wherein Crohn's disease meets dental work

I do have good news forthcoming.  It is being delayed by my promise to withhold such commentary here until my guest post is published on the esteemed BenchFly blog.

In the meantime, I have been to the dentist.  Admittedly, it has been two years since my last visit.  Part of the reason for this is because I've been so overwhelmed with directly Crohn's-related medical appointments/maintenance.  I emphasize directly, here, because my new dentist was kind enough to give me the gritty details (te he) of how the current condition of my teeth and jaw is indebted to my Crohn's treatments.

Just to brag, I have six new cavities, one previously filled cavity that has deepened and threatens to warrant a root canal, and jaw misalignment which threatens to evolve into a serious TMJ problem.  My wallet is thrilled.

For a brief history, I had no dental problems until the age of 20.  No cavities, no alignment problem, no braces.  Then, after my second Prednisone stint, I suddenly had three cavities.  Two years later, one of those cavities became root canal-worthy -- over the Atlantic on a flight to Israel, no less.  Now, at 25 and following my third and longest acute Prednisone treatment and my first year of Remicade, I am blessed with an onslaught of six new cavities, a potential second root canal and likely TMJ.

When I was younger, my dentist gave me the same spiel every six months: "Your gums are bleeding so clearly you're not flossing.  You need to floss more."  As an avid every-other-day flosser up until college, I was prompted to give up the habit when my dental health declined despite my scrupulous efforts and I decided the flossing mantra was bullshit.

My new dentist told me that it was very apparent that I was taking care of my teeth (the flossing habit returned when my husband entered the picture), and that my medications were sure doing a number on my bones.  Say, what?

My renowned gastro was very convinced each time I asked (before each of my three Prednisone treatments to date), that my treatments were so short-lived that my bones were not a concern [repeat: not a concern].  So I wasn't adamant about calcium supplements [read: there were no calcium supplements involved during the first ten years of my treatments].  Nor fluoride treatments.  Oops.  Your gastro hardly ever cautions you to take care of your teeth on Prednisone or Remicade, but the above developments in decay are not specific to me.  Google it.

My new dentist's explanations included citing the bone density loss associated with prolonged Prednisone, or multiple short acute treatments.  Remicade's role seems to be more subtle, in terms of causing dry mouth which, by decreasing salivary flow, decreases the washing-over of gums and teeth with salivary disinfectants such as lysozymes and peroxidases which help fight cavity-forming bacteria.  This example is in addition to Remicade's suppression of the immune response, in itself making the mouth more susceptible to bacterial invasion.

As a scientist, I am embarrassed at not having assumed these conditions of my own accord and treated them despite a lack of concern on my physician's part.  As a human being, I feel bummed and duped.

I am currently brushing twice a day, flossing once a day, using anti-cavity fluoride rinse twice a day, having each cavity filled over several appointments, chewing xylitol gum daily, fitting a mouth guard in attempt to ward off TMJ, and taking calcium supplements religiously.

Wouldn't it have been nice if a gastroenterologist could have helped me prepare to fight these potential side-effects at any of the three times that I've been put on Prednisone, or when I started Remicade treatments?  In fairness, they're not dentists.  But also in fairness, "bone density loss" implies inclusion of teeth as components of one's physiology.  In yet even more fairness, I have not been to the dentist in two years, and perhaps a good dentists like my new one would have mentioned something earlier on that would have helped me to prevent this mess.  Live and learn, eh?  Now we know what my fellowship money will be spent on.