Help! Dental Surgery questions?

[Jules48cats]

Hello all,
I am new to this site but glad to have found it.  It is nice to know that so many other people are going through the same things.  SJS is so hard.  I can't cry because I have no tears, so I take Zoloft because I am depressed and then my mouth gets even drier and that makes me more depressed.
Today I saw an oral Surgeon who says I need to get a tooth pulled because I have an infection in the bone in my jaw.  I had a root canal on this tooth back in 1995 and they never took out the whole root.  The Dentist I saw today said the root calcified and it will be a reoccurring infection.   I wanted him to go in through the gum and fix it but he said I will lose the tooth anyway.  Since the tooth is in the bottom right near the front.  I want to get an implant.  The cost is very high, but I have worked so hard to keep from getting dentures.  I do have a lot of crowns and some bridgework.
Anyway when they pull the tooth, the dentist says he is going to fill it in with donor bone from a cadaver.  Then when it heals they will start the implant.   Does anyone out there have any advice or wisdom?
Jules

[Cheryl]

Jules,
   Interesting timing!   I had a molar extracted today.   A piece of bone was grafted (bone from a cow,) and the dentist stitched up the opening.  After 4 months new bone should grow there, and I will have a post implanted.   4 months later the dentist will snap on the implant and put on a crown.  Yes, it is expensive.   I added it up, and it's over $3000, and that's with a temporary crown.   However, this was my only upper molar on that side.   Since several procedures are involved, the cost will be spread over several months.   I asked about the post, and it can be used later to hold an upper denture implant on that side.   
   I will be interested in hearing about your experience.   So far no swelling, and the only pain was a headache.   If you have more questions, I can try to help.   Good luck!
Cheryl

[Jules48cats]

Cheryl 
Thank you for the reply.  That is about the estimate they gave me too and the time frame.  That makes me feel much better.  My insurance will only pay part of the extraction, so I have to pay the rest.  But it could be worse I guess.
The whole bone graft thing has me freaked out.  I am on Orencia and Imuran.  They both work on ones autoimmune system.   So I have to check with my Rheumy to see how long I must be off of them.   Also can your body reject the graft? 
Doesn't it seem when you get one thing fixed or bearable something else pops up?    I get so tired of it. 
Jules

[irish]

Jules, Welcome you to this site. Lots of nice people here with lots of info and experience.

I have lost all my teeth due to sjogrens and infections and I don't miss them one bit. They nickel and dimed me to death and I spent way to much time in the dentist chair. Also, I was scared to death that the infections I had might kill me.

I had many caps--13 I think plus many root canals. Started slowly getting teeth pulled in the back and finally ended up some years later with a partial plate on top. I knew that my teeth needed to be pulled and no one would listen to me. I went to more dentists and specialists and finally found a dentist who listened to my story and started out by pulling the one tooth that bothered me the most. At one point he pulled the bottom 4 teeth in front and I had no teeth there for close to a year. By then I had been diagnosed with sjogrens after being affected for 40 years+. I had the top ones pulled in the dentists office and the bottom ones pulled at oral surgeons.

It is amazing that I was able to get along without those bottom front teeth, but it was not noticeable until I had a big smile. My young boss used to tease me at times and I would give him the big grin. The fact is that I was not well and I had to do what had to be done to survive and get through the ordeal.

Getting implants when a person has sjogrens is really chancy to me. When we have sjogrens we are at higher risk for infection and when we are on drugs like Imuran, etc (DMARDs) we are at higher risk for infection also. The fact that you have infection in that bone is worrisome also. Bone infection can be quite serious and adding a bone graft and implant would really add to the pot. Also, if it was me I would talk to the doctor that ordered the Imuran as I don't know that you will have 100% healing of that graft without infection.

I am a retired RN and don't know it all, but I do know that dental infections can really be dangerous. When I had my teeth pulled they found that most of my roots were dead and didn't show up on x-rays. Also, I later learned that I had severely low t-cells which is why I had such bad infections. Also, my hubby has 2 autoimmune diseases and after he had a tooth pulled he got infection that went into his bone and also he swelled up around his neck to the back of his head. He was lucky to recover as good as he did. This was a long time ago and they put him on one of the newer antibiotics.

