Tooth extraction query but taking methotrexate.

[Sallysuk]

I have just been to the dentist (new young lady) and been told that I need to have a tooth removed but as I take folic acid? ( think she meant methotrexate so queried her) I must be referred to hospital as the bone may not heal. I asked whether there was a problem removing the tooth and was told it was a simple extraction and if my rheumatologist agrees then the dentist will remove it. Has anyone had any problem with teeth being removed as I really do not want to go into my local hospital as it advertises it has the most covid cases in NW. My tooth is not painful but is crumbling away as a large filling came out last April and when finally seen in August the previous dentist put in a temporary filling and said wait and see.

[Brychni]

I've had 2 removed since being on MTX and no one has ever said it was an issue. Both occasions they asked me about meds and didn't say anything about it.

[Carolsos in reply to Brychni]

I agree with Brychni, I had 3 teeth removed a year ago and I told them my drugs I was taking, mtx, lefluonide and hdy and they said that's fine and pulled them out. I did get dry socket though!

[MadBunny]

I'm a bit confused about the bone not healing. Did she mean the wound? I had an extraction and just had to leave off the mtx until it had healed. The dentist also gave me a prescription for an antibiotic just in case I got an infection. Which I didnt. No disrespect to dentists but it would be unusual if they knew any thing about RA and its meds. It might be an idea to contact your rheumatology helpline to get advice.All the best 🐰

[Sallysuk in reply to MadBunny]

Thanks for reply I too wondered about bone comment hence I asked if it was an extraction problem. It was also not confidence inspiring when she thought folic acid would be the problem not methotrexate, dentists may not know about RA but they should know about meds that may cause dentistry problems. I will phone my rheumatology helpline as they are always so helpful.

[MadBunny in reply to Sallysuk]

I was lucky to have a hygienist who was knowledgeable about inflammation and the link between RA and gum problems. My dentist always looks things up if in doubt I've always consulted my rheum nurse if I'm in doubt about dental treatment x

[Sallysuk in reply to MadBunny]

Unfortunately my previous dentist has sold up to a moneymaking dental company. He stayed working for them for a few months but now he and all the old faces have disappeared and the practice has very smart uniformed staff who push well being checks(not dental) and immediately propose hospital referral before researching other options for tooth extraction. Not the time to change dentists but on the cards as feeling very vulnerable with my new setup. Thanks for listening I wish mine was more like your dental practice.

[MadBunny in reply to Sallysuk]

Same thing happened to me when mine retired.I got a new whizzkid with all the latest gadgets and a very patronising manner.I didn't stay with them for long . I now go to a practice where they are all lovely. My dentist's approach is to leave well alone unless there's a problem . It's unfortunate that you can't change at the moment- let's hope it won't be too long before you can xx

[Neonkittie17 in reply to Sallysuk]

Forgot to say Sally, my rheumy wrote to my dentist at his (and my) request advising about stopping my meds (he knows Mtx as he’s very good on pharmacology and all patients have to complete a meds list/health conditions but wasn’t entirely sure how long to wait after having had Rtx. As is worked out well as I was right in the middle of being between last and next Rtx, at 3 months. My dentist always had said there is a lot of antibiotic they put into the tooth anyhow when doing a root canal. Touch wood I’ve never had an issue. Due to Rtx he’d always want me to have abx after a root canal and after after any future extraction too. He told me as I may need one for the bridge work I’ll have done when safe. He’s from a top Leeds dental practice and is on the board of the teaching committee at the main hospital in Leeds so he’s very cautious about patients with low immune etc. I wish you the best of luck. ❤️

[Hidden]

I’ve major deep canal work on numerous occasions.. no problems with MTX didn’t need to stop taking it.. maybe a second opinion..

[oldtimer]

My previous dentist was a regional dental tutor and very well informed (now only doing cosmetic work privately!) He said that some dentists were concerned by reports of jaw bone being resorbed after extraction when people were on methotrexate, but he had not seen this himself. He recommended taking an antibiotic loading dose just before the extraction to cover any bugs released into the blood stream by the extraction, but to continue with methotrexate. (I'm not on it now anyway, so no recent problems)It sounds to me as if your dentist has a vague memory of some sort of problem - but needs to go and look it up!

I would check with the rheumatology team yourself. I can't see any reason (apart from financial) for referral to hospital for extraction.

[Neonkittie17]

Hi Sally, I had a back tooth root canal-led 5 years ago as the dental hospital said it was a very difficult one but didn’t need an extraction. (My dentist asked them to confirm that even though he’s excellent, and I’m good at holding my jaw open. He just wanted the less stressful experience for me but to me the root canal was less, so he did that.) I had been told by the rheumy to leave two weeks either side free of Mtx as I’d be on abx after it anyhow. We are all advised differently and my meds are Mtx and Rituximab which depletes the B cells. I’ve also got something very similar to you which was done January 2020 in readiness for a bridge, so I’ve two temp fillings at the side to back top that the dentist said would tide me over till I’d had a day case gynae op with GA, start of March (last op my consultant did before the pandemic closed the hospital for scheduled ops.) The dental plan was to go back end of April and do the bridge work but .... of course couldn’t happen. I understand that too not wanting to go in hospital at the mo. I hope the filling hangs in there and not painful until the virus numbers go down/more of the population vaccinated and understand how difficult it is for you in your area. ❤️

[Georgiab123]

Ring your hospital nurse she’ll get answers for you x

[Sallysuk]

Thanks to everyone for your advice. My rheumatology nurse has just phoned to say I should stay on mtx until I have the extraction then stop taking both mtx and sulfasalazine until the gum has healed. She has no problem with the dentist taking it out. Only problem now is getting through to dentist as so many buttons to press and covid msgs before speaking to a person.

[Esmereld]

I take 7.5 g methotrexate, inject benapali and 2 mg prednisolone. I had a tooth out and a bone graft couple of months ago. I will get an implant in March if all goes to plan. I’ll have to miss a week’s meds as have to have a course of antibiotics. My dentist doesn’t see any issues and I’ve been fine.

[Jlwgsw]

I had a tooth extraction just over three weeks ago and am still signed off work. I got a severe infection and ended up in hospital and the consultant said I can't go back on methotrexate until I start to heal and my jaw bone has been damaged.

[Jlwgsw]

I would come off the methotrexate as I had a simple extraction and twelve weeks on I'm still having treatment. I ended up with sepsis and still keep getting infections and have shards of bone coming out as the bone was exposed.I would come off meds for a couple of weeks before. I never had problems before I was on methotrexate and wouldn't risk it.

[Sallysuk in reply to Jlwgsw]

Thanks . I did phone rheumatology helpline and they said to stop meds until wound healed up. I still have the crumbling tooth (2years+) as we decided to wait until it causes me problems. Only downside is that my dentist has now gone private so it will cost me a fortune to have the extraction. No NHS dentists are taking on new patients in our area!

[Whitegate]

My dentist says MTX and antibiotics are OK to take at the same time

[Sallysuk in reply to Whitegate]

Thanks although my rheumatology dep't & GP both tell me to stop methotrexate when taking antibiotics.