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Immunosuppressants and dental work

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Posted 9/20/2011 9:58 AM (GMT 0)
Has anyone on Imuran/6MP or Remicade, etc had dental work done? I'm supposed to get 2 cavities filled tomorrow. They had to get an authorization for work to be done from my GI. He signed it and told me it shouldn't be a problem but I know of other people in the same boat who have been put on prophylactic antibiotics for these things.

The dentist and my GI obviously feel ok going forward but I can't get all of the "warnings" about Imuran and dental work out of my head. confused
Posted 9/20/2011 12:26 PM (GMT 0)
I haven't had any dental work done while on Remicade or Imuran aside form cleanings. But I am a dentist, so maybe I'd be helpful? Typically, I premedicate within the AHA guidelines and in patients where there is a long standing, active infection or one that could potentially introduce bacteria in the bloodstream if they are severely immunosuppressed. I usually only predmed/post-medicate for really rough extractions or a long root canal. Premed usually for deep cleanings.

Personally, I only premed someone who is in our boat on high doses of a double immunosuppressants (like Remicade/Imuran or Humira/methotrexate). If they take that AND prednisone, they get premed with abs and Prednisone. Maybe I'm a little cavalier, but after being on these meds myself and reading up on them. Most times, the risk of an allergy to an antibiotic or a resistant strain of an organism is higher then the potential for infection.

Try not to worry about getting dental work done. Some bacteria will be introduced into your bloodstream. It's normal during the procedure. Even immunosuppressed, your body will be able to fight them off with no problem to you. Restorations are very, very simple procedures with virtually no risk to you.

Hope that helps. smilewinkgrin
Posted 9/20/2011 1:21 PM (GMT 0)
Tooth, you were beyond helpful... thank you! It's great to hear from a dentist. You've put my mind at ease and now I feel like I can feel good walking into the office tomorrow to get this done. Now, the injection I'll have to get in the roof of my mouth to numb for the anterior filling.... not so sure. rolleyes wink
Posted 9/20/2011 2:49 PM (GMT 0)
I've had 4 crowns and just last week had a root canal done.  I am on imuran and remicade.  I have never been premedicated, and I have never had any problems, thankfully. 
Posted 9/20/2011 3:13 PM (GMT 0)
Keep in mind that the doses we are on are considerably lower than the doses for kidney transplant patients. We pretty much are just tamping down an OVER ACTIVE immune system in the gut rather than a normal immune system thru out the body.

I've been on Imuran since 2003 and have had cleaning done twice a year during all that time w/no problems. Despite having COPD I get fewer colds/flus than I did w/o the Imuran.

AND they now have a mouth "number" they can apply that completely erases the sensation of the shot for the dental work!!

The ONLY panic attack I've ever had was at a new dentist's office when I had to have a filling done. I hadn't had to have anything but cleanings for years and years. In between my last dental work requiring "numbing" and this needed filling we discovered that I was sensitive to novacaine (which I don't think they even use any more).

The novacain left long lasting PAIN at the injection site for 2-3 days. We discovered the sensitivity when a hospital routinely gave a minute shot of novacain before setting an IV. I'd never had problems w/setting an IV before but everytime this hospital set one my arm would ACHE for HOURS after to the point I wished I could just tear my arm off! When I finally questioned them and they told me it was novacine to make the IV set more comfortable, less painful the lightbulb came on!

Anyway, when I went in for the filling it was obvious I was really nervous and so the dentist administered some nitrous oxide. I still was breathing heavy, panting and then tears and .... he stopped, said he would order in a special non-allergenic "number" and rescheduled me to two weeks later. (Whether he was humoring me or he ordered something special I'll never know or even if he just never uses novacine any more but wanted to ease my mind).

When I went back for the filling he applied the surface "number" whatever it was, waiting a very short time, administered the actual number shot - and I never felt a thing!!! And I had no pain afterward either.

We've since found that I'm not sensitive to lidocaine which is a close relative of novacain when it was used to remove a mole. And someone told me that novacain also had ephedrine or epinephrine or some such in it and that that was probably what I was actually sensitive to rather than the novacain itself.

