Bryanna - MrsD Suggested I Post

nide44 · 02-18-2010, 10:21 AM

Bryanna,
I've been a member and posting for a few years, over at the PN forum.
MrsD suggested I ask you about this.
This was my post on the PN forum:

Tooth Loss from Meds?
Lately I've been having dental problems. My teeth seem to be healthy (not weak-walled or cavities) but at least 4 have come very loose in the past 10 months, and had to be extracted.
I currently have another loose one, that will be extracted next week.
My dentist has referred me to a periodontist for further treatment & I'll be seeing him the 2nd week of March.
I had severe perio problems (bone loss) about 10 yrs ago and had an extreme amount of work (some below gum-line, bone-grafts) done (about $ 6-8K), but every tooth that was worked on then, no longer is in my mouth - money down the toilet.
I'm not looking forward to another perio round.

Could this recent tooth loss problem, be due to calcium loss from the medications I'm taking? I recently saw a post here, that mentioned something of that sort, while discussing another topic.

I've been on 4200mgs/day Neurontin for 6 years, then switched to 600mgs/day of Lyrica, in the past 3 years.

I also take Tramadol, Zetia, & Terazosin.
I haven't taken any calcium supplements other than a multi vit.

Could this tooth loss be related to my meds?

Would you know anything about this?
any input would be appreciated
Thanks

Bryanna · 02-18-2010, 10:39 PM

Hi Bob,

I read your post and don't have enough time right now to properly respond. I will get back to you tomorrow....ok?

Bryanna

Quote:

Originally Posted by nide44

Bryanna,
I've been a member and posting for a few years, over at the PN forum.
MrsD suggested I ask you about this.
This was my post on the PN forum:

Tooth Loss from Meds?
Lately I've been having dental problems. My teeth seem to be healthy (not weak-walled or cavities) but at least 4 have come very loose in the past 10 months, and had to be extracted.
I currently have another loose one, that will be extracted next week.
My dentist has referred me to a periodontist for further treatment & I'll be seeing him the 2nd week of March.
I had severe perio problems (bone loss) about 10 yrs ago and had an extreme amount of work (some below gum-line, bone-grafts) done (about $ 6-8K), but every tooth that was worked on then, no longer is in my mouth - money down the toilet.
I'm not looking forward to another perio round.

Could this recent tooth loss problem, be due to calcium loss from the medications I'm taking? I recently saw a post here, that mentioned something of that sort, while discussing another topic.

I've been on 4200mgs/day Neurontin for 6 years, then switched to 600mgs/day of Lyrica, in the past 3 years.

I also take Tramadol, Zetia, & Terazosin.
I haven't taken any calcium supplements other than a multi vit.

Could this tooth loss be related to my meds?

Would you know anything about this?
any input would be appreciated
Thanks

Bryanna · 02-19-2010, 09:12 PM

Hi Bob,

Periodontal disease is a progressive infection of the jawbone that causes severe bone loss and loosening of the teeth. There is a misconception that invasive periodontal surgery stops the progression of the disease. The problem lies with the build up of plaque along the gumline which irritates the gum tissue creating openings between the gum and tooth. The plaque seeps down into these openings and becomes infected. The infection has a variety of staph bacteria which destroy the jawbone. The teeth become loose as the bone deteriorates. This bacteria also enters the bloodstream continuously through the blood vessels in the mouth that travel to all of the major organs. It sounds to me like your periodontal disease may not have ever completely cleared up and has just gotten progessively worse over time.

In addition to the periodontal disease, any chronic illness will weaken the immune system making the perio disease more progressive and more difficult to keep at bay. Medication is also a big contrbuting factor to perio disease because it too burdens the immune system and creates an unfavorable condition in the mouth by supressing the flow of saliva. Our mouths have a built in cleaning system called saliva. Without it a condition called xerostomia.... or dry mouth occurs making us more susceptible to tooth decay and/or gum disease. Medications can also cause depletion in certain vitamins and minerals, calcium being just one of them.

I would suggest that before you undergo any periodontal treatment, that you speak with your physician and dentist about your medical and medicine history and how it relates to your oral health. Find out from the periodontist "what the factual long term prognosis is of your remaining teeth if you did have perio treatment and what type of maintenance would be involved in keeping the bacteria from progressing in the near future?" If he says your condition is severe, guarded, or hopeless, then it may not be worth going through the treatment only to lose the teeth soon anyway. One aspect that needs to be seriously considered is how this chronic infection is affecting your overall health.

