TEETH AND GUMS, AND GOING BACKWARDS

I have had a problem with receding gums for the last few years, but it has recently - in the last two years - gotten a little more severe.

I take obsessive care of my teeth and gums, brushing and flossing and getting cleanings, but the gums have still continued to recede.

I have an idea that it is connected to my CFS. Any reduction in immune function can have knock on effects on different parts of the body, and can allow more bacteria growth in the mouth. Added to that is the fact that I have a dry mouth, which I first noticed after starting to take an anti-depressant, Lexapro, and which has continued with its replacement, SAM-e. Lack of proper saliva is a danger for all kinds of oral issues.

Another cause, I think, is steroids. I was taking Hydrocortisone for a year or two, and am at the moment taking Fludrocortisone, for orthostatic hypotension. Steroids of any kind, as I have learned, apparently thin the tissue of the gums and make it more vulnerable to recession.

I finally went to a periodontist - a gum specialist - last week. I found her very efficient and she gave off a knowledgeable air that was reassuring. Firstly she assured me that my teeth weren't about to fall out, which was a relief. On some of my teeth at the front there has been quite a bit of recession, and it does look scary, but she said that I had strong roots and teeth and they were not about to drop.

She also confirmed my suspicion that the steroids were damaging to gum health. She didn't tell me to stop taking the Fludro, but did question how much it was  helping me in general and whether it was worth it. My mouth, she mentioned, wasn't actually that dry, and that the dryness was unlikely to be causing the problems with the gums.

She said that surgery was an option to regenerate some of the gum, but that what she would really recommend is getting my teeth straightened. I have heard this before, I do have too many teeth in too small a space, and they are squashed in there at different angles.

Straightening teeth, of course, means braces. It was something that I really should have gotten done thirty years ago, but in nineteen eighties Ireland a visit to the orthodontist was a luxury that the vast majority of people couldn't afford. In fact, it probably wouldn't even have been mentioned as an option when I was young.

So now I am forty-one, and facing the prospect of wearing braces for a couple of years. More than that I probably will have to have a wisdom tooth extracted to allow this to happen. More fun! It's a good thing I have more or less lost my fear of dentists, or this all would be out of the question.

Of course none of this is certain. It is my decision. But it is clear that my squashed in teeth are worsening the recession in the positions where the teeth are more prominent, and that the gums get stretched when the teeth are misaligned in the mouth. It would certainly help the situation. I just have to see if I can afford it, and if I can stand the idea of train-tracks in my early forties.

There are other implications of the recession though. I have to decide what to do about the Fludrocortisone. It has certainly helped me a bit, though exactly how much I am unsure. It is probably about 5 or 10%, I find that I can be upright more easily with it, and standing is in general not such a strain on my system as without it. This is what fludrocortisone does, it helps maintain blood pressure, exactly what most people with ME/CFS have problems with.

It is a difficult dilemma. Continue taking the fludro and have maybe 5 or 10% greater activity levels, but also have gums that recede at an alarming rate, or have a manageable gum recession problem but lose that 5% or 10% that the medication was providing me with.

I have already cut the dose to half of my previous 0.1mg. I have already started to notice a difference in energy levels, and ability to be upright or stand for any length of time. Not disabling, by any means, but noticeable.

Of course 5% to most people isn't enormous, but to someone with such low levels of basic energy, any percentage point of loss or gain is significant. I have decided to give the steroid up for a while and see how I manage, but I am still annoyed at the thought that there is something out there that could, at least in the short term, improve my quality of life, but which is possibly not worth taking because of the side-effects.

After having established a certain level of activity in the last year or so, a level which is far from good but which is at least something, it is frustrating to know that I may have to take a step backward, as least for now. And on top of that, braces!