Hi everyone! I just had the most painful root canal on my right front tooth last week! So bad I was bodily shaking. I was informed that the infection has been brewing for quite some time and has caused an area of the bone under my nose not to grow around the root. The endodontist put me on an antibiotic, clindamycin due to allergy to penicillin, 300 mg every 6 hours for 7 days with an initial dose of 600 mg. (I was put on the same antibiotic previous to seeing the endodontist for 7 days but only 40 mg every 4 hours.) The endodontist said that the antibiotic will likely not work and the infection will just keep coming back. I'm hoping she is wrong but I took the last of the antibiotic yesterday and today I can feel the bubble in my gum again! She advised that I should have surgery to clean out the infection, cap off the root on that tooth and the one beside it that previously had a root canal and put in a bone graft. I'm wondering if anyone else has had this and if prednisone inhibits the bone graft from taking? I just don't want to go through the pain again much less have more complications. If I am going to have to do this, I want to make sure it's going to work. I'm also wondering how good the antibiotic is for my immune system since being on pred is suppressing it? Your input and knowledge is so greatly appreciated.
Dental Surgery and bone graft needed. Will predni... - PMRGCAuk
Dental Surgery and bone graft needed. Will prednisone inhibit the bone graft from taking?
I imagine it will depend on what dose you are on - you don't say as far as I can see. More of a concern would be if you had been on a bisphosphonate for low bone density. But I can't remember coming across anyone on the forum who have had that sort of problem. There have been a few who have had implants.
I am currently at 9.5 mg tapering from 10.5 mg. I take the last 10.5 mg tonight then I am on 9.5 mg full time til the next taper. I was offered to go back on the alendronate but refused since I was already on an HRT and improving.
So you have been on a bisphosphonate in the past? Is the dental surgeon aware of that?
Yes, back in Nov 2021, I was on it for 2 months and quit since I was having some major dental work done, teeth pulled, implants and crowns all on the top. I refused to take it when the bone Dr wanted me to go back on it "just incase". I was improving and I was on an HRT so I saw no real need. My blood work this time was good as well.
I didn't tell the Endo about the Alendronate since I wasn't currently taking it and it had been a while since I was on it.
If you had all that other stuff done it may well be OK and it was like me, I only took it for a month - but do tell him. Just in case ...
What about being on the antibiotic? I may need to have another round since it looks like it is bubbling up again and I'm not going to get it done right away.
Sorry - what about it? They won't do it while there is an active infection, that's pretty sure. You'd be best asking them - every surgeon has their own predilections!
I was referring to my question earlier about being on the antibiotic and how being on the pred suppresses the immune system. Is the antibiotic going to cause more problems with the immune system?
Don't see why it should. The only effect they should have n the immune system is by messing up the gut microbiome which probably is associated closely with your immune system. Good idea to take a good probiotic as soon as the abx is finished.
Thank you for your responses to my questions. I've been a bit nervous thinking that another round of antibiotic might cause more damage than good. I'm really not looking forward to this surgery as the root canal was so painful but I also want to get a few things checked out to be sure I can handle it. I'm concerned because of how I reacted to the Novocain, which I enquired about if she could do it without the epinephrine and she said they won't do it without it because of the bleeding. I also have to be awake for the surgery but she is willing to prescribe valium so I can take one the night before and the morning of which might alleviate some of the issues.
It is really only unnecessary use of abx that can cause problems in the long term. If you have an infection you will need abx - if infections gets into the bone you are in trouble.
Well I spoke with the Endo's nurse and they are going to order another round but warned me that they can't order another one. I hope this takes care of it at least until I can get some testing done! Yes, I have yogurt every night, with the pred but, with this round I may need to do a probiotic as well? Any suggestions? I have the Monistat on hand just in case that nasty rears it's ugly head!
Hi do they use laughing gas there? I have no idea of it's real name but I have pain issues at dentist....some very bad experiences in past.so my last dentist offered it to me. I didn't think it would work but it helped so much. I also get the shots w/o the roo in them and they work but you have to keep getting them as they wear off fast. A pain for the dentist to stop and give them and then as you said b the bleeding issue with surgery. I feel your pain....I have had lots of dental drama in my life. be easy on yourself and clear with them about what you need. I have found lots of attitude from dentists about their perception of how painful something is. Which is so stupid. Everyone is different. Good luck with it. Be well.