I'm sorry this is not good news to hear

I see alot of patients who have undergone various types of periodontal procedures in an attempt to halt the progression of the disease. It is difficult if not unrealistic to get a hold of the disease if there are too many other unhealthy contributing factors. It concerns me when people put themselves through these procedures when the long term outlook is very weak. So it's wise to find out what stage your gum disease has progressed to and if it has affected all of your teeth. Take those answers into consideration with your overall health, meds, lifestyle... and make the decision that is best suited for you.

Please let us know how things are going........ and always feel free to come back here and ask questions or discuss your concerns with us !

Bryanna

Quote:

Originally Posted by nide44

Bryanna,
I've been a member and posting for a few years, over at the PN forum.
MrsD suggested I ask you about this.
This was my post on the PN forum:

Tooth Loss from Meds?
Lately I've been having dental problems. My teeth seem to be healthy (not weak-walled or cavities) but at least 4 have come very loose in the past 10 months, and had to be extracted.
I currently have another loose one, that will be extracted next week.
My dentist has referred me to a periodontist for further treatment & I'll be seeing him the 2nd week of March.
I had severe perio problems (bone loss) about 10 yrs ago and had an extreme amount of work (some below gum-line, bone-grafts) done (about $ 6-8K), but every tooth that was worked on then, no longer is in my mouth - money down the toilet.
I'm not looking forward to another perio round.

Could this recent tooth loss problem, be due to calcium loss from the medications I'm taking? I recently saw a post here, that mentioned something of that sort, while discussing another topic.

I've been on 4200mgs/day Neurontin for 6 years, then switched to 600mgs/day of Lyrica, in the past 3 years.

I also take Tramadol, Zetia, & Terazosin.
I haven't taken any calcium supplements other than a multi vit.

Could this tooth loss be related to my meds?

Would you know anything about this?
any input would be appreciated
Thanks

nide44 · 02-20-2010, 09:51 AM

Bryanna,
Thank you - I'll see what the initial perio exam conclusion is.
My previous perio work was done at The U. of Maryland
School of Dentistry- Periodontics Faculty Practice. None of the docs who treated me then, are there now, & that's the reason I didn't go back. My family dentist is not a great diagnostician. He's good at cleaning and extracting, fillings & such, but when I went to him for the first time about a year ago (as a referral from my barber when I initially had severe tooth pain & loosening))
He's been treating symptoms, not my overall mouth health. (he's never even taken full x-rays of my entire mouth, just problem, areas) I think I need to have this perio evaluation. i have an appt with my PCP for my Welcome to Medicare physical at the end of March - so things will be discussed with her then.
I never thought about discussing dental or oral health with her.
I assumed she'd just say for me to see my dentist.

Bryanna · 02-20-2010, 11:32 AM

Hi Bob,

It is imperative for your physician to be aware of your dental health... especially since you have periodontal disease. It is unfortunate that too many phyisicians have no clue about oral health and generally shrug off the conversation. With that said, it is up to you to voice a concern about the infection aspect of your perio disease and how it can negatively affect your overall well being AND how your meds may be contributing to your dental problems as well. Chances are your MD will not have any helpful input but it is still important for your concerns to be noted in your chart. And who knows, perhaps it will enlighten her to be more interested in the dental aspect of her patients in the future?

It is a shame that your dentist is not treating you properly. Without diagnostic xrays, it is impossible to know the extent of your condition and based on what you have written here..... it has gotten worse under his care. Is he the one who has referred you to the periodontist??

I really urge you to not go along with any perio treatment until you feel you have been thoroughly informed of all your treatment options. Periodontal treatment stirs up alot of bacteria and if the condition is severe, hopeless or guarded, this bacteria will not be brought under control. When that is the case, there is nothing positive to be gained by having the treatment as it can actually lead or contribute to systemic infections. Sometimes it is wiser and healthier, to remove the teeth because then the bacteria will be eliminated which is better for your overall well being. I'm just putting this information out there to you because I'm not sure you will be given all of the facts.

