Gum Issues?

[bdsmak]

Hi everyone. I'm new to the site. Was diagnosed with Wegener's in November after 4 sinus surgeries and 10 weeks of IV antibiotics all within a 2 year period. I'm on methotrexate, and definitely feel better (sinus pain has finally abated)! I am wondering if anyone has mouth or gum issues. Last month my ENT reorted my septum is now perforated. Ever since my surgery last September, I have had a "strange" feeling in the roof of my mouth - it is a numb, tingly feeling. It doesn't help my "psyche" to know the roof of my mouth can perforate as well. I am also wondering what everyone else does as far as regular dental care. Has anyone discussed Wegener's with their dentist and if so, what advice did they give? Can we still have crowns and root canals? Do we get pre-medicated for cleanings (have one coming up next month)? Do you use any specific toothpaste? FYI - I just found a toothpaste by Jason called Oral Comfort, which advertises "soothing tooth gel with CoQ10 that appears to be gentler than the regular brands - thought I'd report that just in case there is someone out there it could help. Look forward to sharing and hearing from everyone. This is a strange, scary disease....Peace, Betty

[elephant]

Hi Betty, I too had four maxillary sinus surgerie and about three months of antibiotics. I told my dentist about wegeners as soon as I was diagnosed. You may want to talk with your primary physician about getting an antibiotic before getting your teeth cleaned. I use colgate or crest or really whatever is on sale. Do you see a Wegeners specialist?

[Sangye]

Hi Betty, welcome to the group. Palmyra is our resident tooth and gum expert. I'm sure she'll be on at some point to give you some guidance.

Did your doctor tell you the roof of your mouth can perforate? I've never heard of that with Wegs. The hard palate is bone, which is not usually damaged by Wegs. The soft palate is behind it, and does not contain bone or cartilage. I would bet that the odd sensation you're getting is due to some tiny nerves being injured during the sinus surgery. Your ENT would know.

[Palmyra]

Hi there Betty,
Sounds like you have been through quite a lot in a short period of time....sorry for that, and I hope things will be under control for you shortly. So you can sort me out of the crowd, I am a dental professional/ 30 years experience, with more than a bit of professional interest in oral medicine. I am on this site because my daughter has Wegener's. I am sorry to hear of a perforated septum, but if caught early and proper meds are administered, your disease can have limited damage. Many on this site have or are dealing with septum issues, and will be able to give you good advice (first being, have you seen a vasculitis specialist yet?! You should, really you should.)

Regarding the suture or developmental seam in your hard palate, it is anatomically different than your fragile septum, and in a good way. Your nasal septum is of cartilage (poor blood supply and fragile tissue), the developmental seam in your hard palate is made of boney plate...much more durable, and not as liable to be affected by this disease. That said, I would certainly mention your symptoms to your ENT...

Over the years I have read of all kinds of unusual oral symptoms. The good news is they are usually of a temporary nature, and do not pose long term risks. Those with weg do seem to have more problems with inflammation of attached gum tissue...meaning: clean gently and well, and floss gently under the gumline daily. Avoid sugars, and be aware if your mouth seems 'dry'.

Antibiotics prior to dental treatment are not, I repeat not indicated for those with Wegener's. Save those precious antibiotics for when they are really necessary. If white counts are extremely low due to med induced immunosuppression, one needs to be careful with dentistry*. But regular cleanings and gentle flossing are simply good hygiene, and should be performed regularly. Antibiotics are not necessary prior to hygiene or simple restorative visits. Decay and issues of infection should be addressed rather than avoided.

There are really no magic elixers out there for gums or teeth, especially not over the counter. If obvious infection is a problem, your dental professional will address as necessary.

*Wegener's treatment may include immunosuppression, which can (rarely,) cause secondary issues in the oral cavity that are similar to those being treated with drugs to treat cancer. Also, untreated Wegener's can (not always,) present with a symptom described as 'strawberry gingivitis', which makes gum tissue very red and swollen. It resolves quickly with standard treatment for the disease. Another vasculitic disease does affect the oral cavity, Bechet's, and it should be ruled out as part of any differential diagnosis.

Keep us posted on your progress!

[Palmyra]

Sangye,
You are amazing! Love you for your support to this group, and your knowledge! And I agree with all you mentioned. Peace and best wishes to all!

