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Mestinon (myasthenia) and enamel/dental problems

george7222 2 posts Jun 27, 2009 4:47 PM	Hello All, I'm trying to get some information out there into cyberspace - I've posted this on a couple of different forums. This is a problem which I cannot find documented anywhere - I'm hoping writing about it will encourage people to talk about it or investigate it. I'm a 33 year old male, and I've had MG for 15 years. I have been on varying doses of Mestinon for all of that time, and I've been on azathioprine for 13 years. I did have plasmapheresis and Intragam earlier on, but not in the last ten years. I had a thymectomy for a thymoma at the start. On the bright side, I'm doing well. Really no problems except some ongoing mild facial weakness. However! I'm here to write about teeth. Up until my diagnosis with MG I had absolutely no problems with my teeth - not a single filling. Probably over the last ten years it's become obvious that I've got serious trouble with erosion of the enamel on my teeth - I have still never had a filling. The enamel erosion has been on the biting surface of the bottom premolars and molars, the outer side (cheek side) of bottom premolars, the outer surface of the bottom canines, and the back of my top front two incisors. There has also been associated "chipping" of teeth. The premolars and molars on the upper level are not affected (don't know why). Things are starting to look a bit crappy in there. My dentist has covered up parts of the damage with various white substances, but it does worry me quite a bit. My dentist suggested bulemic people sometimes get erosion due to stomach acid on the teeth (and I'm not into that). Also people with reflux can get some enamel damage from stomach acid (I'm not aware of any reflux problems). He also pointed the finger at acidic drinks, in particular Coca Cola. I will freely admit there was a period where I drank a lot of Coke, from 2000 onwards, and this was when most of the damage became obvious. I essentially gave up Coke in 2004 due to concerns about my teeth and I now wouldn't drink it more than once a week. (I drink coffee instead). I think it's true, however, that other people can get away with drinking a lot of Coke. My sister, for example, would on average drink 3 cans of coke a day, and she doesn't have any problems. My theory (I have a scientific background) is that Mestinon causes alteration in the pH or buffering processes your mouth. I think it is very plausible - mestinon (as a side effect) acts on muscarinic receptors in the parasympathetic nervous system causing constriction of pupils, sweating, dilation of some blood vessels, and increased salivation. Conversely, patients on Mestinon will be aware that when their mestinon dose is wearing off, they start to feel "dry" - dry hands, dry mouth, dry eyes. So it follows that if you drink a lot of coke when your mestinon has worn off, there's potential to damage to your teeth, because there isn't enough saliva around. (The same my be true of Too Much saliva, but I don't know how the biochemistry in our mouths works). Regardless, if you're taking mestinon, for the majority of the time you're going to have either too much or too little saliva in your mouth. The closest condition I have found to this is Sjogren's syndrome, where people have decreased saliva and a dry mouth. I did find a report somewhere about chipping of teeth in patients with Sjogren's syndrome. So in summary, if you're taking Mestinon, be careful about having acidic drinks - I think Coke is the main culprit. Hopefully someone will see this post and do some proper research in this area.
carlota 44 posts Jun 28, 2009 11:01 AM	This is Charlotte in Tallahassee, Fl. I have had LEMS for 31 years and in the last 2 years or so, my teeth have been breaking off. As a young woman I had very strong teeth and bones. I was never even aware of when they would break off. I have spent a fortune on two caps on my front teeth, on a root canal and other fillings, and there is still more I should have done. At first I thought it was the prednisone I was on for over a decade, but I have been off Prednisone since about 1991. But I have had a series of IV STERIODS called Zolumedrol. I had several of these infusion in the hospital in 2007 and it was after that that my teeth started to break off. The IV STEROIDs does help with my weakness, but it is truly awful to endure. I believe that it was these IV Steroid infusions that MAY have done this damage to my teeth. I never thought about Mestinon, but I've been taking that for over 30 years also.
MGMike 146 posts Jun 29, 2009 9:53 AM	Hi - re Coke and other similar drinks including the Less Sugar diet variety's. just do not drink them! ever or at all! I understood that years ago research has found them to be both 'habit forming' and containg undesirable elements to human existance (rather like smoking). but I may be wrong on curent research - but anyone please advise us here?
nessierh 28 posts Jun 29, 2009 12:22 PM	hi im a dental student and i know that the less saliva in the mouth can cause dental decay whether you drink fizzy drinks or eat sweets. i think the fizzy drink issue is actually the combination of the sugar and the phosphoric acid found in these carbonated drinks which causes acid erosion. Another culprit is fruit juices or oranges so if you eat these daily it could contribute to your erosion problems. however when you say 'The same my be true of Too Much saliva, but I don't know how the biochemistry in our mouths works' i do and actually excess saliva is a good thing as it buffers the acid in our mouths and prevents decay it is our main protective source in the mouth so mestinon as it causes salivation is good for your teeth but its when the mouth is dry for any reason the bacteria can begin attacking which is why in sjogrens you have decay problems. hope this helps
alice 387 posts Jun 29, 2009 11:40 PM	Hi Nessierh, it's great to have someone with a good understanding in dental problems here. I too have more gum and tooth problems, since I became ill, but my explanation is more prozaic. I think it is mostly due to the fact, that my tooth-brushing, flossing etc, is much less efficient, since I became ill. this is what my dentist thinks too, and he is aslo exteremely cautious with me, and avoids any antibiotics, that could even remotely make MG worse, even when my neruo said it would be OK, as the risk is low, he said that he is not taking any risk with me. he is also one of the most caring and understanding physician, involved in my care. I have reached him, after a very complicated tooth filling broke and for a few months, my previous dentist and another one I consulted, told me that they can't take care of me, because I have "anxiety attacks" the moment they try to do something. he and the rest of his team, saw that I can't lie down and open my mouth (as dentists always put the chair down and sit next to the patient), because I start choking on my saliva, and become short of breath very quickly. so instead of me lying down and him sitting he had me sitted, and he stood up next to me. he respected my request not to recieve any anasthetics, and then did a lot of breaks so I could rest and not have to keep my mouth open for a long time (which was very hard for me), and had his nurse/dental assistant do a lot of sctioning so that the saliva will not bother me as much. he was very patient and gentle with me, and after a few months of having a huge cavity, it was filled!!! you can't even imagine what a relief it was. it was really funny, because with all his efforts I was pretty wiped out after that, so he went out into the corridor, and then came back, and said to me and my husband, who assisted me, that it was OK for me to go out, because he made sure no one was in the waiting room, because if they see me like that, no one will even want to come to his clinic!!! when my condition deteriorated, and I required a respirator, he did not tell me that he can't take care of me any more, but did everything with my respirator mask on, which required some accomodations on their part, and was obviously not their "routine" way of doing a dental cleaning, but as always we figured it out toghether. his gentle, caring and very reassuring approach, combined with a great sense of humor, made the difference. and once I told him that I am really sad that he is not a neurologist. ever since he started taking care of me, my fairly severe peridontitis (which was not even recognized by the previous dentist), is well under control, and I have not had any emergency dental problem. so my adivce to those that have dental problems, instead of trying to find "scientific" explanations-find a really good and smart dentist, as this is not less important in your overall care. alice
george7222 3 posts Jun 30, 2009 6:27 AM	Isn't it also possible that as well as increasing the amount of saliva produced, Mestinon could alter the composition of the saliva? They already know the various salivary glands produce saliva with a different composition. Maybe the saliva produced in patients taking Mestinon is less effective at, for example, buffering acid. Anyone out there looking for a thesis topic???