Dental Work - A Saga

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erricojj

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Greetings, friends. I am a SAVR patient and received an Inspiris Resilia tissue valve on 7/26/22. This is a long-winded story which started when I was 4 weeks post-op. The details are key to understanding the context in which my dental treatment decisions were made. In short, my providers did a great job of putting my heart first, but my GI system paid the price. I am sharing so that you may benefit should you run into similar circumstances.

8/23 - Not quite 4 weeks post-surgery. Started to notice pain coming from a molar on lower left (tooth #19).

8/25 - Visited my general dentist (who also happens to be my son-in-law). Prior to the appointment, I notified my cardiologist that I might need emergency dental work. They were concerned that I might have an infection developing and ok'd the dental visit. They ordered 2000 mg Amoxicillin and I took it 1 hour prior to my dental appointment with my general dentist. He checked #19 and found it was not temperature nor pressure sensitive. It also had been root canaled some years before and had a crown on it. However, #18 was temperature sensitive. His conclusion was that the nerve in #18 was dying and that was the source of the pain. He acted very quickly and was able to get me an emergency appointment with an endodontist that afternoon. The endodontist was informed that I am a heart patient and he asked me to take an additional 500 mg of Amoxicillin prior to the visit. This was about 5 hours after I had taken the initial 2000 mg. The endodontist performed a root canal on #18. He also ordered a 7-day course of Amoxicillin, which I started that night. He also recommended that I replace the crown on #18 as it was probably the cause of the failure. He recommended that this could wait a bit, but not months.

I went home, somewhat relieved...but quite numb.

8/27 - As this was not my first root canal, my expectation was that the discomfort would start to decrease by now. However, I was feeling pain. Once again, I could swear it was coming from #19, but thought I could be wrong and that the area was just sore from the root canal. The pain usually started in the evening, especially when I reclined. I have heard that it is fairly common for tooth pain to increase when someone reclines and increases blood pressure to the head.

8/29 - Called the endodontist and reported that pain was continuing. He advised that it could take as long as 1-2 weeks for it to subside. I accepted that advice and figured I'd just hang in there for a few more days. I was taking Amoxicillin 500 mg 3 times per day, so at least I felt I had that protection.

9/2 - Pain continued, especially at night. Clearly, this was something else. I called the endodontist again and described the pain. He said he would bring me in to check it out. That was the Friday before Labor Day weekend and the next chance to get me in was 9/6. In preparation for the 9/6 appointment, he ordered a 7-day course of Clindamycin and asked me to stop the Amoxicillin and start the Clindamycin. The Clindamycin supposedly has some advantages over Amoxicillin for dental infections, but is harsher on the GI system. I had completed almost 6 days of the 7-day course of Amoxicillin at that point. I kept my cardiologist posted on all of this using messaging in MyChart.

9/3 - 9/5 Not a fun weekend. Took my Clindamycin as ordered. I was (and am still) not allowed to take ibuprofen. Tylenol barely touched the pain.

9/6 - Went to the afternoon appointment at the endodontist. He took some new x-rays and recommended that he proceed to drill through the crown on #19 to see what was going on. There were 2 possibilities: (a) that the existing root canal had failed and infection was brewing down in the root tips, or (b) that the tooth was cracked and infection was creeping in that way. If it was (b), I would need an extraction. He drilled away and when get got a good view of what was going on, he reported that the tooth structure was intact. He then proceeded to perform an replacement of the old root canal. I had been tolerating the Clindamycin pretty well, except for some minor GI symptoms (diarrhea and some cramping) and I asked him if it was appropriate to extend the 7-day course to be sure my heart was protected until any infection cleared. He recommended against that and to just finish the 7-day course. He also recommended that the crown on #19 also be replaced....as soon as reasonably possible. I left there numb again, but much more confident that this had solved my problem.

9/8 - Took the last of the Clindamycin. The root canals appeared to be successful and no pain was coming from #18 nor #19.

9/9 - 9/12 - Dental problems seem to be solved. Still having some GI problems, but chalked it up to the usual reaction to antibiotics treatment. I was also taking probiotics 1-2 per day to try to mitigate the reaction.

9/13 - GI problems were significantly stepping up. Bathroom trips were up to 6-7 per day and not normal BM's at all. Cramping. Called my GP doctor and reported this. I did too much Dr Googling and became fearful that it might be a c. diff infection. One of the first probable causes of c. diff was listed as a recent Clindamycin treatment. This is also a highly contagious infection and could put my family at risk. I started to quarantine myself. The GP ordered a stool sample test.

9/14 - The test came back with "not detected" for about 7-8 bacteria and related toxins, but c. diff was not listed.

