Dental work while rituximab & mtx

[irishponies]

Yes, I did search this site for answers before asking this question. Yes, I did google the question, there is no answer. The answers are for extractions.

I do NOT need an extraction, I need a crown & a regular cleaning & 1 filling. All can be done with separate appointments. Dentist is amazing but will not touch teeth without consult with rheumatologist & rheumatologist is not available to see me for 4 months.

Dentist gave me a medical clearance form to have rheumatologist sign. I do not wish to lose my front teeth and am considering signing form myself as waiting 4 months is ridiculous. (I went to the rheumatologist office yesterday with no appointment. No help at all, wait for 4 month later appointment.)

I understand the issues with infection with an extraction but this is not an extraction. Not an extraction.

Has anyone on these 2 meds had cleanings with no issues?

Has anyone on these 2 meds had a filling with no issues?

Has anyone on these 2 meds had a crown with no issues?

I do not wish to lose my teeth over the "possibility " of an infection. The loss of the teeth is NOT a possibility, it is a definite. My teeth were cleaned every 4 months for the last 10 years. I had no dental issues and took great care of my teeth. I refuse to lose them now.

Thank you to anyone that shares their experiences. I am grateful for your sharing.

[Grizzly-bear]

I believe the advice for any work done on your teeth, not just extractions, is to be given prophylaxis antibiotics. Just the act of having work done can open yourself up to infection.

I’m guessing you might already be on Co-trimoxazole if you’re on rituximab (I am), but you’ll need a broad spectrum antibiotic. Co-trixozole doesn’t interact with the broad spectrums such as amoxicillin.

[irishponies in reply to Grizzly-bear]

Thanks for responding.

I am not on any antibiotics on all. Prophylactic antibiotics were NEVER discussed with me except by the dentist and she will not prescribe them. Which doctor should I ask to prescribe the prophylactic antibiotics?

The rheumatologist has NOT mentioned/stated/warned of any immunity issues AT ALL. The nurse at the infusion center was full of info and was helpful and explained cuts becoming infected.

As I stated, dentist will not do any work without med clearance. Rheumatologist is not available for 4 months.

I am just swinging on a rope in the wind.

Plan B: I'll have to find a new dentist and not mention the diseases. Otherwise, no dental care and no teeth. Any other options?

This is exhausting. Thanks for spending the time to answer.

[Grizzly-bear in reply to irishponies]

It’s really annoying when we’re all given different advice. It’s likely that most people on immune suppressants just get dental work done and don’t think about it. If you go ahead however without antibiotics I would caution you to be on the lookout for any signs of infection.

GP might prescribe but might also say it’s unnecessary. My mum is a nurse and always pushed me to be on the cautious side.

[irishponies in reply to Grizzly-bear]

I'm still considering options. Rheumatologists emailed, stay on all of her meds and said prophylactic antibiotics are not up to her but the PCP. He retired 4/15 and I am still waiting for his replacement. I emailed his office anyway...

Thanks for replying.

[artists]

I have had a couple of fillings and my teeth cleaned while taking mycophenolate and having rituximab. I must admit I didn’t give it much thought. I have always had teeth problems so would hate to have had to wait.

I think l started dental treatment before l had rituximab,so had it in between my infusions. I’m not even sure if l told the dentist . I assumed it was safe .

It sounds like l should have been more careful, however l am fine .

[irishponies in reply to artists]

Thanks for responding. Trust me, I 1,000,000% regret having told her I was taking this crap. I think I'll have to just eat the money I spent on the consultation ($250.00!) and go to someone else and just keep my mouth shut. Until the dentist works on it! Thanks!

[cazy-g]

The only barrier re dental work for me was bisonophates . Had regular dental checks and hygiene treatments despite rituximab however there is a risk of infection and on one occasion I was asked to double steroid for treatment day .

[Paprika60]

Hi, I have vasculitis overlapped by lupus and Sjogrens. Currently I am on Hydroxychloroquine (200mg daily) and Belimumab (similar to Rituximab but much gentler) weekly.I am in the middle of having a major bridge work done which covers most of my front upper teeth, eleven teeth. To make a long story short, I couldn't opt for an implant which would have meant much smaller work. The implant metal could become toxic for people like us. So now I have to do the whole thing as three separate bridges!!! One thing is to have adrenal free anaesthetics as you may have a reaction to a regular one. I get very ill if I get a regular shot. I got this advice from HU member! My dentist always makes sure of this.

I have had no other issues whatsoever. My dentist has put gold metal copings to cover my real teeth for protection before putting porcelain bridge at the end. He has had to cut out bits of my gum line which was painful and took two weeks to heal but I developed no infection. This whole operation is taking over three months! I just make sure I take care of my teeth and gum lines really well. I also use Waterpik for extra clean and super floss at the very end. So cleaning teeth takes good half an hour in the evening. You can also gargle with Peroxyl for extra protection. Your auto immune condition shouldn't be a problem as long as the material they use is not toxic. And dentists shouldn't use dangerous materials.

For instance, filling is now all porcelain based and no longer mercury based. Hope that helps and good luck!!😅

[irishponies in reply to Paprika60]

Paprika60, Thank you! You are so generous sharing your story. I am scheduling my appointments. Thank you, your insights and experience are very helpful. I will refer to them again. Also, adrenal free analgesics is a great tip. I have been meticulous about my mouth care for decades, these meds have been wreaking havoc with my saliva. I am ready for the challenge. Thank you! May I ask further questions?

[Paprika60]

I am pleased to hear that you find my response helpful. Yes, of course. Do contact me whenever you have questions. I get much help from HU. This forum is more helpful than doctors who do not know what we go through. Good luck with your procedures.Lupus society or charity organization in US must have some listing of dentists who are very experienced with patients with lupus, I am sure. Get in touch with your state's branch and they should be able to help you. As in everything, always go with the ones with lots of experiences. The dentist who refused you clearly is inexperienced and is only worried about a possible lawsuit. By the way, why do you need to have your teeth cleaned every four months? Especially when you take such good care of them. My dentist says I have almost no plaque because of my cleaning job. So he told me not to bother and save money. 😉

[irishponies in reply to Paprika60]

I am clean teeth obsessed. It took her less than 20 minutes to clean the ol' bicuspids but that is my bad habit. I don't gamble or drink so clean teeth it is! If I hadn't do it all these years, I probably would have lost them all by now with the chemo & other meds. It is the first visit to this dentist, I don't really blame her for being cautious. She's very willing and spent a great deal of time with me. Trust me, the first thing to go wrong, I will find another dentist. (Back story: I moved 1500 miles to retire near my brother's home. Got diagnosed 6 months later. All NEW everything, doctors, dentists, meds, etc.) Thanks!