Author Topic: Losing teeth and money  (Read 998 times)

Jenny

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Losing teeth and money
« on: February 16, 2012, 06:32:02 AM »
Lost another crown this week, lost one last month, had to have two back molars pulled In the past year and getting one crowned in a couple of weeks. This is getting ridiculous!  My question to you experts is...should I ask my Rhematologist to put me on one of the dry mouth medicines?  Will it help with my teeth problems, or just make me more comfortable?
59 year old female with back, shoulder, neck and knee pain, dry mouth, losing teeth, dry sinuses,Blood test positive for Sjogrens. Secondary Fibromyalgia, Osteoarthritis .
Plaqenil, Vimovo, Norco, misc.vitamins
4 discs in low back fused. Need knee&shoulder surgeries
4hand surgeries,

anita

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Re: Losing teeth and money
« Reply #1 on: February 16, 2012, 07:09:31 AM »
I have wondered the very same thing.  I will eventually lose all my teeth.  They have severe bone loss, are loose/move, and I get cavities 'below' the surface.  I seethe dentist every 4 months now, and use a couple dental rinses.  However I've never used Evoxac or Salagen.  None of my doctors has even brought it up.  I wonder if it's due to my significant medicine list and possible side-effects.  I know some can effect heart rate & BP, which I already have big problems with, so I may not be a good candidate. 

Anyway, I'm interested in what others say about this and whether it really helps save the teeth in the long run.  I can live with the dry mouth...have for years.  But I want to hang onto my teeth as long as possible.
50 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (PID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Nitro, Cardizem, Imdur, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Oxycontin, Zofran

vacumme83

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Re: Losing teeth and money
« Reply #2 on: February 16, 2012, 07:23:53 AM »
I also have this concern. I have some dental problems that are getting worse over time. My doctor has already told me to expect to lose my teeth by the time I'm 35. I'm eager to read what others have to say.

Madison Granny

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Re: Losing teeth and money
« Reply #3 on: February 16, 2012, 09:58:27 AM »
I have taken Evoxac but didn't like the cost.  After about 1 year on it I went off of it.  My mouth seems to be just as good without it.  I think the Plaqeinil has helped it.  As for my teeth my acid reflux seems to be hurting them.  Kind of dissolving them as my dentist puts it.  We are in the process of crowning what the reflux is dissolving.  Can't really keep up.
Primary SJS, dRTA, Osteroporis, OAB, stage 3 kidney disease, hypothyroid and high blood pressure.  Medicine I take are plaquenil, bicarb, prolia, synthroid, toprol and amolipine, citracal and vitamin D.  I use Arex and Azasite and Prolia.  I also have Reynaud's and osteoarthris of the toes

soycoffee

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Re: Losing teeth and money
« Reply #4 on: February 16, 2012, 12:56:49 PM »
Lost another crown this week, lost one last month, had to have two back molars pulled In the past year and getting one crowned in a couple of weeks. This is getting ridiculous!  My question to you experts is...should I ask my Rhematologist to put me on one of the dry mouth medicines?  Will it help with my teeth problems, or just make me more comfortable?

YES! By all means.

I recently contemplated suing my dentist and the dental school, for not telling me to start taking pilocarpine (Salagen) as soon as it was available. That would not have stopped the ongoing process of decay completely, as it was pretty far advanced in my upper teeth. It well might have saved a lot more of my bottom teeth.

Mostly I'm not going to do it because my dentist (otherwise a good guy) left the practice to return to Japan following the Tsunami. I have a lot of furious issues with the dental school, but I confronted them three times, and *finally* got a faculty dentist who would do the work in my mouth, without complaining that I bled too much, or that my mouth was too small.

But, I still feel that I should have been prescribed Salagen *then*, not now, twelve years later.

For anyone asking NOW, Salagen is now available as a generic, therefore quite inexpensive. And there's the new drug Evoxac, that is not yet generic, but might have some different appeal. Both increase the saliva flow, and therefore increase the enzymes that surround the teeth and protect them from decay. A dry mouth cannot protect teeth from decay. Using pilocarpine (Salagen) or Evoxac *does* protect teeth from decay.

Get one or the other, and use it faithfully. The cost of dentures or other means of tooth replacement is huge, unless you make $750,000 per year or more -- in which case, you might want to spend your money on something else.

Not only is there a great cost, there is considerable *time* spent preparing the existing teeth for dentures, or preparing the gums for dentures, and then fitting the dentures, and then adjusting the fit of the dentures.

If 40 seconds a day taking pilocarpine or Evoxac can save a lot of money and a lot of time, well, then, what's the down side?

Anita pops up and says: "Possible interactions with my other meds, and possible side effects. " Like Anita, you would check Drugs.com, and then ask your prescribing doctor, and then work with doctors to adjust meds so that you can take either pilocarpine or Evoxac with no, minimal, or manageable side effects. It is *that* important. That important to us, but perhaps not viewed as important by rheumies. Despite examining my mouth, knowing I produce extremely small amounts of saliva, my rheumatologist did not suggest pilocarpine or Evoxac. I had to ask, and also had to ask for Restasis.

On the plus side, pilocarpine seems to increase vaginal secretions, and not only increases saliva but also improves dry eyes. It increases sweat, but not enough to make my feet sweat, and only enough to dampen my underarms every other day!

If I could, I would make a fuss with your doctor, to get you on either pilocarpine or Evoxac. I can't do that.

