A molar with an old amalgam filling began aching and became rather sensitive to hot and cold drinks a few days ago. When the back of my neck began aching as well, triggering concerns of developing neutropenic sepsis, I decided a visit to the dentist couldn't be ignored. Having moved recently, I hadn't yet visited a local dentist, but had ensured my previous records had been transferred. Being well into severity level 4 neutropenia, (Absolute Neutrophil Count 0.26 in last week's blood test), preparation involved filling a script for a prophylactic antibiotic. My specialist prescribes one 500mg Azithromycin 'Zedd' tablet taken 30 to 60 minutes before the appointment. (Your specialist will probably recommend something else if your compromised immune system warrants it, but I'm limited in what antibiotics I can take.) The local chemist apologised for the cost - about $5 per tablet, as Azithromycin isn't subsidised by Australia's Pharmaceutical Benefits Scheme, and provided me with an information sheet, which among other things, advised me to avoid sun exposure - which wasn't likely given we need to be careful about developing skin cancers with CLL.
When I rang the dental surgery to book the appointment, I asked for the dentist to ring me back so I could explain my risk of infection and that I was taking a prophylactic antibiotic prescribed by my specialist. I also asked if I could stay in a room other than the waiting room.
When I was about to walk out the door to go to the dentist, I received a call from the clinic, asking if I could arrive 15 minutes later, with the receptionist apologetic that they were running a bit behind. When I finally arrived, I'd barely entered the reception area, when I was whisked into an empty room by the receptionist. I was very relieved to see a range of hand washing lotions and alcohol gel at the hand washing basin.
I didn't have long to wait. The dentist was pleased that I had taken the prophylactic antibiotic recommended by my specialist and accepted a copy of my latest blood count results for my file. Thankfully an overall oral exam (including pictures of my teeth and gums) followed by particular attention to the offending tooth, including an X-ray and pulp/nerve vitality test, didn't find anything of concern. I was pleased to see my new dentist has a digital radiography unit rather than the old film X-ray technology, as these reduce radiation exposure to around 30% of that used in film X-rays as well as providing other benefits: canadianacademyofdentalhygi... I was provided with a lead apron to cover my torso, but that wasn't really necessary in my opinion. One CT scan involves about 2,000 (film x-ray) to 6,000 (digital x-ray) times as much radiation as one intra-oral x-ray. In background radiation terms, that's the equivalent of 3 years compared to about one day's background radiation! (Ironically, there is the danger of the lower radiation exposure with digital x-rays perhaps encouraging greater use, but I was pleased that my dentist conservatively only x-rayed the quadrant of my mouth containing the suspect molar.)
When I settled the account, the receptionist had even wiped down a pen with antibacterial wipe for me to sign the receipt!
Now if only all dentist visits could go as well as that!
PS1 Chaya Venkat of CLLTopics/Updates fame, considers that her husband fatally succumbed to an infection passed on by a doctor's tie, which transferred bacteria from another patient when the doctor bent over the patient. You can't be too careful when your immune system is struggling.
PS2 This post is not closed to this community; I'm dropping a card into my dentist tomorrow, thanking him and his staff for taking those extra precautions to protect me from infection. I'm including a link to this post in the card.
Photo: Raindrops on an anterrhinum (snap dragon) flower