[Sangye]

LOL--Thanks, Palmyra. You are a much valued member of this group! :hug3:

[elephant]

Palmyra, I have been have some pain in my upper last tooth (molar) and my left cheek hurst too. I am able to eat, but a little sensitive. Do you suspect abscess or severe sinus infection. I started to take some omnicef and a pain pill. Help!

[Palmyra]

Hey there Elephant,
I am so sorry that you are in pain....so many questions I could ask, but that might be better conveyed thru "notifications" to me privately, so please feel free to go there.

It is never wise to diagnose over the internet, but I can give some simple advice at this distance. First, don't take antibiotics if you are not sure that you actually have an infection. Really, antibiotics are very easy to obtain, but they can cause more harm than good. Diagnosis requires a doc, and your problem is happening on a Saturday night....horrible timing, right? I am so sorry, but it happens.

Omnicef may work for sinus infections, but it is not an antibiotic of choice for dental infection. A simple x-ray/exam from a dentist can usually determine if you are suffering from a dental infection. Swelling would be an indicator that you need to see someone immediately.

As far as pain relief goes, for most dental pain ibuprophen is better than anything else out there. It really does reduce localized inflammation, but as a weggie, if you have kidney involvement you may have been advised to avoid it. Take your physician's advice if that is the case.

Let us know how things are going, as this time of year it is difficult to know if pain might be attributed to allergy/sinus or dental infection. Oral salt rinses, localized ice packs and using a netipot for the sinuses are all good, all the time. I hope you get some relief... Palmyra:thumbsup:

[elephant]

Thanks so much for responding Palmyra. I am going to call my Denist Monday morning and try to get in soon as possible. I feel a little better today. I do self medicate myself, my doctors don't seem to mind because I have been doing it so long. I really do need to get an Eray and exam done Monday. Thanks again.

[DEE]

Hope you get sorted soon Elephant . DEE x :hug1:

[Palmyra]

Yes, good luck Elephant...glad its a bit better, and I hope you get some answers very soon.
By the way, one simple way to try to figure out if it is sinus is to lean over at the waist, placing you head below the level of your heart. If the pressure/pain increases, especially if it is on both sides, it is more likely to be sinus. If it seems to be localized to one small area (assoc'd with one tooth,) has a 'throbbing' component to the pain, or is sensitive to percussion (tap on the tooth with something solid, like the handle of a fork) then it may be tooth related.

[elephant]

Palmyra, I had a root canal on my upper last molar, that is the one that has been giving me trouble the last two years. Plus I have been on Bactrim for two years. I take DS bactrim every other day. About every six weeks I end up taking it 7 -10 days in a row because of suspected sinus infection. My question is why can't I just have that molar pulled out? I would love to have it pulled out so I don't every have to deal with it again. My denist just told me, its not a good idea. Why?

[Palmyra]

Hi there Elephant,
I didn't know you had been having trouble with that tooth for such a long time, and that it had been previously endodontically treated. Is the dentist that advised not removing the tooth the same one that did the root canal? Maybe it is time for a second opinion.
I hope you get some answers today, or at least an appointment with someone that can be of help.

[Sangye]

Pull that sucker! :laugh::blink:

[elephant]

It is not the same doctor, just a denist. He tapped on my tooth and took an xray of it. He thinks it is a sinus infection. I said he will call me in a couple of days to make sure that I am better, if not I will see the root canal specialist for an opinion.

[Palmyra]

Sounds like a good plan Elephant. Glad you were able to see someone today!

The roots of upper molars extend into the maxillary sinus. That can make determining where the pain is coming from very difficult. AND, as those roots do extent into the maxillary sinus, extraction can lead to an exposed sinus tract...not a good thing. Glad you have a plan, and do keep us posted!
:biggrin1: Don't forget to floss!

[pberggren1]

I just finnished flossing, brushing, and showering.

[Palmyra]

So when is the big date :thumbup: it sounds like you are all spiffed up and ready to go! Come have dinner with us in Austin, Texas, very possibly one of the 'coolest cities' in the US. It will be quite the trek for you, but once you have seen Common Ford Park, and had a bit of bar-b-que on the river, a dive into the cool water, and then a romp into town for a tappas meal and good live music, you will have a smile to last for years. Bring your floss!

[pberggren1]

I would so love to come down there to Austin to see you guys.

[elephant]

Thanks again Palmyra, I see the ENT friday and he will check my sinuses. My molar is feeling better.