Dentist

[meemsdream]

I am having a tooth refilled this week. Do any of you take antibiotics before you go to the dentist ? I had my teeth cleaned a few months ago and did not take anything. Just wondering. Thanks, Maria

[AussieNeil Administrator]

Hi Maria,

It's best that you ask your haematologist, because the answer will depend on how badly your immune system has been compromised by your CLL and any treatment you've had. It's a reasonably common recommendation, because there's a significant risk of bugs getting directly into your blood stream and if you aren't able to deal with them due to a poor immune system, you can quickly end up very sick indeed.

My haematologist has prescribed a prophylactic antibiotic for me to take prior to any dental work, but that's because I'm very neutropenic. When I was diagnosed with CLL/SLL, my haematologist actually told me to stop flossing my teeth, because it was severity level 4 neutropenia that led to my diagnosis and blood infections via gum damage from flossing was a risk I could avoid.

Neil

[mrsjsmith]

Morning I I take a sachet of Amoxiccillin powder an hour before I go to the dentist, my GP had never heard of it and some chemists also need to order it so I now have on repeat prescription. Also, I did not think to ask why ? but the practice manager has put on my notes to have my teeth always scaled by hand. Good luck with dentist.

C

[Petey613 in reply to mrsjsmith]

I have been having issues with gum irritations and it was a gum infection that brought me to the hospital and got me diagnosed. A few people I know who are big proponents of homeopathic medicine have me rinsing and gargling with raw organic apple cider vinegar with the mother in it, about 50/50 with filtered water. My gums have been in great shape since I started using it. I had a canker sore last week(biting my lips and mouth in my sleep like a crazy stress ball) and it was really sore when I got up. A few rinses with the ACV and it was completely healed in less than 2 days. Research it yourselves and give it a try I think you will be impressed.

[jaypax]

Hi Maria

Even when you have a simple replacement filling done, there is a risk of bugs getting into your bloodstream so I would suggest that you ask your dentist (or doctor) for an antibiotic cover.

I retired from dental practice 20 years ago so things may have changed but we always prescribed 3g Amoxicillin powder to be taken one hour before the appointment, as mrsjsmith has said.

Ask your haematologist about flossing but I would err on the cautious side and drop flossing and use a mild antiseptic mouthwash instead.

Good luck to you.

Jeff P

[Newdawn Administrator]

I'm interested in the idea of using just one sachet of Amoxicillin powder before appointments because I'd never heard of this and had assumed antibiotics would need to be a course. I haven't asked for any special precautions in the past but after 25 yrs of using the same excellent dentist, he retired leaving me in the hands of a new dentist who used the instruments like power tools on wood! This dentist actually cut the inside of my cheek, seemed unconcerned and was so rough in cleaning them that it caused me pain which I articulated in very firm terms! Naturally that had to change!

Fortunately the new dentist is gentle and concerned and I may mention this to him on my next appointment.

Newdawn

[AussieNeil Administrator in reply to Newdawn]

I've also wondered about the one off approach with prophylactic antibiotics Newdawn. I suspect that the difference is that when you are taking antibiotics prophylactically, you are pre-empting any bacterial infection becoming established. Any bacteria that does happen to get into your blood stream from the dental work is quickly killed off by the antibiotic already present.

surgeryencyclopedia.com/Pa-...

When you already have a bacterial infection established, the rules change - or do they?

blog.oup.com/2011/11/antibi...

theconversation.com/no-you-...

Neil

[meemsdream in reply to AussieNeil]

Thanks Neil, I sit here and scratch my head a lot! I is amazing how many answers there can be to one question. You always give food for thought. I will call my haemot..... tomorrow. Maria

[PaulaS Volunteer]

Thanks for bringing this up, Maria. I was very interested in the responses - especially about people taking just one dose of Amoxicillin an hour before dental treatment, and about the apple cider vinegar mouth washes...

When I needed a tooth extraction three years ago, my doctor prescribed a 5 day course of antibiotics to cover it. However, 3 months ago when I needed another extraction, my haematologist said that no antibiotics were necessary... I don't think my immune system had changed much (if anything, it will have got worse over time - though my neutrophils are still OK). So I'm wondering if it was just different doctors having different opinions, or whether the recommendations on use of antibiotics has changed these last few years?

We hear so much these days, about the dangers of antibiotic resistance due to over-use of antibiotics. The more antibiotics are used, the quicker the bugs become resistant, and there are expected to be HUGE problems with resistant bugs in future So, it would seem best to avoid antibiotics if we can.

I realise we need to err on the side of caution, and some people definitely WILL need antibiotic cover for their dental work. But for people in early stages of Watch and Wait who are facing relatively simple dental treatment, who are NOT getting any more infections than they used to, and whose immune systems are not badly damaged, maybe anti-septic mouth washes would be more suitable (eg Petey613's suggestion of cider vinegar)? I guess the problem is that we don't always know how badly damaged our immune systems are...

Anyway, I hope all goes well for you at the dentist this week, Maria

Best wishes,

Paula

P.S. My latest tooth extraction healed fine with no complications and no antibiotics. (I am on W&W but approaching treatment soon).

[meemsdream in reply to PaulaS]

Paula, I have to agree with you about overuse of antibiotics. It is a hard call. I am also WW and hate to take these drugs before I really need them down the line. I am going to call my haematologist in the morning and see what he recommends. I do think the cider vinegar is fine. I will pick some up today. It can't hurt you so why not...I am finding the answers for questions about Cll are really varied. We sure can't be lumped into one group. Thank you everyone. Maria

[PaulaS Volunteer in reply to meemsdream]

You're so right, Maria, that we CLLers can't all be lumped into one group. And the answers to questions about CLL are really varied, because our disease and ages are so varied. Medical opinions are also different and evolving all the time...

