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Thread: Dentist Advice

  1. #21
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    Quote Originally Posted by Sangye View Post
    ArlaMo, why are you on fosamax? You haven't been on pred very long, have you?
    It's been just over a year now and at pretty high dosage. Started out at 60mg, was on that for about 4 months, tapered to 40, then 20 and ended up at urgent care not being able to breathe. Back up to 40 and I've been on that ever since.

    The rheumy I saw initially put me on the foxamax right from the start. My mom has osteoporosis (she's 62) so I'm wondering if that is why. Should I be questioning that? All my docs, including the ones at CC, have a list of my meds and nobody has said anything. In fact, my internist had me go for a DEXA scan last month and made sure I was on something.

  2. #22
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    The practice of putting Weggies on bisphosphonates right from the start is controversial. Those drugs have some seriously high risks that don't disappear when the drug is stopped. Unless someone is older and/or already has osteopenia, it shouldn't be routinely prescribed. Doing a DEXA scan every year or two is a standard thing while on pred.

    Dr Seo has never told me to take bisphosphonates. I was even on Lovenox for 2.5 years, which really affects bone density. Fortunately I came into all this with "supernormal" bone density-- 40% higher than most women my age. The product of good genes and good supplements.

    Here are a couple of threads with info about it:
    http://www.wegeners-granulomatosis.c...sphonates.html

    http://www.wegeners-granulomatosis.c...sphonates.html

  3. #23
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    thanks you, Sangye. Off to read your links!

  4. #24
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    Quote Originally Posted by ArlaMo View Post
    What should we know about dental stuff and biophosphanates? I take fosomax once a week, but neither the dentist or perio said anything specific about it.
    AriaMo, the use of bisphosphonates is a pretty contentious topic regarding management in dental surgery these days. I have gone to several full day courses on the subject, and there is not wide spread agreement on how to manage the issue.

    I can find several recent/good studies regarding effects on the oral cavity, specifically effects on bone density of the mandible and maxilla. Combined with a compromised immune system and all the drugs to treat this disease, (Pred!) it seems the bisphos can cause 'hyper' bone density, to the point that blood supply is limited...the bone is so dense it can become brittle and necrosed, resulting in poor healing.

    So, if one develops a dental infection and requires a procedure that is likely to involve soft or hard tissue surgery, healing can be a real problem...there have been cases of osteonecrosis (bone death,) reported. It is not that uncommon considering the number of people on these drugs. It is more of a problem for those with 'more problems'....ie, diabetes, smoking, gum disease, impaired immune system, and what type of bisphosphonate therapy that is given (ie, oral vs IV) and duration of drug use.

    The conundrum is, the morbidity of fractures (hip, spine) is/can be life threatening. We are learning how to manage dental treatment for many of these folks, but the rule is, get your teeth cleaned often to avoid gum disease. Arrest decay before it affects the nerve. Some practitioners are suggesting a 'drug holiday' from the bisphosphonates after use for some years. It would be appropriate to question your rheumy about this topic.

    Too long of a post here...I think the subject of bisphosphonates are worthy of a new thread on its own merit.

  5. #25
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    I came to my rheumy in osteoperosis (due to long standing steroid treatment for the asthma I didn't have -- it was WG all along), and immediately went on fosamax. My situation is pretty serious because I am African-American and premenopausal, so my bones should be pretty strong. However, even my doc has suggested a drug holiday after a few years if my condition is stable and the DEXAs remain so. He didn't start me on anything prior to having the DEXA done, but I am also not on prednisone.

  6. #26
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    Thanks Jane and Jan for the good info. I think i will look into getting another bone scan done sometime this year is possible. I think we should all discuss biphosphonates again as well.
    Phil Berggren, dx 2003

  7. #27
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    Ok news on dental assessment,
    I have made up my mind and we have decided to go for two extractions ,four root canals ,two fillings new dental plates and a patridge in a pear tree
    Do not have to alter any medication , can have it done with sedation the same as when I had cataract done . The work will be done slowly with the thought been given to watch for and treat any infection quickly.
    WG consult wants to be informed of treatment dates and to be informed of any problems .
    Hopefuly been done during May if not it will be june the specialist dental surgeron sp only have a day and a half alercated for surgery each month and they go on a priority basis and the NHS state cancer patients first .
    At least they got me to sit in a dentist chair and I let them seal the worse tooth as it had fractured alittle more . believe me thats good for me !!
    Thank you for your support . DEEx
    ps down to 9mg /8mg alternate preds next week
    Last edited by DEE; 04-24-2011 at 04:17 AM.

  8. #28
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    I hope everything goes well.
    Phil Berggren, dx 2003

  9. #29
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    Thanks Phil .

  10. #30
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    Gosh Dee, that's a lot of work. I hope it goes well and you have relief quickly. Hugs to you

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