Should I have concerns about possible dental surgery?

[ArlaMo]

I have a tooth that needs either extraction and an implant, or crown lengthening and a root canal. I need to make an appointment with the periodontist, but I'm wondering if there are issues with someone on Cytoxan and pred having dental work done???

Just what I needed :unsure: All my other teeth are perfect and the dentist wasn't sure why this one was so bad.

[Psyborg]

I've had two root canals in the last 2 months. It's not listed as a side effect that I've seen, but all my problems started when I was on CTX. Certainly not scientific, but I suspect it was hard on my teeth. I didn't have any issues with the root canal, but I am on MTX now, not CTX so I'm not sure that really answers your question. You definitely will want to take pre-procedure antibiotics I'd think.

[drz]

I was told not to do this when on Cytoxan. Now on Azathioprine (generic Imuran) they told me to hold that med for three days if i need a root canal.
Ask your dentist and treating rheumatologist since they would know your situation best and have current lab results.

[ArlaMo]

Good to know, drz! After my visit with Dr. Langford, it looks like we will be switching to Rituximab so I'm going to have to check this all out thoroughly. Hoping my tooth doesn't get worse in the meantime.

[drz]

Good to know, drz! After my visit with Dr. Langford, it looks like we will be switching to Rituximab so I'm going to have to check this all out thoroughly. Hoping my tooth doesn't get worse in the meantime.

I think Rituxan is safer for dental work than Cytoxan but your doctors will know this along with your situational needs. Hope you don't have to deal with tooth pain too. Getting good dental care was emphasized as important in my over all care for Wegener's disease.

[Palmyra]

I have a tooth that needs either extraction and an implant, or crown lengthening and a root canal. I need to make an appointment with the periodontist, but I'm wondering if there are issues with someone on Cytoxan and pred having dental work done???

Just what I needed :unsure: All my other teeth are perfect and the dentist wasn't sure why this one was so bad.

Teeth are fickle...they don't respond like other 'soft' tissues in the body, even if one is systemically healthy.

I agree with Drz...best to consult with your rheumy before any treatment. Better yet, have your periodontist consult with your rheumy.

I am in the field (periodontics/oral medicine) and your periodontist should consult with your docs as to the particulars. It would be advisable to consult with the periodontist for an evaluation, and then let the docs decide on a schedule regarding needs. Normally, endo/crown lengthening is not a major proceedure thougth would take more than one visit, and the outcome is unpredictable (meaning it could succeed or it could fail).

A dental implant is more predictable, but would involve an extraction, possible bone augmentation / healing and then implant placement after an appropriate time. How deep the existing decay extends would lead to a better opinion on the matter, and your dental team should be able to help you with these decisions.

Respectfully yours,
Palmyra, mom of Alison (Crohn's'99, WG'06) 25+ years in perio/oral med

[ArlaMo]

Thank you, Palmyra, for all the great info!!

[Palmyra]

PS....AriaMo....
I think it is unlikely that Cytox or pred had anything to do with your current dental needs other than it may have thrown you 'off schedule' for preventive check ups. Do be aware if your mouth is dry, as that can make one much more suseptable to decay. Topical fluoride and a reduction in any sugar intake would be advised.
Hugs,
Palmyra

[ArlaMo]

I use Biotene mouth wash, recommended by a few of the people here, for my dry mouth. Also the spray. I did try the toothpaste, too, but it made my mouth taste even more metallic.

And yes, I think the tooth problem preceded my diagnosis - I had a filling (tooth 29) years ago on the side/front of this tooth and it has been a bit tender ever since. I never really think about it, but just had the once-every-5-years panorama x-rays done this week when it was discovered.

Probably should heed the sugar intake advice - it would probably help with the weight gain issues as well, lol.:rolleyes1:

[Palmyra]

We like tooth #29 :D, but the good news is it is not nearly as important as the one behind it (#30). Glad you are on the biotene...great product. Good luck with your care. It sounds like you are right on top of everything.

[GrandmaNel]

Just found out today that I have a tooth that is infected. My great dentist said: first, we consult with the rheumatologist. Possible options were extraction, or a root canal - apparently less invasive. Or, nothing right away, but maybe a course of antibiotics. Finally, maybe a specialist dentist for this. Am n 6 mg Prednisone a day, 25 mg. MTX a week. Anyone else have experience with successful dental work and Wegeners?

[Pete]

Just found out today that I have a tooth that is infected. My great dentist said: first, we consult with the rheumatologist. Possible options were extraction, or a root canal - apparently less invasive. Or, nothing right away, but maybe a course of antibiotics. Finally, maybe a specialist dentist for this. Am n 6 mg Prednisone a day, 25 mg. MTX a week. Anyone else have experience with successful dental work and Wegeners?

I had a wisdom tooth extracted and two crowns installed 2-3 years ago. My rheumatologist said that bactrim DS 3x weekly would be enough to prevent infection. I had no problems with any of these procedures. At the time I had them done, I was on 15-25 mg of mtx weekly and 5-10 mg pred daily in addition to the aforementioned bactrim.