Yes and it was used for the root canal. As far as the shots go, she won't do it without the epinephrine. Flat out refuses. She seems to care though because she asked me what she could do to help me get through this. Did I need more Novocain or something else? She offered to prescribe a valium the night before and one the morning of/or a couple hours prior to. I said yes that would help but maybe more numbing agent before the shot. She said that she would do that. She was very concerned for my comfort.
I also found it interesting that the assistant kept tapping my arm when the needles were going in and let me squeeze her hand as well.
Well I am so glad that you have caring providers...that is great. It's tough. Some things are hard for pain control. I would tell them to give me everything. so it sounds like the laughing gas didn't help? You would have to load up on it before they start....and lots of numbing gel before the shots. Well good luck with it. I hope it is so much less painful than you anticipate. Here's to hand holding, Valium in the am and an easy procedure. Let us know how it goes. Be well.
Mention of Probiotics - what experience does anyone have with these? Do they work? Are any better than others and do they really benefit/improve digestion?
I had major dental work done in July and August. I had to take 4, 500 mgs each of Amoxicillin one hour before the procedures. Everything was good.
Unfortunately that falls in the category of penicillin and due to severe allergy, I can't take it. Glad things went well for you! 🙂
Interesting article! Thank you!
I'm so sorry you had to go through all that! It sounds awful. I didn't have any pain either until the needles. I did have a root canal on the tooth next to it years ago, but it didn't appear that it was involved. She said we could pull the tooth but I'm not sure that she wouldn't have to open it up to clean it out. Since the tooth is in the front and the bone has a hole in it, I'm not sure if I would be able to get an implant until the bone grows back and I sure don't want to not have a tooth there! I'm not sure the infection will stop her or delay the surgery. She seemed to think this was the only way to clear the infection. I don't think she's happy with me wanting to wait but I need answers and I don't have an appt with my GP til the 16th.
This all sounds dreadful, but you must have all the Abx to stop it going into the bone. Friend had sore heel and has had to have abx for six months…..
Could you have a denture for the missing tooth rather than an implant when it is healed to save further surgery in the future?
Thank you for your concern and info about your friend. So sorry he has to experience that. Must be pretty painful. I can't imagine being on an antibiotic for 6 months! I'm going to talk the the dentist who did all this beautiful work on my teeth and see what he has to say. This tooth already has a crown and with as much bone that is missing, I'm not sure he would be able to do an implant unless it healed good. Since it is in the front and only one tooth, I'm not sure about a denture. It's already been very costly and I still have teethe to get work done to on the bottom. Since most of the work is on the molars, I may just opt for removal where I can.
I had a similar experience. I was on 40 mg pred at the time having just been diagnosed. I noticed a front tooth was wobbly and mentioned it at the dentist. She did an Xray and found a huge abcess going right up to my eye. No pain - she said it must be draining somewhere. The bone had all gone hence the wobbly tooth. I had to have root canal treatment. She didn't bat an eyelid about me being on pred (and AA). Frequent follow up Xrays showed the bone slowly growing back. It is still not fully grown back 18 months later but the tooth isn't wobbly any more.I was prescribed a course of metronidazole antibiotic which caused no problems I am aware of.
That sounds scarey! So far the infections hasn't been shown to go anywhere but that tooth so I am thankful for that. Did you have to have a bone graft?
Thank you for the info on the Metronidazole, I thought that was only available in cream form. So far the Clindamycin has not caused any issues but I am afraid that with this next dose it might prove different. I was told that there really wasn't anything else she could prescribe that would stronger but she wouldn't prescribe anything more after this. I will be seeing my GP on the 16th to discuss possible options until I can get some testing done to be sure I'm ok to even have the surgery. I really don't want to pull the tooth.
Hi Catdance, I double checked, it was metronidazole. You can't drink any alcohol while taking it and it was my birthday during the two weeks I was on it for! My rheumy raised his eyebrows when he heard, but that's all.
