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When Visiting the Dentist could Kill You

Adrenal Insufficiency

As a Child I loved going to the Dentist. I would get my teeth checked, get a sticker and usually a new tooth brush and toothpaste. I loved the strawberry toothpaste, it tasted so good. As I grew appointments got a little worse. Every once in a while I would need a little work, a filling here or there. I hated those needles and the numb feeling you get after treatment, but at the end of the day it was not that bad. I’d get my teeth sorted and not worry for another six months.

Everything changed when I developed Adrenal Insufficiency. You see the week before I was diagnosed with my illness, I had a dental appointment. I needed a filling. It wasn’t too bad, two injections, drilling and filling a small hole in my front tooth.  It felt funny. I felt light headed. It wasn’t anything like my previous experiences, I felt confused and sleepy.

Once the dentist finished, I stood up, I walked out the door towards the reception and then I passed out. I didn’t know what had happened. I was given a glass of water and told to take a rest for a few minutes.

Eventually I dragged my wobbly body to the Taxi stand and managed to get myself home fairly quickly. I felt ill for a few days. Headaches, nausea and muscle weakness. I did not know what was wrong.

Each night I felt more and more unwell. I didn’t know what was wrong. I could no longer stand. The dizziness continued and I collapsed again. My husband rang the ambulance. I was taken to hospital. This was my first recorded Adrenal Crisis. my Blood pressure was so low and I stayed in the hospital on a drip for a week.

Next I was then told I had Adrenal Insufficiency and given steroids to to take daily for the rest of my life.

I had to return to the Dentist to do further work on my tooth. This time I knew I had adrenal Insufficiency and I knew what could happen if I did not take extra medicine before dental treatment.

You see having adrenal Insufficiency means you don’t produce Cortisol, the hormone that helps the body cope with stress. On a daily basis I have to take enough Hydrocortisone to replace that which my body is not producing.

However if I am unwell or having a procedure which causes the body to be under stress and require more Cortisol, I have to follow stress dosing rules.

The only problem was when I was diagnosed with AI, I was not told about the Stress Dosing Rules.  had no idea I would need to take more Hydrocortisone an hour before any Dental procedure.

So I returned to my appointment. I had the treatment and once again I collapsed. This time we knew what the illness was and I Returned to the A and E, to be treated once more.

It was not until a few months after diagnosis that an Endocrine Nurse explained the seriousness of my condition. I had not been told art hospital that I could die from an Adrenal Crisis. I had not been given stress dosing rules when started on hydrocortisone. The Endocrinology Nurse was supposed to come and see me, but the Sister on the Ward wanted me out as soon as possible and sent me on my way not knowing the seriousness of my condition.

Finally, I got information after a few months. I read that before dental procedures to take an extra 10mg of Hydrocortisone. Then it clicked and I realised what had happened the previous two times.

One year after diagnosis I went back to the Dentist. My Filling had fallen out and needed redoing! This time however the Dentist refused to treat me. He did not want me to collapse.

I had to write to the hospital for a letter to instruct my Dentist what to do. It was a lot of messing around but eventually I got a letter stating I needed to take 10mg of Hydrocortisone before my appointment and all would be okay.

I took the extra 10mg before my treatment and guess what, I did not collapse after my treatment but my muscles went wobbly, I became dizzy and really unwell. I immediatley took another 10mg and was unwell for several days after the treatment.

Clearly the 10mg had not been enough for my body. It’s funny how there is a set text book amount written down for going to the Dentist. Having researched all the recommendations, It’s always wherever I look 10mg for the Dentist.

But what if I weigh a lot more than the average person with Adrenal Insufficiency? What if my daily dose of medication is more than the average recommended daily dose?

Surely if someone on 20mg of steroids a day needs an extra 10mg before a dental procedure, then someone on 30mg a day might need 15 mg.

At the end of the day, I have come to learn that Textbook dosing does not work for me. If I follow the text book rules, I become extremely unwell and am at risk of an Adrenal Crisis and death.

On November the 5th I’m due to visit the Dentist for a filling once more. I was really surprised that the Dentist knew all about Adrenal Insufficiency. He told me “you need to take extra steroids before you arrive”. I was impressed. I knew this was correct, but the question is how much?

I don’t want to take just 10mg as suggested and then suffer hypo-adrenal symptoms for a few days and be unwell all for the sake of a filling. So this time I’m going to double dose and take 20mg. This should cover the treatment and if not, I have an emergency injection on hand!

Going to the Dentist could Kill someone with Adrenal Insufficiency if they don’t take extra meds before a procedure. However, just like i have to work out how much extra to take for exercise, or a painful period or serious emotional stress, I have to work out how much I need for a dental procedure, and it is a process of trial and error. I have to work out my own stress dose rules.

In my mind I’d rather take too much than not enough. I’d rather stay safer than sorry. Going to the Dentist should be a simple experience but more me, it’s something I have to think about and make a decision as to how much meds I should take beforehand.

My treatment will go one of either two ways, I’ll either be okay or I’ll suffer from hypo adrenal symptoms. I don’t expect to collapse this time and I certainly wont die as I’ll be taking my emergency injection with me. I’m hoping the double dose with be sufficient and then I’ll know for next time what does work because at the moment, I only know what doesn’t.

Angela

Disclaimer: Adrenal Insufficiency is a serious condition which people die from every year. I write blog posts about my condition to help raise awareness. Medical advice should be sought from a professional Endocrinologist when stress dosing as every individual is different.