Dentist

[George5545]

Hi all!

So with everything that has happened with moms recent diagnosis, and Covid 19, she hasn’t been to the dentist for a cleaning in almost a year. She used to have periodontal disease and after a lot of cost and discipline, she was able to get her teeth back to a relatively healthy state. She usually goes to the dentist every six months for a periodontal maintenance cleaning.

Her dentist remains closed due to the virus and last time I spoke with them, there is no telling when the will open back up. I’ve recently reached out to another dentist to see if they would see her. I was told early on that I should notify her dentist that the medications she is on (Ibrance/Letrizole) might cause more gum bleeding than usual. So when I told this new dentist office about it, they mentioned needing a medical clearance form from her doctor.

I emailed the oncologist office today and they won’t give her the form until her ANC/neutrophils are above 1500. I looked back through all her test results and she has only been at or above 1500 ONCE since starting her treatment at the beginning of the year! Assuming she ever reaches that threshold again, I don’t know how I can possibly coordinate an immediate dentist appointment! Not to mention that she may never reach that threshold!

Anyone else come across this? I can’t believe something so simple has turned into such a monumental task! Teeth health is so important - especially for the heart!- and I would hate to see her lose all the effort and thousands of dollars she has put into keeping her teeth!

Thanks for reading!

Deanna

[Red71]

I have not been told that. As long as it is just a routine teeth cleaning I don’t have to get any kind of permission. I’ve had my teeth cleaned twice while on those meds. I had to get clearance from my dentist to go on Zometa, ie, healthy teeth and gums, but nothing either way for a cleaning. I would talk to your mom’s oncologist again when you see him in person and ask for more specific information. If they still think she needs her neutrophils to be that high, maybe you can get them to delay starting her Ibrance for a week or two in August so you can coordinate an appointment for then. Elaine

[Barbteeth]

Hi there

I’m a retired dentist from UK and when I was practicing I ( or my hygienist) used to do routine scale and polishes on every patient...there were few exceptions when it couldn’t be done ...many years ago patients with heart valve or joint replacements or a history of rheumatic fever were given an antibiotic before treatment...nowadays this isn’t deemed necessary

In my opinion it would be far worse for your mums mouth to be neglected and then the possibility of losing teeth if her periodontal condition worsens ...she can help herself by using interdental brushes a sonic toothbrush and a good mouthwash like curasept

As Elaine pointed out...most oncologists require the patient to have a dental check up and report before the commencement of Ibrance treatment

Dental practices in UK are allowed to open 8 th June but advised to not use aerosols generating equipment at first which includes ultrasonic scalers...perhaps it’s different in America

Barb xx

[George5545]

Thank you both for your responses! I did send the oncologist a follow up email expressing my concerns. And we will definitely be discussing it further during her next appointment. I know mom wouldn’t be too happy about stopping the meds and the additional blood work to confirm her levels - just to get a teeth cleaning.

I’m almost to the point of not mentioning it to our current dentist when they do eventually reopen. Not sure if the morality of that. Sigh.

Thinking back on it, I think it was the CVS Specialty people that told me to notify the dentist. That’s who we get her Ibrance through.

I’m just trying to jump through the hoops and do what’s right. Ugh!

Deanna

[kearnan in reply to George5545]

That would not be right to NOT inform the dentist. I had to fill out forms for any new dentist I was trying to help me replace my front tooth and I was horrified by how I looked. Any form asked Do you or have you ever had cancer. I could not lie. If something God forbid should go wrong bc of the dental work, you would be out of luck and the doctors may be able to sue you for fraud for keeping that information from them. It not (In my opinion) to withhold that information for a tooth cleaning. You know that would be wrong. It is a pain but you have to tell the truth.

[KMBL_]

I just spoke to my oncologist this past Monday about the dentist, as I haven’t been in a year either. I told her I’d like to go, so she’s prescribed me Amoxicillin to take a few days before to a few days after. I’m Also on Ibrance/Letrozole. My ANC hasn’t been past 1.0 in a while. They’ve let me start back at .94 and .95.

[kearnan]

I had lost an excisor(?), one of the teeth on the left side of my two front teeth. I looked like a hillbilly on TV and this happened the night before I was scheduled at 5 am to be at hospital for surgery. No dentist would even help me (I used different dentists all the time) once the form I had to fill out said I had cancer. My doctor had to write me a note and even then I had several still say no (Medical liability) so for them a cleaning is not a chance they even want to take if they know someone has cancer.

Finally, my onco wrote me another letter as I was trying different dentists (and I had no tooth in front of my mouth) saying I was good for dental work and that they could call her at any time if they were worried. Finally, I found a dentist that said okay as long as she could call.

I kind of get it. Dentists do not want to take the chance working on a patient with cancer because of liability issues and they pay big money for insurance to protect themselves so something as even simple as a cleaning is something they will not want to do.

Maybe her onco can recommend a dentist that she knows has no problems working with cancer patients as long as they have access to the onco.

Good luck. It took me two full months to find a dentist.