You have to be very careful about periodontal (gum) disease, which can certainly be a source of pain felt around the teeth. Periodontal disease is caused by bacteria that thrive on improperly cleaned teeth and leads to inflamed gums, infection, bleeding, pain, and bone loss. I got it quite badly when I was still a young man and have been in zealous treatment ever since. Today my gums are healthy and disease is under control, but something I have had to watch even more closely since starting TNF therapy.
Most people who lose teeth have gum disease. The problem with Enbrel is that it suppresses your immune system and can allow bacteria that were mostly under control to start getting out of control and that definitely can lead to inflammation and thus pain in your gums. (Not saying that this is your problem, but it could be). If you do have gum disease it is important to see a periodontist or at least a careful dentist who can do deep cleanings to get rid of any plaque and evaluate whether you may also need to see a gum specialist.
Mild gum infection problems are the only problems I have really had on TNF blockers (other than fatigue). It feels like a sore tooth or gum/bone area around a tooth and can also be felt as a headache. My problem was there before I went on Enbrel, so Enbrel did not cause it per se, but I knew my risk of it getting worse was raised with immunosuppressive therapy. Therefore, on several occasions when I felt pain and inflammation around a tooth, I always go to the dentist immediately to have it checked and cleaned. In every case it has been the beginning of a small infection that went away after the cleaning. Sometimes I have needed antibiotics. Now that I have switched to Remicade, I ALWAYS schedule a cleaning immediately before or after my next infusion, so I can preempt any problems.
By the way, if you take NSAIDs that can also help to keep gum inflammation down. My first really bad case of gum infection actually occurred when I stopped taking NSAIDs for 1 month. Until then I had no idea that I even had gum disease, but it came on with a vengence. I developed pus filled pockets in several places around my teeth (which fortunately have never come back because I have been careful since). Yes, "trench mouth" is a very nasty condition, but preventable with dental floss. Those of us with autoimmune disease and especially weakened immune systems are more at risk. And did you know they now have found a clear link between gum infections and heart attacks? I think it has something to do with CRP elevation.
Even if you do not have periodontal disease, it seems that the overgrowth of bacteria can also start eating your teeth and cause cavities. I have a friend on Enbrel who complained it ruined a lot of her teeth -- she got lots of cavities during her first 6 months of treatment. That has not happened to me (have not lost even 1 tooth yet, but have had numerous gum surgeries and bone grafts), but as I mentioned, I am religious about going to the dentist. The last thing I want is to loose any of my teeth to a gum infection, or to die from a whole jaw infection.
Edited by Mark D (11/09/08 08:27 PM)
DXed with AS 30 years ago