings. She did say it might not last long but luckily it was ok for 3-4months by which time everything else had settled down health wise. My NHS dentist abandoned me during Covid so have to pay but worth having a dentist you can build a good relationship with who understands your health issues as good oral health is so important to maintain especially with vasculitis and taking drugs as prednisolone

[zoe69 Moderator Volunteer Vasculitis UK]

In my personal opinion you should visit your dentist and get on top of your oral health. I had major dental work while I was on steroids, I was advised to take an extra steroid dose on the day and I was put on antibiotics to decrease the risk of infection.

Make sure to update your dentist on your potential diagnosis and new meds

[oldtimer2]

My dentist is happy to work on my teeth, providing no bone work is required, whatever dose of steroids I'm on. She sometimes gives me antibiotic cover if she thinks it's necessary but not usually. But I do have a good relationship with her, she's happy to look things up when I'm there and she knows a lot as well (several times she's helped with decisions about medication). She is very keen for me to have the best possible oral health to avoid triggering the inflammation process.

[Wegeners88]

Thanks everyone for the replies.

I have signed up to a new NHS dentist and will see them next week and they will assess my mouth and have told them Im on pred/ rivaroxiban. I think if they decide i need abx they will prescribe it or get my gp to. Haematology team have advised I cannot stop rivaroxiban and they will put me down to alternate day pred weaning dose of 10mg by the time I see the dentist (unless my platelets drop in which case they may increase the pred dose).