I hate to sound so negative, but I know that you are able to get a nice partial for that front tooth and it won't be so spendy nor will you have to sit and worry about infections. Don't take my word for it---please talk this over with a couple of your doctors. I would also ask you dentist if it is safe to add a bone implant to an area that has been so infected---especially if he expects the infection to come back off and on. I think I understood you correctly. Thanks for your time and enjoy the site. Irish

[Patze]

Hi Jules,

I'm sorry that you're having so many problems with your teeth, and I sure hope that you get some relief soon!

Irish has a lot of good points, and there's not much I can add. 

Is your dentist/oral surgeon willing to work with you?  Are they fluent in SJS by chance?

Hang in there, and I'll keep the digits crossed that you get some help soon; mouth pain is the worst!

Take care -

Patze

[Wynter]

Hi Jules,

I had the same experience with a failed root canal last year, except it was upper right molar(#31 tooth). My teeth are tight and some of the roots go into my sinus cavity. In Nov. 07, had the root canal. The dentist told me that he couldn't fill the canal all the way because the root was twisted. He said "Oh, it shouldn't be a problem". Well 8 months went by and I was happy because there had been no pain from that tooth. Then in July 08, I developed an infection in that same tooth in the root that wassn't completely filled. The dentist suggested removing just the root, but I wanted the tooth to be gone. The tooth was removed, but I got dry socket and it wouldn't heal properly. I ended up going to an oral surgeon who clean it out, but also had to clean out the bone for the infection had been. Turns out there was so much infection, the socket wouldn't heal. Well it's healed now and I am possiblly going to get an implant, but the oral surgeon wants to wait at least 1 year before evaluating things. My advice is to defenately have the tooth removed, but wait awhile before having the implant to make sure all infection is gone and bone has filled in.

[susanep]

I hope you are able to get done what is good for you.

I have a dental visit this afternoon. First with this dentist. I have a new dental plan and it just kicked in. All I want is to get my teeth pulled, because they are broke off and so infected. The first visit they want to do cleaning, but that would be a waste of time with my teeth. They just need to come out. Wish me luck everyone. I can't wait to get dentures.

My teeth usually do not numb easily either, because of all the infection.

susanep

[Bucky]

Hi Jules,

Ahhhh teeth . . . a sore subject for me (pun intended  ).  I don't know this for a fact, but I believe all the troubles I've had with an infected tooth root is what triggered my Sjogren's.  I'm not a doctor - this is just my opinion.

The following is not to scare you - it is just my experience.

Long story short . . . I had always thought I had inherited bad teeth from my parents.  My teeth would crumble for no reason at all.  In 1978, when I was 21 (a long time ago), I had nine teeth pulled and got a partial both top and bottom.  Fast forward to 2007 and a hole in one of my top front tooth (not THE front teeth, but one next to it).  The tooth got an infection deep in the root - my cheek (nose, sinuses and below the eye) just ached and ached.  This went on for months.  The dentist said he couldn't "save" the tooth and wanted to have it pulled.  In the meantime, my front lower teeth are all crumbling . . . literally, falling apart.

In 2008 I find out that I have Sjogren's.  I have read where having Sjogren's and lack of saliva, can affect your teeth.  I found this out in a BIG way!  (crumbling teeth)

I made the decision to have all my teeth pulled in July '08.  Expensive - yes!  However, having to "fix" all the affected teeth, it was going to be a wash expense wise with no guarantee the dental work would hold.   It has been a long road from July '08 to today.  I am still under dental care relating to this surgery but will be released next month.  It does take a while for your gums to heal after any type of surgery.

I hope you get some relief for your tooth problems.  Best wishes!!

Bucky

[Liz D.]

Hi Jules,

I had a similar problem with one of my root canaled teeth.  The root was twisted and it abscessed again a year after the original root canal.  Talk about pain!!!  The oral surgeon performed an apicoectomy (sp?) and cut through the bone and filled in the twisted part.  It has at least saved my tooth for now.

Liz D.

