PSA and Tooth Extraction

This time around I asked for pain meds. Stronger ones than what I have on hand for flares from my rheumy. I was sure the surgeon would say no since they are getting a bit more strict here as well, but I was surprised to see there was enough pills for a few days. I am hoarding them like diamonds and only using them when I really need it.
It seems here in the USA all the dentists are now sleep specialist. I think they all went to the same weekend conference and took a 2 hour course because they are all pushing sleep apnea and c-paps. I am glad you found a friendly pharmacist to help you out! Those are the best medical professionals.

@Poo_therapy I knew the NHS system was different than our US system but I had no idea is was like that. Tell me, are you assigned to one NHS doctor or can you switch if it isn’t a good match? Why aren’t chronic conditions covered under your private insurance? Is PsA not as common a diagnosis in the UK?

@Amos Now that is mega stinky!!! Shame on them.

In defence of the dentists, there was a very large comprehensive study done a few years ago that showed that night-time teeth grinding is caused by obstructive sleep apnoea in the vast majority of cases. It was a real watershed in terms of how to address teeth-grinding so I’m glad they are all getting educated on it.

They showed that if you fix the sleep apnoea, you fix the grinding. That worked for a really high proportion- over 80 - 90%. If you’ve ever had TMJ symptoms and been told it’s from grinding, you known you’ll do just about anything to get rid of it, and I have had a specialty made jaw appliance ($2,000) to try to fix it. The grinding also causes your teeth to slough off enamel, the sensitivity can be excruciating.

Typically of me, I was not the 80-90%. Someone has to be the others, hey?

For me, the OSA was not causing the grinding. Inflammatory flares (irritating my trigeminal nerve I think), were causing BOTH the grinding and increased sleep apnoea (because affecting all the nerves in my throat including voice changes).

So mechanical solutions did not work. Once the inflammation was under control it became a non-issue. When it came back with my recent (2.5 year) bout of inflammation, I got a cheapish ($100) but comfortable mouthguard from my dentist that is not designed to change jaw position, but just protect my teeth so they have even pressure on them when I grind and they are less likely to crack.

PsA doesn’t cause everything, but it is amazing how inflammation flares can create / exacerbate symptoms form seemingly unconnected diseases.

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The PMI is underwritten on the basis of the existence of the NHS - ergo no chronic disease whatever it is, is covered, not just PsA. So that would include all autoimmune conditions, things like asthma, MS, chronic cardiac conditions, cogential issues etc etc. You can be investigated for these under a PMI but once diagnosed your treatment is via the NHS. The only reason I have PMI is that my employer gives it to me free. I certainly wouldn’t pay for it as given my chronic conditions it would be pointless. Also no PMI would fund the cost of biologics etc either. That is a huge advantage as it means, your insurer as happens so much in the USA, doesn’t pull your working biologic suddenly just because it feels like it. Your NHS rheumatologist is the only person who can decide what biologic you get, so in that way it’s a lot safer frankly. I’ve heard so many countless stories of patients in the USA having to change biologic willy nilly simply on insurer (not medical) decisions.

It’s harder now to switch a consultant if it isn’t a good match but it is doable. Mine has been an excellent match these last 5 years thankfully.

That is true. I didnt think of it that way.

@Poo_therapy I see. Yes I have dealt with the insurance pulling me around because they changed the tier plan on the policy. It can be a nightmare. Plus all the PAs, Prior Authorizations. UGH!

Well… things haven’t gone so well. I was having major swelling near my surgery site so I had an appointment with the oral surgeon. Turns out the tooth next to my removed tooth has abscessed and now I need a root canal on that tooth. It is very painful. I am so worried about another oral procedure but the swelling is large and the tooth hurts a lot. Probably the most pain I have felt in my face.

I am thinking the methotrexate is having a good ole time in my mouth. It wasn’t until after I took my weekly dose of MTX did the swelling increase to the pain of major pain. The root canal is booked for Tuesday, a few days after my weekly MTX dose. Without MTX my psoriasis goes nuts on my hands and feet. BUT I need my mouth to heal. Its been months of constant appointment, procedures, and pain. Also taking a 2nd round of antibiotics.

Any advice @tntlamb ?

Good news everyone!
No root canal needed! I had some pretty nifty images done of my tooth and it shows that it is inflamed and sensitive but perfectly fine. I had a good talk with the endodontist about PsA, auto immunes, and inflammation. She gave me some very good advice. For now I will rest my mouth and see how things go. Hopefully over the next few weeks it will finish healing and that tooth will calm down.

@tntlamb One of the images showed that this particular tooth sits right on top of that major nerve in the jawline you were talking about. Like right on it. That’s why it is hurting so much. That nerve is not happy due to the procedures with tooth #30. Doing a root canal could have damaged that nerve. So glad I found a great doc who was willing to take extra images and give me an honest opinion. She recommends that I never have implants and never have future root canals. Will look into other means of replacing that tooth, like something temporary or what I can use only when eating. She gave me some options.

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