9/15 - Contacted my gastroenterologist. Until now, my only interaction with her was for colonoscopies. She ordered another stool test as well as blood tests. Again, all the components of the test were listed as "not detected". C. diff was not listed. However, I received a call from the gastroenterologist's office informing me that I did not have c. diff.

9/16 - now - I still have some symptoms but they seem to be decreasing each day. I continue to take probiotics. The gastroenterologist also recommended avoiding dairy products and to eat a low-fiber diet. I have an appointment with her a few days from now. I also have an appointment with my dentist about 2 weeks out to replace the crowns. It is supposed to be a non-invasive procedure, but I will be taking my 2000 mg Amoxicillin. Hopefully, my GI system will have calmed down completely by then.

The learning for me that it was necessary to protect my heart both from the dental procedures I underwent as well as the infections that might develop if we didn't act. I don't see any particular decision that could have been made better. Unfortunately, the luck of the draw was that I had 2 separate problems that resulted in me taking a total of 13 straight days of antibiotics. I generally do not have dental problems, so this was highly unusual and unlucky.

I intend to stick to the protocol of antibiotic prophylaxis for dental work, but I am now much more aware of the risks of a long course of antibiotics, especially with stronger drugs such as Clindamycin.

Has anyone had a similar experience?
 
Last edited:

pellicle

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Joined
Nov 4, 2012
Messages
10,407
Location
Queensland, OzTrayLeeYa
Hi
Has anyone had a similar experience?
thankfully no, but, if you're asking about the effect of antibiotics on your GI I'd say that it really does depend on your specific flora, as everyone reacts differently. GI flora is individual and interestingly is inherited and effected by close partners.

I believe that my gut flora is now pretty tolerant to Amoxicillin however. I'd never noticed it in the years before (I had my 2nd OHS in 1992 and have taken oral prophylaxis for dental treatment since.

More recently I had this done (back Nov 2012) and was pumped full of vancomycin, penicillin and others (via a PICC) to mix it up for months (including a redo "scrape "about 3 months later until it was finally over (more or less) some 5 months later. I remain on Oral amoxicillin (initially 500mg 3 times a day, but about 3 years ago dropped myself back to twice a day, and recently once a day).

During that time I think its fair to say my GI Flora was pretty messed up, but happily I was sufficiently distracted by other issues to not be concerned by that particular issue and when I go to the dentist now (for say, a sub-gingival clean) I do not notice anything.

Which is why I say "it depends" and is "case by case" in its effect.
 
Last edited:

Paleowoman

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Has anyone had a similar experience?
Hi - I had a different but similar experience with Azithromycin. I had a chest infection and was put on a course of Azithromycin, the course is only three days. At the end of the third day I started to experience bad upper GI symptoms, reflux and pain. I actually had to phone 111 which is out of hours NHS advice - they sent an ambulance and I was taken to A&E where I was checked out and given medication. But problems continued with a lot of pain and a couple of weeks later I saw a gastroenterologist by which time my gut was also in a bad way. I took loads or probiotics and very light diet...it settled after about six weeks.

Re the tooth - I had a cracked tooth, pain, lower back molar, about a year after AVR. I had a root canal on it but got very severe pain after. A maxillo facial surgeon said the tooth was still decayed and extracted it...but pain continued, it turned out it was due to neuropathic pain from the nerve being sensitized where the local anaesthetic injection for the root canal had been given. It was a nightmare but after several months the pain subsided.

With the tooth episode I was given so many courses of Amoxicillin that I became sensitive to penicillins so now I am prescribed 2g Cefalexin for prior to invasive dental procedures. And when I needed antibiotics for a sinus infection I was prescribed two weeks of Doxycycline without any ill effects at all :) I took plenty of probiotics along with it and after....always take them after any antibiotics and eat plenty of live yoghurt.
 

erricojj

VR.org Supporter
Supporting Member
Joined
Jun 12, 2022
Messages
32
Location
CT and FL
Hi - I had a different but similar experience with Azithromycin. I had a chest infection and was put on a course of Azithromycin, the course is only three days. At the end of the third day I started to experience bad upper GI symptoms, reflux and pain. I actually had to phone 111 which is out of hours NHS advice - they sent an ambulance and I was taken to A&E where I was checked out and given medication. But problems continued with a lot of pain and a couple of weeks later I saw a gastroenterologist by which time my gut was also in a bad way. I took loads or probiotics and very light diet...it settled after about six weeks.

Re the tooth - I had a cracked tooth, pain, lower back molar, about a year after AVR. I had a root canal on it but got very severe pain after. A maxillo facial surgeon said the tooth was still decayed and extracted it...but pain continued, it turned out it was due to neuropathic pain from the nerve being sensitized where the local anaesthetic injection for the root canal had been given. It was a nightmare but after several months the pain subsided.