[navydad]

I had two pulled last week that crumbled, my dentist agreed that we;ll pull them a few at a time,, my insurance covers a 1000 a year,, so by the end of the year there going to be out on top,, and i;l get denturd on top,, dentist said the gums will heal better getting a few out at a time,, and LESS infections

[Jules48cats]

Hello All
You have given me a lot of information, some of it I knew but a lot of new info too. 
I do worry about infections because of the Orencia, it is a once a month infusion for the RA.  I do plan on talking to my Rheumatologist before I do anything. 
The oral surgeon I talked to seemed informed about SJS.  But how do you really know.  Do you know how long I screwed around with eye Doctor's before I found one that really helped me?   I wanted the oral surgeon to perform an apicoectomy, ( where they do an incision in the gums and clean it out) but he said I will lose the tooth anyway.   Like most of you I have had really bad teeth most of my life.  I am 55, so back in the 60's I had a dentist that would pull my back teeth instead of doing root canals.  My older sister went to the same dentist and by the time she was 18 she only had twelve teeth left.  She must have had SJS also.  She died when she was 24. 
So when I was in my 20's and my wisdom teeth came in, I had really good dental insurance and had root canals done on all of them.  I went to a Oral surgeon in Hershey at the time and it took over two years and cost a lot of money..   
But I never had any problems with them.   
My regular dentist now is great, and I spent tons of money on crowns and bridgework, so I really want to save what I can.   But then again I don't want to risk a bad infection.  The Orencia can turn it into a super infection.  Plus I have had both knees replaced and it probably won't be too many years before I get my right hip done.   
I hate being off my anti inflammatory drugs very long because my hands and feet swell up so much, I can't get out of bed.     
Anyway you all gave me a lot to think about and to ask my Doctor about,  Thank you all. I will let you know in the next couple of weeks what happens.   

[irish]

jules, You have told us so much more that relates to your decision about your teeth. The fact that you are on the monthly infusion of a drug that can affect healing and infections. Also, the knee replacements can be an issue also. Anyone who has an artificial joint is at high risk of infection. I would assume that you are getting antibiotics before you have any dental work done.

When a person gets an infection the bacteria can settle in the artificial joints so this is always important to consider when considering dental issues. I am 66 years old now and like you struggled so with my teeth. My one worry was that with all the infection that I had it would either travel to my brain or settle in my heart causing endocarditis or infection. People don't realize just how important it is to have heathly teeth and to be thankful that they do. Will be thinking of you.

I am going to add one more bit of information here. As we age(I know it is a dirty word) our body is more prone to infection. The function of our systems is not on par with what it was when we were 20 or 30 so that is another factor to consider. Irish

[Jules48cats]

Sorry I have been out of the loop,  Thank heavens the dentist told me it would be 4 to 6 weeks till I get my tooth pulled, because they have  to have the dental insurance payment approved. 
Last week was such a long week and I am feeling a lot of stress.  My husband got sick on Tuesday with what we thought was stomach flu.  He was throwing up every day.  Thursday we went to the Dr. and she gave him a shot and some suppositories,  By Thursday night he wasn't getting any better and I called the Dr again.  He did call back but blew me off.  said to give the medicine more time.   ( blah, blah.)  Friday morning he was worse so I called and they gave me voice mail, so I hung up and we went to the hospital.  Good thing we did, he had a blockage in his small intestine.  They operated on Friday night and removed 3 feet of his small intestine. He is doing better but not out of the woods yet.
  Then I had to work this weekend.   So I am really feeling fried.  But I do want to talk to Dr Trostle , My Rheumy about the whole Dental issue.  I trust him, and you all have given me a lot of info so I know what questions I need to ask.
Yes I always take antibiotics before I go to the dentist because of the knee replacements and I have a heart mummer also. 
Thank you in advance for any prayers or thoughts for my husband.   
Take care all and I will let you all know what happens. 

[beverley]

I haven't been for ages and I feel really guilty because I know my teeth are deteriorating, but I am terrified of the dentist.  Silly I know, but I always have been.  Also I can't afford it - no NHS places near here and it costs a fortune.

Beverley

[Katybarstool]

Jules

Your and your hubby have certainly been through the mill. What a difficult time for you both.

I will add you to my prayers.

Kathyx