dental work while on V + O

[skipro]

As a result of the issues below, it looks like my only strictly dental salvage is

1. Having 3 molar implants

Plus

2. A major bridge reconstruction for my front upper and lower teeth

During my FCR in 2018 I was neutropenic and my oncologist advised against any dental work

I have since relapsed had had “all necessary dental work done” before starting V + O. But the pre treatment dental work has created a rather large problem now and am concerned about the risks of infection and failed implants if I do it.

I’ve started V + O (I’ve had 5 infusions and started the 100 mg on the way up to 400mg) and my neutrophils have declined and are low although not terribly low the trend has gone from 7000 to 1600 with normal on our lab of 2100.

Anyone have any experience with major dental work on V + O or othe treatment that causes neutropenia?

Thx

Snowshoe

[lankisterguy Volunteer]

Hi skipro,

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I believe that most CLL experts would be concerned, in general, if your Neutrophils / ANC was below 1000 and alarmed if it went below 500, regardless of the cause. You may want to ask your Hem/Onc to run frequent blood tests to build confidence that yours is not continuing to drop as you reach 400mg. Some patients have mentioned that and had to back down their Ven dose.

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OTOH, here is a discussion about prophylactics and dental work from yesterday:

healthunlocked.com/cllsuppo...

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Len

[Pacificview]

Well, I am on pins and needles waiting for this post of yours to populate with feedback.I am right behind you on V & O as my 5th infusion is this thursday. As soon as treatment started I broke an upper tooth. Then yesterday broke a lower tooth at the gumline....no smiling.

I have a Dentist appointment after my preinfusion blood draw and Onc visit tomorrow. I did not even think about my body possibly not accepting an implant due to treatment.

I had two teeth pulled and implants installed over a year ago with no problems at all. But that of course was pre treat watch and wait. I suppose if the teeth need root canals. I will get them pulled and wait on implants till post treatment???? We shall see what the onc says manana as well as the Dentist.

[JigFettler Volunteer]

Hey! I had severe Neutropenia during FCR like 0.3 monthly x 6 mths, also Lymphs at 0.0 at 1 point. FCR causes constipation and I don't mind saying the piles bled. 🙈

So there was open blood contact with gut EColi. Yet no infection. Sure I was scared... waiting for my gram neg septicaemia. Didn't happen.

How was that? My questions on the matter at the time to some learned CLL experts caused a shoulder shrug and a "probably "T cells are on it" response.

But O&V affect the signalling systems and don't work like FCR, as I know you know!

Here in the UK I've found dentists don't really have an opinion in cases like ours. I avoided dental work during FCR.

Hope goes well tho, for you!

Jig

[LeoPa]

I can't answer your question but I have a story to tell. Once upon a time my grandfather who died in 1982, told us about a case in the village where a guy got a high quality denture. That must have been in the 30s or 40s maybe. Everybody was amazed by how he could crack nuts with it. But it cost him the price of a cow, which was big money back then. Then I remember how my mother told me that she couldn't be more happy with her denture. She suffered a lot through life with her teeth. Once she had none left she finally got rid of the pain and suffering and was living in Bliss so to speak. If it is made well it is as good as anyone needs. So my take away from all this is that once I get to the point where I need to consider different alternatives I'll likely go with a well made high quality denture. I'm scared out of my wits just to think about implants.

[skipro in reply to LeoPa]

I'm the same about implants, yet all the dentists want to give me dentures with implants that "lock the denture into place" and tell me if I get the other type, I won't be able to eat or get nutritions. There is a $45K profit margin difference so can't help but wonder about their motives.

[LeoPa in reply to skipro]

My mother had a simple implant without any locking device. She told me she was very happy with it. That she liked it way more than her own teeth. Because it never hurt while she suffered a lot from tooth pain and tooth problems. So I figure it's all about the money.

[Snoopy234]

I understand your concern. When I went to a new dental center for a routine descaling, the hygienist told me that she couldn't do it because of the medication I was taking (Brukinsa) which made me dangerously vulnerable to infection. She told me to ask my doctor for a strong antibiotic to be taken one hour before the intervention and two hours afterwards. I did this and had no problems with the descaling, in spite of some slight bleeding. Perhaps your dental work could be done while taking the same precautions and pausing your medication for a few days (to be discussed with your hematologist of course).

[MGirl-Aust]

Hi skipro,

I had a tooth extraction and implant while on V+O without any problems. My neutrophils were between 1 and 2 at the time, and immunoglobulins were low-ish. I went to an oral surgeon rather than regular dentist (not sure if that made any difference, but I had a bit more confidence in the surgeon), did not have any prophylactic antibiotics before the procedures, and used regular warm salt water rinses (religiously!) after each procedure for at least 2 weeks as far as I remember, to keep the area clean while it healed.

Good luck with your decision - I know it’s not much fun living with teeth problems hanging over you.

[skipro in reply to MGirl-Aust]

I'm glad this went well. I'm wondering about the wounds from all teeth being removed with a screw in denture. How will the saline rinses get to the healing wounds?

[MGirl-Aust]

I had the tooth extraction first, wound healed up, then the implant was put in around 3 months later. Saline rinses done after each procedure to keep the area clean, especially in the first few days when you can’t use a toothbrush. I’m not sure if the saline gets into every nook and cranny, but it cleans the area as much as possible. Note that after the extraction I was advised to rinse the saline around gently, to avoid dislodging the blood clot.

[skipro in reply to MGirl-Aust]

what did you eat?

[MGirl-Aust]

Different soups that I had prepared beforehand and put in freezer (added pieces of cut up bread into the soup after a couple of days), yoghurt, smoothies, oatmeal, eggs. After a few days I could eat more normal food, chewing on the opposite side only. All the best!