Dental Work
 

It's been awhile since I've posted. However, I check in every day.
I'm facing dental work, the first I'll have since being diagnosed last November.
Due to a very low pain threshold, I will be sedated.
Is sedation safe? What precautions should I take? All suggestions will be greatly appreciated
Thanks

Jan

Jan,

The MG Manual has a section on dentistry:

Myasthenia gravis (MG) may manifest neuromuscular weakness in the head and neck region that produces characteristic features that may provide clues to diagnosis and challenges to dental treatment. Consultation with the patient’s neurologist is recommended prior to dental treatment in order to ascertain the extent of neuromuscular weakness, frequency of neuromuscular exacerbations or crises and to discuss the need for medical management to optimize the treatment outcome in the unstable patient.

Myasthenia Gravis: A Manual for the Health Care Provider (PDF) - page 100

The MG Manual is free. You can download it in PDF format, and it is easily printed.

-Mark-

Thanks for the suggestions Mark, however, I was rather hoping for sharing of personal experiences

I have had dental work done. They just used local anesthesia and I didn't have any problems. Except that I am terrified of dentists.........

I am sure that I already had MG when I was sedated for a routine colonoscopy (fun, fun :eek: ) even though I was not yet diagnosed, and didn't and it didn't cause any problems.

I would just be sure that the person in charge of sedation is aware that they really, really have to monitor your breathing. Somebody needs to watch you until you are up and around. You should be fine.

Jan,

Forgive me for asking this, but is it a pain threshold or a fear one? ;)

I had probably one of the worst dentists when I was young. I think he filled cavities that weren't really there just for the money. And he did a really poor job of it, too.

I have a great dentist now. He understands the importance of using the best, MG-friendly numbing drug (even though I always have kick back from it later). There might be discomfort at most, but never pain. I'm someone who can faint with severe pain.

Sedation is pretty dangerous in a non-hospital setting for a MGer. As Celeste said, they need to have equipment to monitor your breathing/O2, etc. And be prepared to dial 911 if necessary. You should also ask if they are certified in CPR.

What kind of dental are you having?

I just had a root canal today. No pain, just pressure when they packed the empty root area. And they "talk" to me throughout, so I know what's going on and how long things will take. I make my jaw go slack, so I will have minimum muscle weakness later.

The epinephrine from lidocaine or whatever drug is used can cause a person to get shaky. Bringing a small juice box with will help to counteract that (it's a biochem thing).

You can ask to rest, if you need to. They can split a procedure up into a couple of days, too. Make sure you take Mestinon before the procedure so that you're at your strongest.

My point is that you can manage just about anything during a dental appointment, even pain.

Make sure you make time to sleep after an appointment. That will really help. Afterwards, drinking with a straw, eating soft foods (chewing will make jaw weakness worse), placing a cool pack on your jaw or taking Tylenol (to help with any post-pain), etc. will help.

I have known people who put headphones on and listen to music while doing dental, too.

Personally, I'd rather have a little pain than risk the sedation. Only you can make that choice. At least make sure the clinic is prepared for ALL possible scenarios if you do that.

If you get worse after the appt., keep your neuro in the loop (and a pulmonologist, too, if necessary).

I'm sure you'll be fine!!! The fear of the unknown is worse than the actual dental procedure. I hope it goes well for you!

:hug:
Annie

Celeste and Annie, thanks for your response.
I have a very low pain threshold and prior to my dx, was sedated for a simple cleaning.
I'm now in need of deep cleaning, a bridge replacement a root canal and a filling.
I'm more than willing to forego sedation but am unsure as to what drugs are actually safe for use with mg. In addition, I believe my dentist is 'scared spitless' to have me as a patient.
I live in a very small town and I doubt very much that we even have a dentist that's familiar with mg and the necessary precautions needed.
I guess my alternative would be to find a dentist in the 'big city'
It seems that nothing is easy with this disease and pursuing a knowledgeable dentist is just one more challenge.
Again, thank you both for your suggestions - I'll check back in when I have more information
Jan

Jan, My dentist had no idea what MG was all about, but I let him know a few things. He's been my dentist for over a decade! Doctors often just need a little knowledge and reassuring.

It might help if you have a discussion with your internist and/or neuro about this.

I've done fine with Xylocaine, but everyone is different.

Is your MG "stable" right now?

Why don't you begin with one thing? Start with the deep cleaning, for example. That way, you can rest in between areas and get used to what it feels like to have your jaw open that much. And then you can see how you do hours afterwards and a couple of days afterwards.

As long as you reserve time for rest/sleep afterwards, you should be fine. But check with your other docs about sedation to see if they have any recommendations.

I really hope you can figure out a way to have this work done. Putting it off can put you at risk, too.

:hug:
Annie

Thanks Annie. Great advice that I intend to follow...
Jan