Tooth pain update - Can vasculitis cause this?

[AllyGY2013]

I have posted previously about trouble with tooth pain (upper right side at back).

This week a had a funny sensation in the same teeth so I took the naproxen and hoped it would settle but then it started to throb so, on Thursday, off to the dentist I went, who prescribed antibiotics as there was an infection under a root filled, crowned tooth (done a very long time ago), the tooth was tender to the touch, the gum was tender underneath it. He said things should get better now – how wrong he was! 3 hours later in a lot of pain (tooth, gum and roof of mouth) then a further 5 hours later, taking double dose antibiotics and 60mg of codeine phosphate and in tears in unbearable pain, it is now 10pm and I decide to phone the dentist at home, he was out but phoned me back within 10 mins and met me at the dental surgery shortly after.

He injected the area to get rid of the throbbing so we could discuss treatment and we decided the only course of action to alleviate the pressure and get rid of the pain was to try to remove the tooth, which wasn't going to be pleasant as full anaesthesia would not fully numb it and as there was infection it would be risky but it was that or continue with the top dose of pain killers that weren't doing anything. No choice really.

Even with top dose anaesthesia, some directly into infected area, I must admit it was painful but I managed and left his surgery at 11:30pm, was in pain until 3am but managed 2 hours sleep after that. Went back the next day for a wound check and swelling was going down, had no pain and felt so much better. OK it cost me a total of £130 but worth every penny and he didn't charge me a call out charge as he said I was 'so brave' and he 'couldn't have done it'. Needs must. I can't fault his service and thanked him profusely!

Yesterday, Friday, I had no pain and the swelling was going down but today I am sore, a little swollen and am taking paracetamol for pain; I am still taking the antibiotics (normal not double dose), the many injection sites are painful but hopefully I will feel better soon and if it doesn't improve he has told me to contact him.

My dentist can't understand what would have caused the infection as it came out of nowhere and he wondered if it could be anything to do with the vasculitis? I don't know – do any of you have any ideas? Can vasculitis type problems cause these type of reactions or infections?

[lovenothate]

Hiya, hmmmm I'd also be interested in any feedback as Im going through a similar thing - with tooth due to be extracted on Tuesday - antibiotics haven't helped and still so much pain!

[AllyGY2013 in reply to lovenothate]

I was very lucky with the treatment I received and certainly couldn't have waited considering the pain I was in. I hope the extraction goes well for you, honestly I can say it wasn't a nice experience but when asked would I make the same decision again i.e. to take it out considering the risks and discomfort I would suffer at that time, the answer is a resounding yes it was worth it and I would make the same decision now. I'm still in pain, still swollen and still fighting infection but that unbearable throbbing is gone and hopefully now the infection will get an escape route and give the antibiotics a better chance to tackle it. I wish you well and hope more people will offer advice and tell us their experiences.

[lovenothate in reply to AllyGY2013]

Bless you, thanks that's very reassuring I'm not usually that bothered about the dentists but admit I am a bit apprehensive about this one!!

[nicholls]

Hi so sorry you are going thru this and what I am about to type will not make you smile all this happened over a year . Sore face not tooth had to have a ct of my face for addenbrooks was told go to dentist you have a problem. So off to dentist who did xray lots of oh no and etc etc. Massive infection across three teeth but coming from one tooth which was a root canal tooth. It had to come out warfarin levels had to be checked then we were good to go. Had high dose antibiotics before to try and get rid of infection nothing seemed to work. Tooth removed sore face improved yippee feeling better 4 weeks in facial pain back to dentist. Where the pocket of infection had been now had a lump, think about it like a balloon holding all the nasty infection that had gone down but had nowhere to go. It had to be removed so was refered to addenbrooks Maxa facial unit. Whilst this was going on I had Campath treatment which didnt help things as it removes part of your immune system (I have behcets ) As time went on and many visits another tooth suddenly massive infection and yes root canal again, this went on for a few months. So sat down asked how many route canal teeth were left and made the decission to remove them all. So 8 teeth removed in total one cyst removed, each tooth they took out there was evidence of infection, still not out of the woods but face not as swollen.

