Should I have concerns about possible dental surgery?

[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.