No I didn't have a bone graft, and she saved the tooth (my dentist is a Doctor in dentistry and trained in the USA. She has a really good reputation). I didn't need a crown as that tooth was already veneered. It was smack bang in the middle of lockdown in England and she gave up her lunch break to see me. I bought her a big bunch of flowers to thank her.
I hope you get yours sorted out and that they don't have to extract it.
I would be very worried about the clindamycin - ironically, the dentist I worked for for 9 years contracted C. diff in early summer this year from taking one round of this antibiotic and has been bed-ridden ever since due to debilitation and bed sores. I understand there are several antibiotics which have this reputation. From my experience as a hygienist, have they told you that you will also have to have crowns placed on these teeth? they will very likely turn dark and be brittle because of the root canal treatment. You might be better off to have them extracted and a permanent bridge placed. Please consider all the options before you do anything.
Same here with the no pain and tapping on teeth with a hammer. Since there was no pain that was why they didn't discover it until the infection bubbled out into my gum. Last night the bubble let loose of some of the infection but I hadn't started the antibiotic yet. I took the first dose with the night dose of pred so I could also have the yogurt with it. The infection was actually noted in a CT scan back in Feb but the dentist that did all the crowns, bridge and implant work didn't see it either. He wasn't given the report. The Endo caught it right away and took another picture that shows the hole where the bone didn't grow back. However, the tappping on the teeth wasn't painful at all.
Dad2Cue, I have had my fair share of bad dental experiences, since I was a young child. All of my molars came in without enamel so I spent a lot of time getting repairs and wasn't allowed sugar only at Easter and Christmas. I had to brush my teeth right away, taking the enjoyment out of savoring it. It seemed like such a waste to me as a child but I did what I was told because I was afraid of the results and for all the efforts I'd still have 8 to 10 cavities at one time! Funny thing, they said due to the lack of sugar in my diet, it stunted my growth. Lol! For a women, I am not short, 5' 4" so in the long run I don't think there was much truth to it or I just caught up later in life. Just funny how they viewed things back then.
Hi Maxslady, I'm so sorry to hear about your boss/friend. Sounds absolutely dreadful! I have been dealt the winning lottery when it comes to things to be allergic to! Clindamycin is unfortunately one of the few antibiotics I can take. I have a severe allergy to penicillin. It can cause death. So there isn't much choices out there for me. So far there is only one tooth involved, #8, right in front! It already has a crown. The surgery she wants to do involves cutting across the underside of that tooth and the smaller tooth next to it as a courtesy for prevention, clean all the infection out, clipping the end of the root tips and putting a filling in to cap the end. I will be talking with the dentist that has done all this beautiful work on my teeth to see what my choices are. I certainly don't want to run around without my front tooth!
I have had PMR and Diabetes 2 for three years, only just able to walk short distances and driven my car once a few weeks ago. Down to 5mg Pred and probably staying there for a long time.
With regard to pain medication, I just had my two big toenails completely removed a week ago, never to return I hope! I have endured many years of foot injections and they were so painful. I am not needle phobic, I inject myself twice a week and am not afraid of any other injections, just in the feet.
I stood up for myself and the hospital Podiatrist organised for me to use the Green Whistle (like they use in Ambulances) for the whole procedure. It was amazing, I did not feel anything, not even pressure. I would even say that it was a pleasurable experience! This was a first for Podiatry pain medication in South Australia!
Planning to use it to have all my teeth removed ready for dentures, as Prednisolone has ruined my 75 year old teeth!
I understand your predicament and wish you well. Good luck to you. 🤗
Not quite clear how you can use Penthrax for having teeth removed since it must be inhaled continuously for pain relief.
In my case they had me breathe in and out the Penthrox five or six times, gave me the injections for the first toenail, then took it away until I let them know the feeling was returning after about 15 minutes. They topped me up with Penthrox and the other injections to work on the second toenail removal.My neighbour (an ex Nurse) always has Penthrox for any dental work requiring injections, using the same procedure.
I hope that explains how it can be used effectively. They told me that it was not meant to be used continuously.
You can use 2 tubes one after the other and breathing them in and out continuously.
I wanted an implant but the dental surgeon said because I'd had 1 dose of Bisphosphonate, he said if I had any more he couldn't guarantee the grafting of the bovine collagen I needed because I had bone loss in my gum.
Think that is a bit OTT ...
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