Anyway, didn't mean to make the story so long. Ask your dentist to please surface numb your gums before injecting the actual "number".

Hey, Tooth, would you care to comment on or clarify my above situation regarding novacain and the surface mouth "number" too, please?? Knowing about the surface mouth "number" might make those who haven't had invasive dental work in a long time more comfortable to contemplate.
Posted 9/20/2011 10:33 PM (GMT 0)
ChronieToo, you bring up a good point with our Imuran dosages being much lower then kidney transplant patients. Their dosages are up to 250mg sometimes and that makes their white counts a lot lower.

Dentists actually don't use Novocaine anymore because 1 in 2500 don't have the proper enzyme to break down the molecule in the anesthesia. So they stopped using it sometime (not sure when, I'm a relatively new grad). But basically, the reaction you had is what a reaction to Novocaine feels like. The topical anesthesia is what we call the "number" you're talking about it. It's a flavored, stronger version of Oragel or Anbesol. Problem is that it has benzocaine in it, which is in the same family as the novocaine. So you would potentially have a reaction to the topical too. I can wax poetic for hours about the differences between ester anesthetics (Novocaine) and amide anesthetics (Lidocaine), but I'll stop before I bore you to death. :)

In short CT, I think you were having a reaction to the ester in Novocaine or the Epinpehrine. But without you being my patient, I can't tell you exactly what happened. :)

But my generation of dentists do definitely use topical anesthesia and ask how you're doing during procedures. From some of the horror stories I've heard from my patients, dentists used to be really cranky years and years ago. But if anyone needs work, I'd recommend seeing a dentist before it gets to be a problem. Things get more complicated with us since we're immunosuppressed...
Posted 9/20/2011 11:09 PM (GMT 0)
I don't think it should be a problem. I took out my 4 wisdom teeth and my GI said I could continue taking Humira at that time and I did just fine. I've also had cavities filled and haven't had to ask the gi because they've been minor.
Posted 9/20/2011 11:21 PM (GMT 0)
Well I had a root canal done today, with a post insertion (my tooth had broken badly) and placement of
temporary crown. The only problem I had was my jaws were a bit hesitant to open and shut after sitting
with my mouth wide open for so long:). I have found myself a super dentist, and everything went like
clockwork!!

Tooth, I wanted to post this because as you said in the your post old generation dentists left a lot to be
desired, but you new generation dentist have got it just right... Thank you for caring!!
Posted 9/21/2011 1:43 AM (GMT 0)
I've had loads and loads of dental work done, and I've been on 6MP since 2004. No problems of any kind, so far.
Posted 9/21/2011 11:33 AM (GMT 0)
Personally I think it all depends on the combination of medications you are on. I need some work done, and it was started 2 and a half weeks ago with a root canal. He only did what he said was the first part of it. It was done on a Friday afternoon. By Sunday I was in so much pain I went to my local Dr and he said it was infected, gave me antibiotics and pain relief. On the Monday morning I went back to the dentist. The infection was so bad and I was in so much pain that I had to have that tooth extracted, and it had also infected the tooth next to it which was my bottom wisdom tooth - so they had to cut that out while I was there too (it had to be removed at some point any way). It took a good week and a half to recover from it. I have never been in so much pain. When I saw my GI last week and told him, he said that the combination of 6mp and Allopurinol can completely wipe out your immune system. I have bloods done every 6 weeks to check it and it's very low, so my body wasn't able to fight any infection. So from now onwards I have to have premeds.
Posted 9/22/2011 4:14 PM (GMT 0)
Thanks to everyone for the input. I had the fillings done yesterday and lived to tell about it! tongue It was super easy. They did put the topical gel on to numb the surface before doing the injection but when he went to drill the second tooth, I was feeling pain, so he did some sort of a block for the whole lower left half of my jaw (tooth, I'm sure you know exactly what I'm referring to). Since it was a last minute add-on, if ya know what I mean, he didn't use the numbing gel for that one and YEEEOW! that hurt! I was a big girl, though. :-)
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