I just read Thayer's post below, and it reminded me how other health issues also make a LOT of difference to our need for antibiotics (such as Thayer's heart condition). So, we have to work at communication between our different health professionals... It's good that you're going to contact your haematologist tomorrow, to see what he recommends... He'll know the bigger picture of your health situation (hopefully), and can talk with your dentist (and you) about what's best.

Best wishes,

Paula

[sun_flower in reply to PaulaS]

I agree Paula I had a tooth extraction last year and it healed fine I didnt know I had CLL at the time and apparently have had it nine years in all those years of ignorance I have had dental work and not even been diagnosed but I guess we are all different with this horrble thing and I am lucky mine is non progressive and other bloods are normal.Good luck maria,I also have a dental appointment this week the 1st one since being diagnosed.

[meemsdream in reply to sun_flower]

Thank you Paula, Good luck to BOTH of us!

[thayer]

lI do, because of past open heart surgery. Ask your dentist. He knows I have CLL. NO comment from about CLL.

ASK YOUR DENTIST.

[MsLockYourPosts Passed Volunteer]

I always take 2000mg of amoxicillin before any dental procedure. I have a combination of a mitral valve prolapse, which is why I initially was told to take an antibiotic prior to any procedure, and CLL.

[SeymourB]

I really have mixed feelings about my occasional gum infections, especially since I took a MOOC (Massively Open Online Class) on bacteria and chronic infections from the University of Cophenhagen:

coursera.org/course/bacteria

The course is aimed at a literate, non specialist audience. It starts again in November. They focused on their research in otitis media, lung infections in cystic fibrosis, and infections caused by bone implants, but did spend time on gum disease.

Bacteria that's locked in a biofilm, as in our gums, sinuses, lungs, ears, etc., easily resists antibiotics. These biofilms are what cause chronic bacterial infections. Standard antibiotic therapy can only stop freely moving ("planktonic") bacteria.

en.wikipedia.org/wiki/Biofilm

I do indeed floss regularly. I am not neutropenic yet, but my IgG is below normal. I think if you are already flossing regularly, you stand a better of preventing some chronic infection. If you haven't been flossing, I can't recommend starting to floss without having some antiobiotic prophylaxis. Mouthwashes don't do nearly as well as flossing. So I would say, if you are flossing now, don't stop.

I briefly checked PubMed, and found many articles on immunocompromised people and dentistry, but no review level that I could access. Maybe I'm not using the correct search terms. This is an important topic that deserves much more focus - something we can take with us to the dentist and the hematologist, who may not be aware of each other.

=seymour=

[meemsdream in reply to SeymourB]

Thank you for the info Seymor. I do floss and will continue to do so for now. I don't want to have more fillings replaced because I didn't! Maria

[PaulaS Volunteer]

As I've read everyone's comments, and looked up the links (thanks Neil and Seymour), I see how complicated this subject is. But I think we all agree it's a very important topic, needing more focus.

Some of the info in Neil's links seemed contradictory... One explained how important it is to finish a course of antibiotics (a message most of us are probably familiar with). Another said that this wasn't always the best thing, because the longer the course of antibiotics, the more the "friendly" gut bacteria are killed off too, which allows more of the antibiotic-resistant gut bacteria to flourish... This may be one reason why Clostidium Difficile is more of a problem than it used to be... Big sigh....

There are so many factors involved, it must be hard for doctors and dentists to know what's best. And new research is showing new things all the time...

When people have heart problems, or their immunity is known to be very low (eg they have low neutrophils and low immunoglobulins), then antibiotics will be vital for their dental work and other potential infections. But for fit, untreated people in early CLL, whose bloods are still OK, and are showing no signs of more infections than usual, then antibiotics may do more harm than good, in the long run. (Of course there are many folk in between those 2 extremes, so everyone's case has to be considered individually)

I'm glad now, that my haematologist advised against antibiotic cover for my tooth extraction earlier this year. Yes, I am about to start treatment for the CLL, but my neuts and immunoglobulins aren't too bad. And my tooth socket healed up with no problems. I did a lot of warm salty mouth washes afterwards, which probably helped.

I suspect that many doctors and dentists feel they had better play safe and prescribe antibiotics for ALL their CLL patients having dental work - just in case something goes wrong. But looking at the bigger, more longterm picture, this may not always be wise.

Paula

P.S. Neil's link to theconversation.com/no-you-... was particulary interesting, and easy to undertand.

[Oleboyredw-uk]

Three months on since last comment here and I find myself needing to see if there are any new views.

It looks like I'll be having a crown in January following my visit to the dentist today. Now, this is a 'new' dentist to me and in the three visits I've made so far have been pleased with her. She was aware of CLL, and gently felt my nodes under my chin for swelling on all three visits and was aware of my reasons for Aciclover and Co-trimoxizole in our first meeting.

Today she did something I've not seen before, gave me a handheld mirror after her examination and re-ran a sort of demo of it to show me her observations. Needless to say that ended with an "If this was my tooth I'd consider a crown".

Long and short of it, I'll probably go with her observation. I asked about antibiotics and her opinion was that it was something they used to do but don't really do so much now (I forget the rest of the comments). Anyway, I pointed out I'd discuss it with my consultant and let them know.

Without turning over all the previous material (which I am reading) any new comments or contributions?

rob