Mtx and dental extraction

[stephwest]

Hi All.
I am taking 15mg MTX per week and have 2 loose teeth (prob caused by MTX) my dentist is scared to remove then whilst on MTX the consultant at the clinic says to stay on MTX and have the teeth out because they will became infected eventualy what do I do ?stop MTX and have them out or risk what the dentist says is a danger of jaw infection.
Many Thanks
Stephen

[Pete]

I had three teeth pulled recently. I am taking no wegs maintenance except rtx (had an infusion about a month flowing dental work) and 5 mg/day of pred. I talked to my wegs doc about the dental work, and she prescribed a 10-day course of amoxicillin to begin 3days before the procedure. I had no post-op issues.

[mishb]

Hi Stephen, good to see you

My dentist would not do any dental work until he received a letter from my Rheumatologist to say that it was okay.

Long story short, it was okay and the healing went well. I took a course of antibiotics a week prior to the extraction, and for the week of, and everything was fine.

Everybody heals differently though, but just to let you know, my Rheumy said that if I needed too, I could stop taking the MTX for two weeks prior to the dental work, and then a week after (so a total of 3 weeks). I was too scared to do this though.

[Dirty Don]

Stephen, I had the entire mouthful removed a couple of years ago. Bad care, lots of pred did most of the damage. Dentists, frankly, didn't know what WG is. But, they dutifully looked it up, listened to me, and all went well. Each time extractions were started, like Mich, I started a course of antibiotics...all went well. I was deathly afraid of infection in the sinus area...both the surgeon & the care dental teams worked hard to make sure I was comfy & assured. Also, I was on MTX and it was NOT declared to be symptomatic effects of MTX...it was the pred. Best to you.

[stephwest]

I have just tapered off Pred but still on 15mg MTX per week and its the pred not the MTX that causes loose teeth is it ( I have googled for hours) -I have 2 loose teeth but stalling any extraction as long as possible, rinsing with hot salt water and corsodyl mouthwash to stop infection, thinking about stopping MTX for 3 weeks then dentist? what do you all think about that idea.
Thanks
Stephen

[annekat]

Hi, Stephen... it seems everyone is different in how Wegs and the meds affect their teeth. I had two rotted wisdoms and the molars next to them removed while on the full dose of CTX and at least 20mg. pred, if I remember the timeframe right, which I might not. I felt the damage and rotting had already begun before my WG dx, due to my own nelect. At dx, I had a lot of gum pain and reddening which resolved upon treatment, but those back teeth had already begun to go and were only going to get worse. I didn't even know the extent of it until one of the molars just broke off one day. The rot had spread from the wisdoms to the molars. The only real pain was in the one really bad wisdom. Anyway, the dentist I use teaches at our university hospital in Seattle, where there are also some pretty good WG docs, and is very smart and competent and knows what WG is, as does the oral surgeon he referred me to. Yes, there could have been an infection, and it could have been pretty dangerous with WG. So we just did it, it was easy, and it was over with. They saw no reason to stop the CTX or pred I was taking. There were no ill effects and I only needed one pain pill afterwards! I don't imagine it would hurt anything to take extra precautions, though, such as stopping your maintenance meds, and the antibiotic mouthwash sounds good too. In fact, I can't remember whether I got an antibiotic beforehand, but it seems like a good idea. In any case, I guess listening to your doc is the best policy.

[vdub]

I have had quite a bit of dental work done to include removal of a cracked tooth. Nothing special was done, but because I'm immune suppressed, I was put on antibiotics before and after the procedure. Your mouth is totally full of nasty bacteria that gets into your blood stream when any oral surgery is performed, so if you are suppressed or if you have any artificial joints, you need to get the antibiotics. I have never been asked to stop the antibiotics, tho.

[Dirty Don]

MTX is not the culprit...it tries to make us normal...lol.

[jjwestside]

Ask your rheumatologist if there is an oral surgeon that he/she has worked with before. They can work together to come up with a plan for you.

[drz]

I had antibiotics to calm down infection before a tooth was pulled. I also stopped my AZA for a couple days before and after per my treating doctors recommendation. Dental problems seem to be the norm for people with Wegs and it is important to have a good dentist and see them regularly.