Hopefully your condition will not be so severe...... please keep us posted

Bryanna

Quote:

Originally Posted by nide44

Bryanna,
Thank you - I'll see what the initial perio exam conclusion is.
My previous perio work was done at The U. of Maryland
School of Dentistry- Periodontics Faculty Practice. None of the docs who treated me then, are there now, & that's the reason I didn't go back. My family dentist is not a great diagnostician. He's good at cleaning and extracting, fillings & such, but when I went to him for the first time about a year ago (as a referral from my barber when I initially had severe tooth pain & loosening))
He's been treating symptoms, not my overall mouth health. (he's never even taken full x-rays of my entire mouth, just problem, areas) I think I need to have this perio evaluation. i have an appt with my PCP for my Welcome to Medicare physical at the end of March - so things will be discussed with her then.
I never thought about discussing dental or oral health with her.
I assumed she'd just say for me to see my dentist.

nide44 · 02-20-2010, 03:58 PM

Bryanna,
My dentist is the one who referred me to the periodontist, after I told him that I had had perio treatment, and bone grafts 10 yrs ago at the Faculty Practice at U of MD.

He's just been pulling my teeth (about 6 of them) in the past year.
I went to him because he's located just a few blocks from my home, and was recommended by my barber when I had 2 teeth paining me severely. He suggested partials, as I had other teeth that had been pulled over the years, and the 2 uppers he took were in the back, leaving me little to chew with. He made molds and had flexible partials made for me

I hadn't been to a dentist in at last 5 years and mine had moved away to another city (Annapolis MD). I live in Baltimore and didn't have a dentist since he moved his practice.

While in Ireland this past June, 2 front bottom teeth were bothering me (in the front this time) and I was forced to go to a dental clinic in Galway. They splinted the teeth and gave me an Rx for antibiotics to see me thru until I got back to the states. when I came back, my dentist pulled them and my plates went out to have 2 teeth added.
Around the Holidays an upper behind the canine was sore & loose & he pulled that one - plate went out to have another added.

Now I have another upper on the opposite side (also behind the canine) that is sore and loose. He sent my plate out to have another added, and will pul this one as sooon as the palte comes back from the lab, one day next week.

His procedure is to pull the tooth and then puts the plate in, immediately - rather than packing the socket with gauze. Its been a successful procedure the last 2 times, as I'm a smoker (I know- I gotta quit - SOON, its given me emphysema... I've just found out in tha past 60 days) and it protects the socket. I cut down on my cigarettes & leave it in for at least 24-48 hrs and eat soft foods for 2 days.
But he's not shown any desire to treat the cause - just has said that I have to see a periodontist again.

I didn't know of any, so he gave me a business card for the one that I've made an initial consult appt. on 3/10.
You may be right. further perio work might be useless and I'd be better off having done with it. After this extraction next week. I'll only have 8 uppers left of my own. The bottom plate replaces 5,.
I'm not insured for dental (altho I could try to bide-my-time & wait until next Dec to sign up for Medicare supplemental & dental) and am not in a position to rape my retirement fund for thousands that would be just throwing money down the tubes. It might be more economical not to go to expensive, extensive perio work and just get full dentures (and all that implies). Implants are financially out of my league.

(And I don't wish to do 'Gabby Hayes' impressions
no teeth, no plates, just gums )

Sorry for the long post, but I haven't discussed this with anyone, and as I typed, it just became "War & Peace". Just venting, I guess - losing any teeth is a very personal issue with me and a little upsetting, if not a bit traumatic. Losing these many in a short period is unsettling, to say the least.

Bryanna · 02-21-2010, 01:03 PM

Hi Bob,

Thanks for explaining your dental history in detail. It is pretty much as I had suspected it to be. The periodontal treatment that you had several years ago may have been of some help, but only temporarily because of the lack of dental care in the years afterwards to help maintain some stability. Your smoking habit also impeded the healing process which made the surgery only somewhat successful if at all. Perhaps you should have been better informed at that time of what the outcome would be if you didn't have continued dental care and kept smoking. More times than not this information is not presented too well by the dentist or his staff and the patient leaves thinking they're situation has been cured.

Your description of how your dentist has been treating you is very typical when a patient is reluctant to loose their teeth to a denture. This does not mean that there are any healthy teeth worth keeping, it's just a way to pacify the patient for a very limited time. The problem with this scenerio is that your perio disease is out of control which has caused your teeth and jawbone to become infected as well. This situation is not healthy and may be contributing to other health problems.

Again from your description of your dental and smoking history, any periodontal treatment that you have to retain your existing teeth is not going to cure your perio disease. I know the thought of losing your teeth is scary but you need to realize that you are hanging onto infected teeth that are going to affect your overall well being and you are going to lose them anyway. Since you are use to wearing a partial denture..... going into a full denture will not be much different.

I hope this information is helpful to you. Sometimes we need to re-evaluate what it is that we're holding onto...... because the alternative can often be more rewarding in the long run

Take care.... keep us posted!

Bryanna