When your child has arthritis – most doctors’ appointments are more than routine. It’s
usually more than a “regular check-up”. Often, they involve an extra trip to
the lab for a blood draw, or a swing by for some x-rays. Or there may be some
special eye exams, or heart tests. You come armed with notebooks and photos
documenting symptoms, and print-outs from the internet about treatment options.
When things are going well, and arthritis is quiet – appointments are still a
joint by joint exercise in holding your breath and praying that things are
still good. When things are going bad… well, appointments can take a lot out of
you. It’s a little mini-battle in the war on arthritis – whether you are seeing
the rheumatologist, the cardiologist, ophthalmologist, endocrinologist,
pediatrician etc etc.
The dentist however – I always thought would be a pass. A gimme of normal
childhood doctor visits – as long as Caitlin never developed any symptoms of
TMJ – or had other issues of arthritis in her mouth or jaw. Heading to the
dentist would just be “regular” – the cleaning, the free toothbrush, and out
When Caitlin was six, she had a regular check up. At the end of the cleaning,
the dentist called me in to give me the news that Caitlin had several
“pre-cavities”. I was floored. The dentist went on to tell me that she was
obviously eating too many sweets and was not brushing properly. My hackles were
up like a cat ready to engage. No, I said. She has attended a pre-school that
is military in its food laws – they don’t even allow yogurt covered raisins.
They are sticklers for “growing foods.” Anything else in the lunch box – they
pull it out and leave it in your mailbox with a reprimanding note. And at home
– we follow the same, I said. (To be fair – if he said the same thing about
junk food today, I could not be so defiant in my reply. Once she hit first
grade, my grip on her food habits were greased by every friend who brought a
Kool-Aid Jammer or bag of hot cheetos in their lunch. I simply could not
control every morsel anymore.)
Could it be her arthritis, I asked? More precisely, could it be her
medications? No, he said – dismissing me with a head shake before I even
finished. But, what about methotrexate, I countered? No- he replied. In my
residency, I saw kids with cancer on much higher doses than your daughter, he
chided. And they had no problems. He continued with a wink – “I know how hard
it is to admit that we haven’t been doing the best by our children’s teeth.
You’d be surprised how many parents don’t want to admit to feeding their kids
so much candy – and that’s usually the culprit.” I was too furious to respond,
and frankly, it was a topic I had never researched. I did not have the
ammunition to argue with this man who had years and years of medical training.
I turned and headed out to the nurses desk where I asked for a copy of my
daughter’s file and notified them that I would be switching dentists. I
couldn’t wait to get home to do the research. (I have been known to be
hot-headed and to hold a grudge, in case you couldn’t tell).
Here is what I discovered:
One of the side effects of methotrexate, even at low doses, is dry mouth.
Saliva in the mouth has an anti-bacterial effect. Loss of the cleansing
properties of saliva can lead to build up of bacteria, and thus, to tooth
Prednisone also has the potential side effect of xerostomia (dry mouth).
Prednisone is also a glucocorticoid, which can increase not only blood sugar
levels, but the levels of sugar in existing saliva – which some dentists will
attribute to an increased risk of tooth decay. In addition, prednisone can
cause a leeching of certain minerals from bone – most notably, calcium –
leading to a potential thinning of bone, including in the mouth. Thus, on many
fronts, the side effects of prednisone can cause havoc to your oral health.
Here are some other drugs that can contribute to dry mouth: Naproxen, Motrin,
Piroxicam, Diflusinal and most antihistimines.
When the doctor called me two hours later, clearly he has been browsing the
same pages I had. He sheepishly agreed that perhaps, in my daughter’s case with
her rare medical condition, it’s possible that her medications have something
to do with her cavities. I had to rant first – and I had to tell him that while
I appreciate the fact that he went to school for much longer than I did, and
while he chose a different field of study – it doesn’t make him omniscient and
me an idiot. When it comes to my daughter’s condition, I have the upper hand
when it comes to experience and study. Then I had to give him all of the above
information and we discussed the many ways that rheumatoid arthritis, and the
associated medications, CAN lead to tooth decay. Then I thanked him for
following up with me. He apologized for dismissing me so quickly. We made peace
– I backed down from my angry mom perch, and I agreed to keep heading to his
office for all of my kids’ dental care needs.
Over the years, I have really come to respect him for that day. I think, if I
were him, I probably would not have called. But he did. However, I think he
probably still treats me as if I am a caged lion – ready to jump at him. When
we saw him a year ago – it was about three months after Caitlin had her hip
replaced. After the standard tooth cleaning, he called me in to chat (as an
aside, we have never had any other issues with cavities – we take extra
measures to combat those med side effects). When I mentioned that Caitlin had a
new hip, he visibly blanched. “Did you give her a prophylactic antibiotic
before the cleaning to prevent infection?” Now it was my turn to be sheepish. I
had never known about that. He was on the phone in a flash calling all over
town to try to reach the surgeon, or the rheumatologist or the pediatrician. He
gave me his personal cell phone number and asked me to call him regularly until
he had an answer. Then he personally called in a prescription and insisted we
go to the pharmacy immediately and that Caitlin take the antibiotic right
In the end, it wasn’t about me having to be right and needing to prove him
wrong. It wasn’t even about needing to prove that I’m some type of super-mom
who will never have a child with cavities (probably not gonna happen). It was
about needing that medical professional not to quickly dismiss something I am
forced to take quite seriously every day.
He went way above and beyond to look out for us that day, and I know he will
anytime we need him. Not only because he’s a really great dentist after all…
but because I think I still scare him…. Just a little. And that’s OK.