[drz]

I had to take antibiotics for week before they did root canal since they didn't want to work on it with an active infection given my poor immune system and risk of infection. Other wise they don't do any thing extra other than advising some rinses with antiseptic mouth wash they sold me. I also use it whenever I have open sores in my mouth. I am on maintenance meds too.

[annekat]

I had two wisdom teeth and the two molars next to them extracted all at the same time, while on CTX, pred and Bactrim. The oral surgeon and my dentist both teach at the University of Washington and know about Wegener's. It was a few years ago and I don't remember if I stopped any meds beforehand, but if I did, it was minimal. I don't remember if they gave me any extra antibiotics. But I do remember how skilled the oral surgeon was, that I was comfortable the whole time, and that I healed very well and only needed to take one or two of the pain killers I was sent home with. I don't know that it would be that easy for everyone or why it was so easy for me.

[GrandmaNel]

Thank you all for the good report. Stay tuned, I'll let you know how it all plays out....

[Middlesista]

I had a wisdom tooth extracted and two crowns installed 2-3 years ago. My rheumatologist said that bactrim DS 3x weekly would be enough to prevent infection. I had no problems with any of these procedures. At the time I had them done, I was on 15-25 mg of mtx weekly and 5-10 mg pred daily in addition to the aforementioned bactrim.


My RA took me off Bactrim when I started MTX. I am finally going to MGH tomorrow to see one of their vasculitis docs and plan to ask him about this.

[annekat]

My RA took me off Bactrim when I started MTX. I am finally going to MGH tomorrow to see one of their vasculitis docs and plan to ask him about this. A lot of us still take Bactrim while on MTX. There are some precautions in the literature but they can apparently be dealt with. Some insurances will require a pre-authorization from your doc before filling the prescription. On Medicare Part D, I have had 3 different companies providing prescription drug coverage. The first was the most reluctant to approve it, but finally did. The second had no problem with it at all, the cashiers at Walgreens just had to over-ride something on their registers each time I got either Bactrim or MTX. The third, my current plan, asked for a pre-auth, but all they did was talk to the nurse and they asked her if I was being treated for cancer. She said no, and they approved it. My mind is not retaining the info about what the issues are, but you might look at the info sheet that comes with the meds. And asking a vasculitis doc at MGH should be very helpful. You don't want to be caught without protection from opportunistic lung infections, which is what Bactrim does. (I know this is getting off the topic of teeth... we'll try not to get carried away.)

[me2]

I have been on methotrexate for some time and just today filled a prescription for bactrim. The pharmacy wouldn't do it until they checked with my doc. He gave them the go ahead and they then made a note in their records and gave me the prescription.

[cjhnsn29]

Arlam. Well for someone who has been through dental surgery. I will tell you what happened to my teeth. I have been a Dental hygentist for 20 years. My teeth were cleaned all the time. I started having problems with my teeth. The gums starting going
over top of my teeth from not having enough blood flow. They sent me to a periodontist where they did perio surgery on my entire mouth. That bought me some time and very expensive. I then eventually starting having mobile teeth after a few years. Then I starting having alot of broken teeth first it was one then two etc. I ended up with 6 abcess teeth and they didn't have enough bone to support root canal, crowns, crowns legenthing. Well of course I had to end up having them extracted. I lived for 5 months with all the abcess teeth and infection. The oral surgeon would not extract the teeth until you have all the money. By the time I was able to get them extracted and had 4 bone grafting because there was so much infection. Then of course you have to get teeth made it cost me 10,000.00 out of pocket before anyone would do anything... That's my teeth situation.. Hope you have better luck. C.J.

[PANDASmomx2]

Just found out today that I have a tooth that is infected. My great dentist said: first, we consult with the rheumatologist. Possible options were extraction, or a root canal - apparently less invasive. Or, nothing right away, but maybe a course of antibiotics. Finally, maybe a specialist dentist for this. Am n 6 mg Prednisone a day, 25 mg. MTX a week. Anyone else have experience with successful dental work and Wegeners?

My opinion after having extensive dental work, abscesses with over 15 root canals, 6 failed root canals, endodontics to fix failed root canals, 9 extractions plus wisdom teeth extractions, and will have 5 implants, is to bypass the root canal and go straight to extraction. There are multiple reasons I suggest this option. First, root canals and crowns are expensive and often extraction with implant and crown are the same price. You bypass all the possible failures and additional expenses. Second, extraction is not painful, neither is a root canal or endodontics, as you're numbed for any of the three procedures. Third, it's been theorized that root canals can increase cancer risk (if you disagree with this theory please don't yell at me, I'm just passing along info I've received from dentists/oral surgeons). Fourth, no matter which option you choose a course of antibiotics should be used, my docs suggest a full 10 day dose, 5 before the procedure EVEN the root canal. I've been on 50 mg. prednisone and preventative antibiotics during extraction procedures with no adverse affects. I have not been on MTX during extractions yet, so I'm no help there. I do use the antibiotic mouthwash Paroex usually sold by the oral surgeons. It can have side effects if used for too long, so I only suggest using it for a month then just as needed. The risks with extraction are dry socket and if you choose implants, know that they can fail. I havent had one fail yet in 15+ years, but it can happen. To avoid dry socket, I suggest paying the extra money for the collagen plug. Also avoid using straws, smoking, sucking hard candy, etc for at least 2 weeks after extraction. Additionally, the oral surgeon should have you swish that antibiotic mouth wash just prior to numbing for extraction. Whatever option you choose, please make sure to treat that tooth infection aggressively, as teeth affect the sinuses and sinuses affect the teeth and infection can spread to other teeth.

