Need some feedback...

[Stretch1]

After my last visit with my onco it was decided that I still do not need IVIG and to take an antibiotic and viral medicine when needed -

Visited a new dentist yesterday as old one retired and was put thru the paces with a myriad of X-rays and poking around my mouth. My rt eye and temple hurt and finally an upper tooth - dentist determined that a nice pocket of infection had formed and abcessed in an old root canal and now he’s set to clear it out tomorrow. He also found infection in Another root canal and in a front tooth. I’m taking 500mg amoxicillin 3x a day today and 2 grams of it before the procedure - 2 questions: is the ivig warranted at this point and does it sound like this dentist is doing the right thing to control the infections? Btw - I brush, floss and rinse at least twice a day so obviously that’s not working -(dont floss as often).

[Cllcanada Top Poster CURE Hero]

Sounds pretty standard from my experience...I have always had amoxicillin prior to all dental work and once after an extraction a short course of penicillin.

IVIG is very expensive and there are fairly strict criteria for getting on it, you usually need a number of bacterial infections in the prceeding year and Ig counts around 400. It varies a bit by insurer and country.

Hope the dental work goes well, good to get that done...

~chris

[Stretch1 in reply to Cllcanada]

Thank you - needed to know that’s the standard of care - my Igs are at 300 but onco still doesn’t believe I need the IVIG

[ap64]

I brush floss use soft picks and anti bacterial rinse. As well I get three cleanings a year. i have extreme sicca complex and CLL have to babysit my teeth. This regimen works. Try adding the picks to your routine.

[Stretch1 in reply to ap64]

Ok thank you

[wmay13241]

My wife's NIH CAR-T trial protocol requires an IVIG infusion when her IgG drops below 400. Fhr her this occurs once every four months.

[Stretch1 in reply to wmay13241]

I keep hearing that 400 number to trip the IVIG infusions - however I’m at 300 and my CLL specialist does not believe I need it yet

[wmay13241 in reply to Stretch1]

When to start IVIG varies by the doctor, the clinical trial, and perhaps your insurance company. My regular oncologist did not start my wife on IVIG because she was not getting frequent infections even though her IgG was 325. Her NIH CAR-T clinical trial protocol requires IVIG when her IgG falls below 400.

[sandybeaches]

Your dentist appears to be treating your root canal infections in the correct way. Usually these infections happen when the tooth or cap develop a small crack ( visible usually only on x-ray ) that allows the bacteria to invade the surrounding tissue.

Even though a good oral hygiene routine is followed, these types of infections usually cannot be prevented.

There are different protocols for administering IVIG depending on where you live, as Chris stated, or treatment one is on. For example, here in British Columbia, where I live, I would have to have at least one very serious bacterial infection before I was allowed to have IVIG treatment, ( down from two previously ) even though my IgG level is now 430.

Sandy Beaches

[Stretch1]

I understand what you and the experts are saying - just not happy with the fact that I’ve got to suffer from more infections more often in one year than I have or have the one big infection that could land me in the hospital before ivig is recommended - in other words why not proactive instead of reactive medicine?