# Graves and dental work



## Sandex10

Hi. I have a question about having dental work done while hyperthyroid. I made an appointment with a dentist because I have a wisdom tooth that broke, and is causing pain. I mentioned to him that I prefer novacaine without Epinephrine, because it makes me feel like I'm going to pass out. He said I should avoid it (Epinephrine) anyway while hyperthyroid, and that it could be dangerous. I wondered if that is true.
He is going to check with my endo before pulling the tooth, just to make sure of any concerns. I'm into a week now on my Methimazle. So far I don't feel any better yet. I just wondered if anyone has any advice or opinions on having dental work/surgery with Graves/hyperthyroidism. I know that the Meth can cause low white blood count( I'll have bloodwork done in a month), and if so, you need to worry about infection. Is there anything else I should know, or be concerned about?


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## Andros

Sandex10 said:


> Hi. I have a question about having dental work done while hyperthyroid. I made an appointment with a dentist because I have a wisdom tooth that broke, and is causing pain. I mentioned to him that I prefer novacaine without Epinephrine, because it makes me feel like I'm going to pass out. He said I should avoid it (Epinephrine) anyway while hyperthyroid, and that it could be dangerous. I wondered if that is true.
> He is going to check with my endo before pulling the tooth, just to make sure of any concerns. I'm into a week now on my Methimazle. So far I don't feel any better yet. I just wondered if anyone has any advice or opinions on having dental work/surgery with Graves/hyperthyroidism. I know that the Meth can cause low white blood count( I'll have bloodwork done in a month), and if so, you need to worry about infection. Is there anything else I should know, or be concerned about?


This happens to be "very" true and thank goodness you told your dentist this!!!! He/she can get something else for you. It is not a long acting so they have to give you more after a period of time but this is no big deal.

And not to alarm you but make sure they have a "crash cart" and know how to use it. I think it is the law as per OSHA.

I also think you may benefit from and antibiotic. You will have to see what everyone has to say.

By the way, Graves' is just terrible on the teeth and the gums. Take extra care in dental hygiene.

God bless; let us know! It's just one thing after the other.


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## GD Women

I am under the assumption for Gravers to avoid Epinephrine. I always tell dentist that I am Hyper Graves'. In fact one of my dentist nurses is Graves'. I have had no problems with the dentist so far.

As long a your dentist knows you are Hyper Graves' and to avoid Epinephrine
you should be fine. However if you ever feel your heart racing while in the dentist chair, stop your dentist from what he/she is going and let them know for just a precaution.

Good Luck!


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## Mariposa

This is such good information to know.


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## Andros

Mariposa said:


> This is such good information to know.


Life saving actually!explode


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## Sandex10

You are so right Andros. Thanks so much, everyone, for all of your care, concern, and valuable input. You are all angels! There's still so much I don't know about this disease. I guess from now on I'll have to question everything. I think part of me is still in denial about having this disease. I feel like I need to play it down sometimes, or risk appearing like a big whiner. It's so nice to talk to people who can relate !!


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## rkh3

Tell me more about Graves and dental issues, especially the gums. Mine have receded a lot in the past 4 months. Diagnosed with Graves about 5 weeks ago.............
I have a dentist appointment tomorrow to start a crown. now I am a bit worried about the Novocaine, hate it anyways.
________
volcano vaporizer classic


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## GD Women

Epinephrine - epi (epinephrine is the same as adrenaline). Injection contains adrenaline and might cause an adrenaline rush. Symptoms are: feel an increase in heart rate, a racing heart, shaking uncontrollably, breaking out in a cold sweat, not being able to breathe properly (breathing rapidly/hyperventilating), leading to dizziness, lightheadedness and tingling in fingers, toes and lips. Hyperthyroid Graves' don't need this for most of us are in overdrive as it is.

Mepivacaine and prilocaine work for a reasonable amount of time even without the epi and can be used instead. But it may be more difficult to achieve profound numbness without epi. In this case, using laughing gas or IV sedation in addition to the local anesthetic may be helpful.


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## M. Vawdrey

After your Graves is resolved - via RAI - can you have epi.?


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## GD Women

Graves' is never resolved, perhaps controlled. Hopefully symptoms and levels are, resolved. Once thyroid levels are stable and there are no hyper symptoms, epi. hopefully should not be an issue.


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## rkh3

Does Graves cause gum recession?
________
volcano vaporizer


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## Andros

rkh3 said:


> Tell me more about Graves and dental issues, especially the gums. Mine have receded a lot in the past 4 months. Diagnosed with Graves about 5 weeks ago.............
> I have a dentist appointment tomorrow to start a crown. now I am a bit worried about the Novocaine, hate it anyways.


Novacaine is not a good idea............you will read about it in the article I am furnishing part of. You will have to scroll way down on the page to find the article.

Hyperthyroidism. Before treating a patient who has hyperthyroidism, the oral health care professional needs to be familiar with the oral manifestations of thyrotoxicosis, including increased susceptibility to caries, periodontal disease, enlargement of extraglandular thyroid tissue (mainly in the lateral posterior tongue), maxillary or mandibular osteoporosis, accelerated dental eruption46 and burning mouth syndrome (Box 2). In patients older than 70 years of age, hyperthyroidism presents as anorexia and wasting, atrial fibrillation and congestive heart failure. In young patients, the main manifestation of hyperthyroidism is Graves' disease, while middle-aged men and women present most commonly with toxic nodular goiter. Development of connective-tissue diseases like Sjögren's syndrome and systemic lupus erythematosus also should be considered when evaluating a patient who has a history of Graves' disease.

The rest is here..............

http://jada.ada.org/cgi/content/full/133/7/849


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## Sandex10

Thanks for all the info. I'm finishing my antibiotic before I get my tooth pulled. I think the Methimazole may be kicking in. I'm not so hot all the time like I was before, and my heart isnt pounding as much. But I still have some shakes, which I think is from being so weak. Will some strength come back on it's own, or is it something I'll have to build back up through exercise and strength training (with docs ok, of course)? I'm so sick of being a couch potato, but I know it takes time.


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