Tooth extraction and tocilizumab

[WaltzG]

Hi I am going to have to have a tooth extraction....dentist says chance of jaw necrosis from tocilizumab and I wonder if anyone has had this ....I know from here that it is only a small chance but its scary ! Also will I need to come off medications (tocilizumab and methotrexate) first? Advice appreciated

[SnazzyD]

It can happen but from what I can see doesn’t happen so often such that every bit of information is emblazoned with warnings. Unless I missed it, the NICE guidelines didn’t have a specific note. Your immune suppression will make you more prone to infection and extraction can create a direct line to the jaw, but if your need is for decay or damaged tooth material, your risk is already there. I’ve also read advice for stopping to be 2-4 weeks prior so it seems to vary. Your Rheumy team need to know because they are the prescribers and are managing your condition, so have you tried to call them? Perhaps the Rheumy nurse. Others will reply so sit tight.

[WaltzG in reply to SnazzyD]

Many thanks I will be asking my rheumy next week ..

[PMRpro Ambassador]

I had a molar out last year - a fractured root. I got the appointment because of the pain when biting and he was all set to do it there and then until I told him I was on TCZ. So he handed me a big dose of antibiotic and told me to take it 2 hours before I came back in the afternoon. Tooth extracted in his usual efficient manner, socket covered with adrenaline soaked gauze (I'm also on anticoagulant medication) and told to come back if I had any problems with the socket. Healed nicely with no problem.

The literature I have read about jaw necrosis after tooth extraction seems to emphasise close monitoring and immediate action if the socket causes problems. I think I might stop the TCZ and MTX following the extraction - can't remember if I did but I'm not on MTX and I had had the antibiotic.

I would contact the rheumy team if you can.

[WaltzG in reply to PMRpro]

Ahh so pleased for me and you that went OK 👍 I will remember the antibiotics x