MGA News Winter 2006

Mrs Gravis the elder, my mother, was keen on oral hygiene, that’s the awful modern jargon for keeping your teeth clean. Three times a day my brother and I were marched into the bathroom and introduced to the delights of Euthymol toothpaste, Eucryl and a host of other patent tooth cleaning preparations, many of which have long since disappeared from the chemists’ shelves. These were applied with hard bristle brushes and required two minutes activity; to this day I can time two minutes quite accurately without the benefit of a clock. As a healthy small boy, as with washing my neck, I always regarded tooth cleaning as an absolute pain. However, Mrs Gravis the elder was determined and it instilled a habit which has come to serve me well in later life. Keeping your teeth in good order is important for everyone, but doubly so for a myasthenic. We should all be keenly aware that any infection can make MG worse; tooth and gum disease can be especially nasty.

Despite all my attention to cleaning and regular visits to the dentist, this summer I suffered three badly infected teeth. I had been aware for some time that all was not well, but had felt no pain. I had cleaned and flossed and used all the recommended mouth washes, but eventually a crown came off revealing the ugly truth. The dentist’s verdict was that this stump and the other two were beyond saving and had to go. He is keenly aware of my MG and has taken the trouble to ensure that he knows all about the problems which a myasthenic can present. He wisely decided that for safety’s sake the extractions should be done in hospital where, should something go wrong, there would be proper backup.

I was referred to our District Hospital where, despite my referral being marked urgent, the people who decide these things put me in the normal queue, forecasting a two to three month wait for a preliminary appointment and a further three months before the actual extraction. Meanwhile the myasthenia began to worsen. The only way round the delay seemed to be by spending some of the hard earned Gravis savings on going private. I did this and saw the maxillary and facial consultant (referred to as the Max and Fax, a title to conjure with) within the week; the extractions were scheduled for two weeks later. In the meantime the neurologist who looks after me kindly arranged to see me as an urgent case. He was keen that, in my current condition, any work carried out should be under a local anaesthetic, not a general. As a result he and the ‘Max and Fax’ spoke to one another and agreed a course of action.

The extractions went well. I am sure that it was psychological, but I began to feel better as soon as the anaesthetic wore off. I was given a course of one of the antibiotics indicated for use with myasthenics. Of course, if there is a side-effect to be had, then you can guarantee that Gravis will have it and I did, but it cleared the infection. With all medication there is a trade-off between the good it does and any side-effects; in this case it was well worthwhile. The gum is healing well and I am gaining in strength. I may even soon be back to what passes as normal for me.

With the benefit of hindsight, which of course always gives 20-20 vision, I should perhaps have seen the neurologist before going private. Not everyone in the NHS understands MG and his input might have speeded things up.

Why didn’t I feel the pain of the infected tooth? Well my tame boffin friend tells me that steroids can mask the pain of even quite a nasty abscess, something that I shall bear in mind for the future. In the meantime I continue cleaning and flossing like mad. My boffin friend, aware of my dental habits, teases me by signing off emails to me with ‘keep flossing!’ and of course he is right.

MGA NEWS Winter 2006

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