Best way to treat tooth abscess when you have Churg strauss

[Katie18]

My dentist thinks I may have an abscess on my tooth but he is not sure as I also have a back wisdom tooth growing at a strange angle into my teeth. The abscess has not showed up on X-rays yet and he plans to do another in 2 weeks time as he wants to make sure because the treatment of removing the tooth or canal root filling is very invasive.

My symptoms started out as an almost continual nagging pain moving to just a shooting pain if I bite on something - it now seems more obvious that it is coming from one of my back teeth. As I have CSS I have not been able to take ibroprophen but have managed by increasing pregabalin and using paracetamol.

My dentist has now suggested I could take an antibiotic which may ease some of the pain. I told him this would mean my coming off my azathioprine - and so he then said that probably I shouldn't bother. He doesn't seem to know much about my condition or the effects of my medication so I worry about him giving me the best advice sometimes. I took a prescription just in case I need it, Three days later I have started to feel generally unwell and my neck under my jaw seems slightly tender - this could be reated to my tooth or just a cold. I'm not sure whether to go ahead and take the antibiotics (even though the dentist said they had some unpleasant side effects) as I've since read people with poor immune conditions generally should have antibiotics. Also do I need to increase my steroids for that period whilst I takethem? I do hate the idea f taking more tablets and increasing steroids when I have fought so hard to reduce them. And sometimes there seems to be so little guidance from the medical profession. You also hear so much about how you shouldn't take antibiotics unless absolutely necessary, Sorry to rant - i get quite indecisive sometimes when i feel unwell - just wondered if anyone had a similar experience?

[HiveMind]

I was told by my (then) rheumatologist that I should take antibiotics if ever I should need dental work. However my Dr said I didn't need them! Fortunately I have good teeth and have never needed any work done since being diagnosed so this has not been an issue for me.

I was under the impression taking the antibiotics were a "safeguard" against infections arising from any debris being dislodged in the mouth and entering the bloodstream.

So, sorry I've not been of much help but I think it all depends on your Dr's/consultants as to what the process is.

Surely there must be some standardised directive with regard to dental treatment for Vasculitis patients? Anyone?

[Katie18 in reply to HiveMind]

Hi thanks for replying to me. I have been to see my doctor as I was in such pain this weekend. He prescribed antibiotics and doubled my steroids for a short period. It has helped a lot. My consultant's guidance is everytime i have any illness or infection or virus i will probably need to do that and come off my azathioprine. I didnt really class a tooth abscess in that way - but now I've learned my lesson.

[John_Mills Volunteer]

Hi Kate, I do not know of any reason why antibiotics would be contra-indicated for someone on aza - in fact quite the opposite. There is nothing about that I can find in the BNF.

As an ex-dentist, I would be inclined to suspect that your impacted wisdom tooth is number one suspect as the basic cause of the pain. There is particular antibiotic which is especially effective for treating pericoronitis around the wisdom tooth.

John

[AndrewT]

Dear Kate,

I agree with John, who told you not to take antibiotics with Aza.? I was on this drug, for about seventeen years, and never had any 'problems', with antibiotics, and I certainly needed them several times! I was also advised to have a course of antibiotics if, and when, I had any dental work done. Something I adhere to to this day- I have recently had a kidney transplant, hence a partial new drug regime, and am now on tacrolimus in place of azathioprine.

I don't have precisely your condition- I don't have exactly anyone's condition, I have 'uncategorised vasculitis (around five different 'strains' overlapping). I have had some, fairly non invasive, dental work recently and I didn't need any antibiotic cover. I am fortunate to have a dentist who has known me for some years and is, after all this time, quite familiar with my condition.

Anyway I wish you all the best, do check about the Azo., will you?

AndrewT

[Katie18]

thank you john and andy for your replies. ive been told at least twice by my consultant that if i need antibiotics for any infection i should come off aziathioprine and double my steroids. i will ask the question again when i see her in december and again when i next go to manchester to see dr bruce. My GP seemed happy with that advice too? maybe if the dental xray does not show an abscess clearly i should raise the wisdom tooth theory again. My dentist did say i could get a second opinion as he knew i wasnt happy during my last visit - which didnt fill me with confidence. Anyway the antibiotics and extra steroids have taken the pain away for now. thanks for the advice