Hello, everyone. My husband has just had 2 molars extracted within a month. He had serious pain and wicked headaches. Now he is having similar symptoms again... The molars were at the very back on opposite sides. Now it is one of the upper ones...
I am concerned that this is related to CLL. He has had wicked headaches off and on since just before diagnosis a year ago. The docs had no idea it was his teeth.
The dentist extracted one was so surprised to see him back so soon foe another. He was very concerned at the speed at which the decay occurred.
I don’t know what to think... Any ideas anyone?
Thanks!
Heathet
Written by
hsouter
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I have had an issue with dry mouth from I think the meds or the cll in general. This has caused a lot of decay. I use a rinse to stimulate my saliva glands and chewing gum during the day helps with that also. My dentist said without normal saliva the decay will continue to be an issue. He gave me PreviDent 5000 to brush my teeth with at night to help rebuild or protect the enamel on my teeth. Not sure if this helps you but this has been an issue for me. Best of luck and chin up!
Infections that tend to resolve in normal people last longer for many of us. In addition, microbes in some areas - mouth, sinus, gut, and lungs - tend to form biofilms that make it hard for antibiotics and the immune system to reach the actual core of infection. In general, I find that we force general practitioners onto a steep learning curve. Specialists seem to be more aware of immune system issues, I find, but even some of them need a clue sometimes. There are controversies in a lot of this.
For the upper molar, I wonder if the dentist did an x-ray to see if there was also a sinus infection. That's what happened to me with a root canal shortly after my diagnosis. It took several rounds of antibiotics to knock it out. He was surprised how tough it was. He now also prescribes 2000mg Amoxicillin to be taken an hour before any dental treatment that might cause bleeding, to help prevent blood-borne infections. While I don't think lack of prophylaxis led to the second molar infection, it's at least theoretically possible.
Sinus infections last for months for me now, and often block my left ear completely. I use a nasal rinse bottle to break up biofilms in the maxillary sinus, and my ENT swabs to do cultures - different microbes each of 2 times in the last year or so.
No infections since May, 2018, but I also started SCIG (sub cutaneous immunoglobulin).
Some references for antibiotic prophylaxis practice in general:
Bactaremia is the presence of bacteria in the blood - that's a concern for many of us, moreso if in immunosuppressive treatment, neutropenia, and/or hypogammaglobulinemia. It may be warranted in watch and wait, where disturbed immune system signalling prevents proper response to infection in some patients. Many of us don't get assessment of Ig levels, and even normal Ig levels may not protect as well as in normal people.
A change in the NICE guidelines on antibiotic prophylaxis
Antibiotic prophylaxis has been controversial, because it's almost impossible to do a controlled study ethically, and because of increased antibiotic resistance in the general population. Much of the focus is on preventing IE (Infective Endocarditis), and in bone or joint replacement patients. In my opinion, there's not enough focus on our population:
Indications of antibiotic prophylaxis in dental practice- Review
So you might find papers pro or con, but look for recent reviews and medical association papers on the topic. I found this massive set of prophylaxis recommendations for surgery from 2013:
Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA).
Over 1000 references! It covers so many kinds of surgery - but no dental! Sheesh.
But even 2013 is so long ago. Since then, fluoroquinolones are no longer 1st line antibiotics, for example.
Conclusions:
Ultimately, my non-professional opinion is that antibiotic prophylaxis before any kind of procedure that causes bleeding is a good idea for all but the most indolent CLL. Professional societies secretly hate each other. Consensus lasts only until the next controversy.
Evidence based medicine suffers from a lack of evidence. Demand better written guidance from every medical professional so that they will demand it up the chain.
Disclaimers:
I am not a doctor, pharmacist, or attorney. I am a prep school dropout who knows how to work a web browser. See a CLL Specialist - or two!
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
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