Root canal on Humiri

[Jaxine]

Quick question I'm due to have root canal treatment next Sat. I will have been off my medication ( Humiri) 3 weeks by then. Is this a sufficient amount of time? I've left messages with Rhemy team but to no avail!

[oldtimer2]

very cautious recommendations I found in a paper for dentists said:

1. FBC and platelet count if bleeding is involved with dental procedure procedure

2. PT, INR if the patient has liver disease

3. Discontinuation of the biological agents prior to oral surgery (extraction, periodontal surgery) 4-5 times of the drug’s 1/2 life.

Half life for adalumimab (Humira) is around 20 days.

However, I've had root canal surgery without any precautions at all - my dentist who looked it up said I didn't need to worry and antibiotic cover would be given if necessary.

But recommendations do seem to vary enormously between rheumatologists, so if you can get hold of yours, that's the best policy.

[Jaxine in reply to oldtimer2]

Thanks for the information kind of you.

[ruth_p]

I also had root canal while on Humira and didn’t stop my injections.

[Jaxine in reply to ruth_p]

Thank you Ruth, reassuring.

[Paula-C]

I know you have to stop taking anti tnfs before and after root canal treatment but I can't remember how many weeks. I'm on enbrel and a few years ago one of my crowns came out, I phoned my dentist the next morning and a few hours later I was in the dentist having root canal treatment (I've got a marvellous Nhs dentist), I had injected enbrel a few days before. I had no problems at all. Have you tried phoning your consultants secretary?

[Jaxine in reply to Paula-C]

Thanks for that Paula, yes no answer I even went into hospital but there was no one around to see me. I think ill be fine

[Blodynhaul]

Sorry my answer isn't exactly relevant to you on Humura, but I've asked a similar question recently as I have 2 or 3 teeth needing extraction. I'm on the Jak-inhibitor Filgotinib which is one pill a day, so much shorter half-life and was told to stop it for extractions (but not for fillings, not sure about root canal). I could go almost to the day before stopping it due to its short half life, then stop it for at least a week afterwards. Reluctant to stop it currently, so trying to hang on with the teeth with saltwater, painkillers & Vit C !

[Jaxine in reply to Blodynhaul]

You poor thing! Thanks for replying though. I've no 7dea I was due to take my injection yesterday so I'm giving it 3 weeks clear sure it will be fine.

[Blodynhaul in reply to Jaxine]

Sounds more than enough time! Good Luck!

[Jaxine in reply to Blodynhaul]

yes but I've woke up with a bad knee think I'm going to have to take my injection today!

[Blodynhaul in reply to Jaxine]

O dear! wonder if anti-inflamms could tide you over..! but not for me to say! good luck

[Jaxine in reply to Blodynhaul]

I'm taking paracetamol and codeine just waiting to hear bk from dentist. My rhymy nurse has told me stay off biologics for 3 weeks before and 2 weeks after., going to be horrible in terms of the RA!

[Blodynhaul in reply to Jaxine]

Yes, it makes sense what they say to temporarily stop the biologic etc, but, like you, worries me sick hoping horrors won't kick up again!

[Mmrr]

I remained on my JAK inhibitor, leflunomide and my daily prednisolone was upped for a few days after several dental extractions (not root canal treatment). The cavities were a little slow to heal, but did so without any infections or other issues.

[Jaxine in reply to Mmrr]

I've just spoken to my rhymy nurse, she has told me to stay off bilogics for 3 weeks prior to root canal or extraction and 2 weeks after. My RA is going to be fierce!!

[Mmrr in reply to Jaxine]

There seems to be huge differences across rheumatology departments. Last year I had 2 spinal surgeries with 3 days of each other. On the advice of my neurosurgeon I stayed on all of my meds throughout and my steroids were doubled for a few days. The wounds were slow to heal but did so without any issues.He advised me that a rheumatoid flare would be more troublesome to my recovery including wound healing than any small threat of infection..

The research demonstrates between a 3 - 5 % rate of infection for non immunocompromised people, and a 5 - 10 % risk for the immunocompromised. So depending upon the research you choose to follow, there is no difference in infection rates or at least it is small.

I was told the nurses would be vigilant in looking out for early signs of infection and I would transferred from the high dependency unit to ICU and started on IV antibiotics if they even thought I was brewing an infection.

My rheumatologist advised to stop all meds. I'm so pleased that I followed the neurosurgeons advice. Seemingly his is the new emerging approach to 'clean' surgery (not bowel surgery, where meds would be stopped). There is a growing realisation that a flare is more problematic for healing.

Interesting stuff.

[Jaxine in reply to Mmrr]

Thank you for that Mmrr. I actually conveyed that having been off humiri for 2 weeks and 3 days was already resulting in me experiencing neck pain and knee pain if left for another 2/3 weeks without meds I would be in a great deal of pain and anguish. Surely just for a root canal procedure this advice seems nonsensical! She stated because it s the mouth an it is much harder to heal and more likely infections to occur. I already have an infection after the dentist drilled my tooth last week. I am now on antibiotics. Also the antibiotics won't work if I'm on meds. But I agree with you, it seems madness, what if I had, had an emergency tooth extraction no time to plan!

[Mmrr in reply to Jaxine]

I hope the infection clears up without issue ( I'm sure it will). It seems that with many things rheumatological there are no hard and fast rules and we should follow guidance given to us....with a dollop of common sense at times.

[Jaxine in reply to Mmrr]

Agreed! After 4 years of an RA diagnosis I am the master now of my condition. X

[Mmrr in reply to Jaxine]

My rheumatologist was not happy that I didn't stop my meds... I told her, when asked, at my recent F2F I had no issues, the wounds healed well and I followed the advice of my neurosurgeon (I was more concerned about catching Covid whilst in the hospital to be honest, we were in the midst of lockdown, but the department is brand new, all single ensuite rooms). I thought I misheard her when she said 'what does he know he is only a surgeon' (my partner confirmed what she said when we left the consultation).

Unbelievable.

[Jaxine in reply to Mmrr]

Omg! It s irrelevant I would 100% trust my surgeon absolutly your surgeon is intelligent enough to provide you with a trusting degree of what is safe versus not safe for you taking into consideration your condition with RA. And he was right you took his advice which proved right. I have caught Covid and experienced little side effects of the virus, where as my husbund who also caught Covid was extremely ill and has no health problems. Whilst they have to give their standard advice and convey precautionary measures the ill effects of RA flare ups are debilitating, a root canal proceedure should not require 4/5 weeks off medication. I asked if iinstead I could take a small amount of pred and she said no! So I have an infection, head ache, ear ache, tooth ache and now my joints are becoming fierce. I read that actually pred can help in tooth ache as it reduces the inflamation . I don t know baffling!!