Soycoffee









« Last Edit: February 16, 2012, 01:04:31 PM by soycoffee »
Primary Sjögren's Syndrome // Gabapentin, Prednisone, Dibencozide, Methyl B12, Adenosyl B12, 5-MTHF Folate, MSM for pain, SAM-e, TMG, zinc, multimineral, D3, Benfotiamine, Melatonin, Spicy Hot V-8 Juice

soycoffee

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Re: Losing teeth and money
« Reply #5 on: February 16, 2012, 02:15:16 PM »
I have wondered the very same thing.  I will eventually lose all my teeth.  They have severe bone loss, are loose/move, and I get cavities 'below' the surface.  I seethe dentist every 4 months now, and use a couple dental rinses.  However I've never used Evoxac or Salagen.  None of my doctors has even brought it up.  I wonder if it's due to my significant medicine list and possible side-effects.  I know some can effect heart rate & BP, which I already have big problems with, so I may not be a good candidate. 

Anita, doctors and dentists, for some reason, never bring it up. I would not assume that the doctors have a good reason. My rheumatologist never brought it up, despite knowing how dry my mouth is -- one drop in five minutes in a supervised test -- and how damaged my mouth is. I asked him and he happily prescribed pilocarpine with no problem. Your doctor might have reservations along the lines you suggest.

Work with him, work together to make it possible, to modify or treat side effects. It is *that* important. Gee, I'm a pain about this. It's from the pain my (lack of) teeth has given me!

Her's the important part, below:
Quote
Anyway, I'm interested in what others say about this and whether it really helps save the teeth in the long run.  I can live with the dry mouth...have for years.  But I want to hang onto my teeth as long as possible.

Because there are no tv ads, and because doctors haven't mentioned it to us, we just don't know. Dry mouth is the cause for the tooth loss, and pilocarpine or Evoxac is the cure. These two drugs work not only to (re)establish saliva flow, but to restore in the mouth the environment of enzymes that protect against tooth decay. The dry mouth of Sjögren's is the drying up of salivary glands, and the drying up of secretions from salivary gland, and the absence of the enzymes in those secretions.

See, for example, the middle of p. 206 in The Sjögren's Book. for the paragraph on how pilocarpine/Salagen works, and I'll quote the following paragraph:

Quote
Quote
Serious adverse effects are rare with pilocarpine. While side effects such as sweating, flushing, and urinary frequency are common, they are typically of mild or moderate intensity and of relatively short duration. Side effects may also be alleviated by taking the medication after meals. Use of pilocarpine is contraindicated for individuals with uncontrolled asthma, narrow angle glaucoma, or acute iritis. Caution is advised with use in patients with cardiovascular disease.
Daniel J. Wallace, Ed., The Sjögren's Book Fourth Edition, Oxford University Press, 2012

The quotes are from Chapter 20, "Treatment of Dry Mouth," by Fox,Singh, and Papas. If you have the book, there's a lot more on dry mouth, but I've selected their endorsement of pilocarpine (and Evozac, I believe) as effective treatments of dry mouth that reinvigorate the salivary gland output of saliva. In turn, functioning salivary glands bathe the teethe in enzymes that protect against tooth decay (p. 201).

I don't drive, so I can't tell you about the possible negative night-driving effects on vision; you might ask on this forum. I suspect that the problem comes because pilocarpine increases tear production ==> blurred vision ==> difficulty seeing at night. Since pilocarpine is short acting when you start, if you must drive at night, then not taking the medicine in the four or five hours before you drive, might shut down this particular side effect -- or at lease minimize it.

Much success,
Soycoffee


Primary Sjögren's Syndrome // Gabapentin, Prednisone, Dibencozide, Methyl B12, Adenosyl B12, 5-MTHF Folate, MSM for pain, SAM-e, TMG, zinc, multimineral, D3, Benfotiamine, Melatonin, Spicy Hot V-8 Juice

anita

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Re: Losing teeth and money
« Reply #6 on: February 16, 2012, 03:33:38 PM »
THANKS SOYCOFFEE!!!  I will be inquiring with my dentist & GP and also asking my cardio about interactions.
50 yr old SjS, APS w/strokes, Autonomic Neuropathy, PN, Nephrogenic DI, (PID) IgG def., Cushing's, Asthma, Gastroparesis.  Sero-neg w/+ lip biopsy.  Meds: IVIG & pre-meds, Arixtra, Aspirin, Plaquenil, Nitro, Cardizem, Imdur, Toprol XL, Domperidone, Nexium, Midodrine, Symbicort, Oxycontin, Zofran

eyeamdry

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Re: Losing teeth and money
« Reply #7 on: February 16, 2012, 06:11:12 PM »
If we know of something and think we might need it, or at least it might be worth trying--for sure bring it up with your doctor.  I asked my rheumy if she thought I could try Provigil and she said "well, sure."  Problem is my insurance won't pay for it and I have to pay a lot for Evoxac and Lyrica and some of these times, I may have to decide which I can afford to take and leave some of the others off.

Quote
also have this concern. I have some dental problems that are getting worse over time. My doctor has already told me to expect to lose my teeth by the time I'm 35. I'm eager to read what others have to say.

What a mean and arrogant man.  How does he know you'll lose your teeth by the time you are 35?  If he is trying to tell you to be careful and take care of your teeth by doing all you can, that's one thing.  But to just say you'll lose your teeth by 35 is nonsense.  How does he know?  Sounds like a jerk.  I think he's mean and not just trying to be honest.  Lucy