June 17, 2021 at 8:00 am #16315Jodi EndersKeymaster
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.
January 14, 2022 at 9:29 pm #18060Rick BParticipant
I am about to have extensive dental work done. Does anyone else have experience with that and can you discuss your experience.
January 19, 2022 at 8:49 pm #18076KelleyParticipant
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!
January 19, 2022 at 9:24 pm #18077Scott McCormackParticipant
Very informative. Thank you for this timely post as I am going in for oral surgery (including some bone reconstruction) next month. It is scheduled two days after my next IVIG infusion.
January 21, 2022 at 9:11 pm #18105Thomas Lee ClarkParticipant
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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