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PMR/GCA - Steroids and Dental Work

Hello everyone

Has anyone had invasive dental work whilst on steroids? Have lost a crown because the post has fractured in the gum. My new dentist is concerned about my health problems not least the steroids whilst doing invasive dental surgery. Another bare root he says may have to be dealt with in hospital perhaps at a later date when I am off the steroids!!!

I would be grateful to hear from anyone who has had a similar experience, please.

MrsO

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  • Ms JH

    I have had PMR for close to two years. The course of my PMR has not always been smooth but I am now down to 5mg of Prednisone a day. I recently had to have ambulatory knee surgery and my GP was most concerned. My rheumatologist recommended 50mg of Prednisone intravenously on the day of surgery and 45mg on each of the three days following surgery (triple my current daily dose). This helps to compensate for shock to the system of surgery (and of the heavy dental work) and for the body's inability to produce any naturally after being on the medication for so long. This is also the reason why it is difficult to get off steroids because the body has to learn to produce them again by itself and the reason why we should not try to lower our dosage too quickly. Lowering too quickly can also produce a flareup which is always to be avoided because that can trigger GCA in someone who just has PMR and the reverse. I suggest you consult your rheumatologist and GP because delaying needed dental work may not be in your best interest. I did very well with my surgery. Hope this helps.

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  • Guest

    Dear Ms JH

    Thank you so much for your very informative response to my query - it is always so useful to hear of someone else's experience and very reassuring. I'm glad to hear that your knee surgery went well and you were obviously well looked after.

    I have noted what you say about increasing the steroid dose on the day of invasive dental surgery and for a few days thereafter. You mentioned that you had to triple the dose to 45mgs for a few days so does this mean you were on a dose of 15mgs leading up to the surgery? I have recently decreased to 4mgs after being on 5mgs for over 5 months. Like you, I have been on Prednisolone for just under 2 years (21 months) starting dose 40mgs, having been diagnosed with Temporal Arteritis following one year with serious illness which wasn't diagnosed as PMR until development of the Temporal Arteritis. I have since heard that people who suffer from PMR without being prescribed steroids have a 7 out of 10 chance of contracting Temporal Arteritis as opposed to 3 out of 10 being treated with steroids. Needless to say, therefore, my risk was high and I was unlucky!

    I will try and make contact with my rheumatologist tomorrow, although he has said several times in the past and is adamant that steroids do NOT stop your own body's production of cortisol and seems to believe that once you reach 7.5mgs and below, everything is balanced out. It is so confusing when even the consultants have different opinions and different approaches. But then I suppose this is a very confusing illness even for the specialists - it is very much a case of trial and error!

    Once again, thank you so much for your kind and helpful response and I wish you a speedy and complete recovery from this illness, likewise for everyone else out there in a similar position.

    MrsO

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  • Ms JH

    Dear Mrs O,

    I apologize for the confusion. What I meant to say was that I was on 5mg a day beforehand and that the rheumatologist insisted I needed to up the dose before and after. Just before surgery I received 50mg and on the three days following surgery I took 15mg each day for a total of 45mg. Alternatively I could of tripled the daily dose on each of the three days before surgery.

    In my case, the surgeon felt that my dose was \&quot;so low\&quot; that it didn't make any difference but my GP felt otherwise and he called the rheumatologist to confirm. Those two have been taking care of me all along and I trust their judgment. I am sorry that your doctor feels differently. You are right that there is so much the experts don't know. My rheumatologist also tells me that every patient is different which makes caring for us a challenge.

    I always feel that dental work takes a terrible toll on my system and that is why I felt compelled to write even though my surgical experience was quite different. I do hope that you can figure out what is best for you and that it all works out.

    Again, I'm sorry for my confusing dosages.

    All the best,

    Ms JH

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  • Guest

    Dear Ms JH

    Thank you so much for clarifying and so promptly. I have just heard back from my rheumatologist's secretary with the answer that I do not need to increase the steroids for the dental procedure. He is a highly thought of rheumatologist so I will, therefore, try to relax in the surgery (and cross my fingers!).

    It's been good to chat with you through this wonderful website, and all the way from New York, too - wow!

    Best wishes to you,

    MrsO

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