Have just had another treatment of Campath and this time it feels so different for the better. Dr Jayne and Dr Smith look after me and both have said that prednisalone causes so many problems with teeth. Hope your feeling a bit better now its gone it will take time.

My problem now is what do I do with all these holes ? Max fax have said no implants as they feel will cause problems and I think dentures will just make the ulcers worse. Plus have a sore right side of face and under jaw and wondering if I have another cyst thing.

[AllyGY2013 in reply to nicholls]

Thanks so much for your reply, feeling sore and swollen today but definitely not the agony I was in!

I have a working diagnosis of GPA and was only on prednisolone for a short while in 2012, I have taken plaquenil since then.

I'm hoping the antibiotics will kick the infection into touch but am not convinced they will, fingers crossed. Unfortunately I have quite a few root canal fillings, although I have had 3 out so far only this one was due to infection. The latest tooth wasn't showing signs of infection but there was/is definitely some under the tooth in the gum and it feels so much better now. I was due to have a root fill and crown done but I delayed this (mainly due to cost I must admit) now I'm thinking I might just have the tooth filled and hope, as crowning it may just be throwing good money after bad, It's a prominent tooth so don't really want to lose it but will definitely discuss further with my dentist now, perhaps I can do without it. :0(

I've had a flare over the past few months, unfortunately I didn't realise at first what was happening so suffered for a couple of months before seeking help from the GP and wonder if this flare allowed the infection to get a grip?

After everything settles I will have to think about filling the gaps too, as I now have no back teeth top right and missing ones bottom right but have been advised that implants would not be advisable and I too get ulcers.

I see the rheumy specialist 6th October so hopefully we can get things under control again.

[nicholls]

I think what ever happens teeth are always going to be trouble because of the pred involved. Currently on 11mg but have been up to 40 mg for 3 months on several occassions. The worst part for me was how fast everything happened and getting a denist appt is never easy where we live, then because of all my medical problems he refers me back to addenbrooks it just seems such a mess.

[lovenothate in reply to nicholls]

Can I ask... Are you on any 'bone protection' with your pred? It's just that I've been on it for over 18 months now and have never been offered bone protection... I do wonder whether that has something to do with my tooth issues now

[AllyGY2013 in reply to lovenothate]

I was prednisolone for about 6 months (from memory) and not a very high dose, I decided to take calcium and vitamin D supplements at the time because I was having a hard time eating and drinking any foods, let alone the right ones, so after discussion with my GP I took the supplements until I could tolerate food and drink more and then luckily for me, I came of the prednisolone and started to take Hydroxychloroquine. I am overweight (no denying that) but I stay as active as I can and eat as well as I am able.

If I was in any doubt I would chat to my medical provider, whether GP, Dentist or Rheumatologist and get their views and so make an informed decision. I honestly don't know what other protection there is so sorry I can't help more.

[ldwilliams]

I have been diagnosed with Buerger's Disease, which is a form of vasculitis i believe.

I have read on a few sites re BD that gum disease and dental probs in general are linked with it, but they do not know why

Perhaps this is the case with certain other types of vascultiis ?

[BronteM]

Teeth are the worst, aren't they? I'm so sorry to hear about your problems. My dentist is fairly sure that my steroids etc are causing my infections, as well as the general stress. After a winter of shingles and UTIs, I was over the moon when my bladder finally started to feel relatively normal. But then my teeth started up! An abscess under a back tooth in my lower jaw tooth meant that I had to have a root canal filling. There is no infection there now but it still doesnt feel right and may still have to come out. Then two old fillings broke and had to be repaired. Now I have another abscess in my upper jaw, and this one is a real problem. It is under a tooth that is supporting a bridge...and my dentist does not feel that he can deal with it, so is referring me to a specialist clinic. I've had two lots of antibiotics and at the moment I am coping with paracetamol, mouth washes and Sensodyne. I've also been supplied with a mouth guard, and that has made a big difference....apparently infections can be caused by pressure (I grind my teeth!) and the guard stops me doing that. It's very comfortable, and I'm sleeping better since I got it. Perhaps you could ask your dentist if he thinks it a good idea for you?