With the tooth episode I was given so many courses of Amoxicillin that I became sensitive to penicillins so now I am prescribed 2g Cefalexin for prior to invasive dental procedures. And when I needed antibiotics for a sinus infection I was prescribed two weeks of Doxycycline without any ill effects at all :) I took plenty of probiotics along with it and after....always take them after any antibiotics and eat plenty of live yoghurt.
Wow! I think your Saga beats my Saga.

I'm sure non-heart-surgery-patients have their stories too, but our worries are at a different level.
 

carolinemc

Well-known member
Joined
May 31, 2010
Messages
1,256
Location
kansas city, mo
Greetings, friends. I am a SAVR patient and received an Inspiris Resilia tissue valve on 7/26/22. This is a long-winded story which started when I was 4 weeks post-op. The details are key to understanding the context in which my dental treatment decisions were made. In short, my providers did a great job of putting my heart first, but my GI system paid the price. I am sharing so that you may benefit should you run into similar circumstances.

8/23 - Not quite 4 weeks post-surgery. Started to notice pain coming from a molar on lower left (tooth #19).

8/25 - Visited my general dentist (who also happens to be my son-in-law). Prior to the appointment, I notified my cardiologist that I might need emergency dental work. They were concerned that I might have an infection developing and ok'd the dental visit. They ordered 2000 mg Amoxicillin and I took it 1 hour prior to my dental appointment with my general dentist. He checked #19 and found it was not temperature nor pressure sensitive. It also had been root canaled some years before and had a crown on it. However, #18 was temperature sensitive. His conclusion was that the nerve in #18 was dying and that was the source of the pain. He acted very quickly and was able to get me an emergency appointment with an endodontist that afternoon. The endodontist was informed that I am a heart patient and he asked me to take an additional 500 mg of Amoxicillin prior to the visit. This was about 5 hours after I had taken the initial 2000 mg. The endodontist performed a root canal on #18. He also ordered a 7-day course of Amoxicillin, which I started that night. He also recommended that I replace the crown on #18 as it was probably the cause of the failure. He recommended that this could wait a bit, but not months.

I went home, somewhat relieved...but quite numb.

8/27 - As this was not my first root canal, my expectation was that the discomfort would start to decrease by now. However, I was feeling pain. Once again, I could swear it was coming from #19, but thought I could be wrong and that the area was just sore from the root canal. The pain usually started in the evening, especially when I reclined. I have heard that it is fairly common for tooth pain to increase when someone reclines and increases blood pressure to the head.

8/29 - Called the endodontist and reported that pain was continuing. He advised that it could take as long as 1-2 weeks for it to subside. I accepted that advice and figured I'd just hang in there for a few more days. I was taking Amoxicillin 500 mg 3 times per day, so at least I felt I had that protection.

9/2 - Pain continued, especially at night. Clearly, this was something else. I called the endodontist again and described the pain. He said he would bring me in to check it out. That was the Friday before Labor Day weekend and the next chance to get me in was 9/6. In preparation for the 9/6 appointment, he ordered a 7-day course of Clindamycin and asked me to stop the Amoxicillin and start the Clindamycin. The Clindamycin supposedly has some advantages over Amoxicillin for dental infections, but is harsher on the GI system. I had completed almost 6 days of the 7-day course of Amoxicillin at that point. I kept my cardiologist posted on all of this using messaging in MyChart.

9/3 - 9/5 Not a fun weekend. Took my Clindamycin as ordered. I was (and am still) not allowed to take ibuprofen. Tylenol barely touched the pain.

9/6 - Went to the afternoon appointment at the endodontist. He took some new x-rays and recommended that he proceed to drill through the crown on #19 to see what was going on. There were 2 possibilities: (a) that the existing root canal had failed and infection was brewing down in the root tips, or (b) that the tooth was cracked and infection was creeping in that way. If it was (b), I would need an extraction. He drilled away and when get got a good view of what was going on, he reported that the tooth structure was intact. He then proceeded to perform an replacement of the old root canal. I had been tolerating the Clindamycin pretty well, except for some minor GI symptoms (diarrhea and some cramping) and I asked him if it was appropriate to extend the 7-day course to be sure my heart was protected until any infection cleared. He recommended against that and to just finish the 7-day course. He also recommended that the crown on #19 also be replaced....as soon as reasonably possible. I left there numb again, but much more confident that this had solved my problem.

9/8 - Took the last of the Clindamycin. The root canals appeared to be successful and no pain was coming from #18 nor #19.

9/9 - 9/12 - Dental problems seem to be solved. Still having some GI problems, but chalked it up to the usual reaction to antibiotics treatment. I was also taking probiotics 1-2 per day to try to mitigate the reaction.

