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MG Dentistry Precautions
As an individual living with MG, you must prepare yourself for any event that may worsen symptoms or lead to a crisis, including dental visitations. Oral health professionals need to communicate with your MG doctor before treatment begins to ensure that the dental care is safe. Antibiotics should be approved as some types may exacerbate MG. Dental hygienists should be prepared to make adjustments when working with patients affected by MG to ensure a safe and effective dental appointment.
Suppose you have uncontrolled MG or significant respiratory weakness. In that case, you should consider receiving treatment at a hospital-based dental office equipped to treat MG patients, especially in the event of a crisis. Schedule appointments for the time of day when your symptoms are less severe, if possible.
In addition to your physician’s approval of the treatment, it is beneficial to double-check the office and dentist are aware of all needed accommodations ahead of your appointment. A thorough review of your medication regimen is critical to limit adverse reactions during dental hygiene care. I would additionally have a physical list to bring.
If you are taking CHE inhibitors, you may experience potential complications with other medications used in dentistry, leading to a crisis. Ester-type anesthetics for pain control, such as procaine, should be avoided as they increase the risk of a toxic reaction. Recommended instead includes local anesthesia: lidocaine or mepivacaine.
A dentist should use a vasoconstrictor with local anesthesia instead of bilateral blocks. Do not take aminoglycosides, bacitracin, ciprofloxacin, erythromycin, clindamycin, and neomycin which can cause neuromuscular blocking. Penicillin is typically safe with MG doctor approval.
We, as MG individuals, are at high risk of pulmonary aspiration, involuntarily inhaling an object or fluid into our windpipe and lungs. Dentists need not use power scalers and air polishers. High-speed suction is necessary to stop oral debris from being inhaled.
Certain medications used to control the symptoms of MG have side effects that may alter dental hygiene care. Drug-influenced gingival enlargement is plausible in patients taking cyclosporine. Antibiotic premedication may be necessary if you take corticosteroids, cyclosporine, or azathioprine to diminish the risk of infection.
Nitrous oxide-oxygen sedation can safely control anxiety and stress, which can worsen symptoms. Dentists should be cautious with sedatives such as benzodiazepines and barbiturates.
Additional tips to ensure the best MG symptom control during your dental visits include the following. Take your medications so that they reach maximum efficacy immediately before treatment. Complete medical history forms before arrival to conserve energy. Ask if the temperature in the treatment area can be kept cool. The presence of a caregiver may reduce anxiety and help with verbal communication. If you experience weakened head and neck muscles, you may want to request a semi-upright position. A mouth prop can lessen muscle strain if you have difficulty keeping your mouth open. The use of dark lenses may reduce eye strain. Ask that, in general, they avoid shining dental lights in your eyes as much as possible.
Never be afraid to alert the oral health professional team if you are experiencing discomfort, need a break, or have concerns.
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9 Replies
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I am about to have extensive dental work done. Does anyone else have experience with that and can you discuss your experience.
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Clindamycin brought me out of a semi remission. MG is much worse this time and not going anywhere. Be careful of any meds and good luck!
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Very informative. Â Thank you for this timely post as I am going in for oral surgery (including some bone reconstruction) next month. Â It is scheduled two days after my next IVIG infusion.
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Not Just Dentists but every dr. or specialist you may visit needs this info. The Nephrologist now has this flagged on my records. I thought he knew.
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I had a crown pop out last night and have a dental appointment on the 5th of January to have it reglued. The dentist has not had an MG patient so I am cautious.
I have printed a couple of gMG dental documents to give to my prospective dentist to try to determine if he/she is capable of further treatment.
I have also contacted my Neuro to advise him that dental work is necessary to get his input regarding treatments/procedures.
Thoughts?
Scott
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Great information, Jodi! I’ve found that since my MG diagnosis, I’ve become anxious during cleaning and dental procedures because I choke frequently, especially when water is sprayed. During the height of the pandemic, hygienists weren’t using air or water power and what a difference! So they’ve noted on my chart to not use air or water except for suction and occasional rinsing. Although my dentist is familiar with MG, the hygienists aren’t so well informed so I take a few minutes before they start to explain why I need them to avoid spraying water anywhere near my throat and to use suction more often for saliva control so I don’t choke. My dentist gives me a second suction tube so I can control saliva during procedures, although a couple of his assistants are excellent at keeping fluids away from my throat. Anyone else have some practical tips we can try?
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Update –
Since my post above, I have had one root canal with a crown and 2 extractions. Fear kept me from going since I got gMG.
My dentist has one other MG patient. I brought in some educational documents prior to procedures anyway. for the office to review Every time I come in the office I’m referred to as the MG guy. My wife, Carol also comes with me.
All procedures went well. Am having another crown and a Partial.
I remain hopeful.
Scott
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I am in severe need of dental work. I have not been to a dentist for more than 10 years after I was shamed by my dental office (everyone I saw there) because the Mestinon caused extra saliva (they recommended I stop taking it for several days before my next appointment, lol) and I couldn’t hold my mouth open long enough. How do I find a dentist that can handle my issues? I am now oxygen dependent and have extreme difficulty with aspiration.
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OH, wow..I wish I had read that sooner…thankyou Jodi for your 2021 post on dentistry..do you have any updates since you wrote?
I have had a lot of dental work and I have been fortunate so far but would love to print something out for my dentist.
Thank you. michele
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I was anxious about going for routine cleaning for the first time after being diagnosed with MG. I gave them our brochure about a week in advance. They proudly surprised me with a hygienist who had done her final project on MG while in dental hygienist school.
I have increased salivation which is one of the side effects of Mestinon. I asked to take control of the suction device to avoid the sensation of drowning in my own saliva. They happily agreed.
I hate the bite-wing x-rays. They never go back far enough the first time and have to do them twice while I gag through the whole process twice. This time I insisted, “Let’s get it right the first time,” and she did.
I told the hygienist that I was anxious about having my first MG crisis right in her chair. I made her promise to coach the EMT’s that I was not drunk, not having a stroke, and that my lungs were fine, it’s my diaphragm muscles that weren’t working.  She assured me that she would and even repeated my instruction to the dentist when he came in for his look.
It went well.
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