[Middlesista]

My RA took me off Bactrim when I started MTX. I am finally going to MGH tomorrow to see one of their vasculitis docs and plan to ask him about this.

MGH doc agreed with keeping me off Bactrim while on the MTX

They r recommending 1gm of amoxicillin before having cavity filled however. That was from the dentist but have to check with my RA

[crowneagle]

I'm on
Cytoxan now and I just told my doctor I'm taking a drug holiday after the infusions are done. Just so I can deal with my teeth. I wouldn't trust what the doctors say even though my general surgeon said I can't get my hernia operation done until I'm off the chemo.

[drz]

I'm on
Cytoxan now and I just told my doctor I'm taking a drug holiday after the infusions are done. Just so I can deal with my teeth. I wouldn't trust what the doctors say even though my general surgeon said I can't get my hernia operation done until I'm off the chemo.

They will do it if the hernia gets straped and life threatening. Other wise any elective things will be postponed.

[GrandmaNel]

Had the tooth out, all seems okay, but had a flare with eyesight loss, so now on 50 mg. of prednisone and other stuff as well. Next going to have this 6 pulse treatment with cyclophosphamide. Little nervous about that, need to read up on it.....

[MikeG-2012]

Had the tooth out, all seems okay,

So glad everything went OK.


Next going to have this 6 pulse treatment with cyclophosphamide. Little nervous about that, need to read up on it.....

Can you talk to your doctor and try to see if you can get Rituxan instead of the cytoxin? There are far less side effects with RTX than with the cytoxin chemo...

Not sure if the approved standard protocol still states that CTX first and the on to Rituxan?!?!

[GrandmaNel]

Thanks To all who responded to my query, and HI Mike, from Illinois, my husband likes your scooter! That'd speed us up, he said....we are in Southern Ontario Canada, good hospitals here, but public medicine a wonderful thing for something like Wegener's, but they decide your treatment.......I asked about the Rituximab and was told the government mandates the cyclophosphomate first, then if it fails, the Rituximab, which they said is $20,000 - I forget whether it was for a year, or a set of treatments. We do have some private insurance through my husband's work, so if it comes to it, hopefully it is available. ..#everydayisanewadventure!

[MikeG-2012]

Thanks To all who responded to my query, and HI Mike, from Illinois, my husband likes your scooter! That'd speed us up, he said....we are in Southern Ontario Canada, good hospitals here, but public medicine a wonderful thing for something like Wegener's, but they decide your treatment.......I asked about the Rituximab and was told the government mandates the cyclophosphomate first, then if it fails, the Rituximab, which they said is $20,000 - I forget whether it was for a year, or a set of treatments. We do have some private insurance through my husband's work, so if it comes to it, hopefully it is available. ..#everydayisanewadventure!

Big scooter (BMW) or the other scooter I used to use here at the office? (-8

I thought cytoxin must be the first strike protocol. I didn't know if they had changed things yet. I've had 12 RTX treatments and two more the next few weeks (one tomorrow) and one on my birthday on June 3. $28k, WOW! I am blessed to have good insurance through the college where I work. Without the insurance, we would have surely lost our house by now. )-8

Remember to drink a lot and pass a lot. CTX does have a side effect of bladder cancer if it stays in your bladder too long. My hair never fell out completely, but did get very thin when I was on it. I took the pill form and that was a little less toxic--but it was for 6 months! (sigh) If you have the strength, get up and move every day. I lost so much muscle mass that I wish that I had pushed myself a little harder during the high dose pred days. Pred will deplete your muscle mass and add on a bunch of puff weight. (Stay-Puff Marshmallow Man Syndrome)

I hope you are on the right path towards a healthier new normal.

[annekat]

Cytoxan seems to work a little faster for some people than RTX. The idea is to get the thing under control, then can switch to another med if it makes more sense. I've heard of cases of CTX and RTX being used together.

[GrandmaNel]

Hullo Andrew, I tried to post a profile pix today, but it failed......no scooter in mine, unfortunately Mike. Will try again tomorrow...Thanks for he notes, Grandmanel

[Middlesista]

Had the tooth out, all seems okay, but had a flare with eyesight loss, so now on 50 mg. of prednisone and other stuff as well. Next going to have this 6 pulse treatment with cyclophosphamide. Little nervous about that, need to read up on it.....

Had you had problems with eyesight before GrandmaNel? Doc at MGH and my PCP told me not unusual for flares to present with original symptoms