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Dental Cavities on Prednisone
My husband was diagnosed with PMR 1.5 years ago. His rheumatologist has him on 7 mg prednisone daily plus 8 mg methotrexate one day a week. He started on 30 mg prednisone. The past three dental exams have found six or seven cavities that needed fillings. We were not informed about this possible side effect when starting prednisone. The dental bills are insane! Has anyone been able to convince their medical insurance to cover this? It’s not caused by bad dental hygiene. It’s a result of the prednisone to fight the PMR.
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@jfannarbor
This study focuses more on dental caries and long term corticosteroid use.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10475248/
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No research ever provides definitive answers to these questions and this one is no exception. This study suggests steroid inhalers are mostly the problem.
"Future randomized controlled clinical studies are warranted to confirm these findings."
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5 Reactions@dadcue - we are covered by Kaiser Permanente’s Medicare medical and dental insurance. I will contact them this week to see if we have that three month provision in our plan. Thank you so much for your replies and suggestions.
It's possible that the methotrexate, not the prednisone is causing this. Lots of research online.
@dadcue I hope that your dentist told you which teeth she was watching so you could pay more attention in cleaning those teeth. I am amazed how many people I come in contact with who see their dentist on a regular bases and every visit there are teeth to fill. Dental caries is a preventable disease as is periodontal disease. Dental caries in not like cancer. Caries can arrest and never progress if your oral hygiene removes all the carbohydrates that feed the bacteria that cause decay. I conducted a randomized clinical study that looked at treating questionable carious lesion and there was no benefit in treating questionable carious lesion prior to those lesion becoming clearly carious. The size of the resultant cavity preparation was not different between early treatment (questionable) and later treatment (unquestionable caries). If you are interested in the articles search PubMed with Author Hamilton JC and any field dentistry.
@dadcue I do not question that no one randomized clinical study will answer any medical question. One of the problems with studying the question, "Is prednisone related to tooth decay" is what is the level of oral hygiene prior to taking prednisone and after taking prednisone due to some disease. Often the disease the requires prednisone causes physical and mental problems and life style changes that affect the level of oral hygiene.
One of the best tools to give dental patients is disclosing tablets or drops. I tell them
to brush their teeth normally and then use the tablet and wherever there are red spots those are areas they are routinely “ missing”.
Have them do this for a week and they will usually develop a better routine to get to those spots.
Then let them recheck once a week.
You can’t see what you’re missing if you don’t do that.
Good luck,
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3 Reactions@jfannarbor it is my understanding that prednisone causes xerostomia (dry mouth) which is linked to gum disease and cavities. Am I misinformed?
For medication induced dry mouth, I take biotine. I tolerate it much better than saliva substitutes. What is your recommendation for dry mouth?
@laura1970 Yes, my dentist said I had dry mouth and suggested the tablets that encourage salivation. She had noticed a marked difference in my teeth and jaw by comparing the xrays and was quite alarmed. I don't think she had had a prednisone patient before.
@dadcue great article. Thanks 😊
@laura1970 I have been on and off prednisone due to PMR, mainly on, for 35 years and I am a dentist. I have not had dry mouth or a problem with dental caries. The only study I could find related to dry mouth and corticosteroids was done in rats and used dexamethasone which is much stronger than prednisone. I do not doubt your dry mouth I just wonder about the cause. Prednisone is given for auto immune diseases and some of those diseases cause dry mouth. Again there may be a connection between prednisone and dry mouth and this would be a good forum to learn about it. I personally have not experienced it or know of studies that prove it, but I am all ears.