9/13 - GI problems were significantly stepping up. Bathroom trips were up to 6-7 per day and not normal BM's at all. Cramping. Called my GP doctor and reported this. I did too much Dr Googling and became fearful that it might be a c. diff infection. One of the first probable causes of c. diff was listed as a recent Clindamycin treatment. This is also a highly contagious infection and could put my family at risk. I started to quarantine myself. The GP ordered a stool sample test.

9/14 - The test came back with "not detected" for about 7-8 bacteria and related toxins, but c. diff was not listed.

9/15 - Contacted my gastroenterologist. Until now, my only interaction with her was for colonoscopies. She ordered another stool test as well as blood tests. Again, all the components of the test were listed as "not detected". C. diff was not listed. However, I received a call from the gastroenterologist's office informing me that I did not have c. diff.

9/16 - now - I still have some symptoms but they seem to be decreasing each day. I continue to take probiotics. The gastroenterologist also recommended avoiding dairy products and to eat a low-fiber diet. I have an appointment with her a few days from now. I also have an appointment with my dentist about 2 weeks out to replace the crowns. It is supposed to be a non-invasive procedure, but I will be taking my 2000 mg Amoxicillin. Hopefully, my GI system will have calmed down completely by then.

The learning for me that it was necessary to protect my heart both from the dental procedures I underwent as well as the infections that might develop if we didn't act. I don't see any particular decision that could have been made better. Unfortunately, the luck of the draw was that I had 2 separate problems that resulted in me taking a total of 13 straight days of antibiotics. I generally do not have dental problems, so this was highly unusual and unlucky.

I intend to stick to the protocol of antibiotic prophylaxis for dental work, but I am now much more aware of the risks of a long course of antibiotics, especially with stronger drugs such as Clindamycin.

Has anyone had a similar experience?
Strange the dentist did not prescribe codeine or some other pain relief. Thank you for sticking with the regiment for dental work. But be sure they also prescribe some pain relief.
 

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
1,688
Thanks for sharing your experience so that others can learn.

I have to agree with Caroline regarding the pain medication. Dental pain can be excruciating. I had a couple of root canals about 20 years ago and hydrocodone was standard for a few days afterwards.

Then, 3 years ago, full tooth extraction and no pain killers afterwards other than Tylenol. I was told it is now their policy to not prescribe prescription pain killers following dental work, as they are doing their part to help fight the national pain killer addiction problem. It is a bit much. If there was ever a time when you need to take the edge off of the pain for a few days it is after dental work.
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
10,407
Location
Queensland, OzTrayLeeYa
I was told it is now their policy to not prescribe prescription pain killers following dental work, as they are doing their part to help fight the national pain killer addiction problem. It is a bit much. If there was ever a time when you need to take the edge off of the pain for a few days it is after dental work.
🤦‍♂️
I swear that only the dumbest most badly schooled and poorly educated on the specifics get on these committees that make these decisions. Either that or its proof that no matter how intelligent members of a committee are, that the act of being forced to make a consensus view dumbs it down to the lowest level or everyone.

Its like the situation with antibiotics, only someone who has no understanding of bacterial reproduction, no grasp of genetics and no concept of how these mechanisms works could make the determination that long term supply of antibiotics is a bad idea. The problem is actually the opposite of pain killer issues but reading this some numbKnuts has applied painkiller logic to antibiotics.

FMD
 

dchrisc

chrisc
Joined
Jul 11, 2022
Messages
4
Location
Washington state
Thanks for sharing your experience so that others can learn.

I have to agree with Caroline regarding the pain medication. Dental pain can be excruciating. I had a couple of root canals about 20 years ago and hydrocodone was standard for a few days afterwards.

Then, 3 years ago, full tooth extraction and no pain killers afterwards other than Tylenol. I was told it is now their policy to not prescribe prescription pain killers following dental work, as they are doing their part to help fight the national pain killer addiction problem. It is a bit much. If there was ever a time when you need to take the edge off of the pain for a few days it is after dental work.
In that regard, it sounds like keeping unused pain killers rather than throwing them out is a good idea. Particularly if one hasn't had issues with pain killer addiction. Dental pain as you put it can make life pretty miserable.
 

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
1,688
In that regard, it sounds like keeping unused pain killers rather than throwing them out is a good idea. Particularly if one hasn't had issues with pain killer addiction. Dental pain as you put it can make life pretty miserable.

Good point. er, I mean, never would I ever do such a thing. I mean, if theoretically, I had some left overs from my OHS, and theoretically, some 22 year old marine smashed up my ribs in Jiu Jitsu 2 weeks ago, and theoretically, I was unable to sleep due to the excrutiating pain, I would never ever break the rules and take one to help ease the pain so that I could sleep, ;) 🥱
 

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