Dentistry

[Anna]

HELP!!

What has everyone been told regarding trips to the dentist post op?? It seems doctors in the US advise to take antibiotics prior to any dental treatment and doctors in the UK don't. Have I got that right?

I have had no advise regarding visits to the dentist but am now in a state of panic. My crown has just fallen out of my tooth and left a giant hole. I have been advised that when they put a crown in they seal the tooth's nerve tunnel meaning that there is little chance of infection. Is this right? I'm panicking because I have a giant hole in my mouth and am only 4 1/2 weeks post op. Am I at risk of infection? Do I need to go see the doctor for antibiotics? It's Sunday so I have no chance of getting hold of my surgeon, doctors or dentist today and it may be a while before I can even get an appointment at the dentist! Eeeeeeek.

Any ideas?

Thanks, Anna

[Juno]

I think views vary, not only from country to country, but from doctor to doctor. Most recent research has shown that antibiotics are not game changer in regards to implants. But, Dr. Gross and my dentist both have asked me to take an antibiotic 4 hours before any dental procedure (including a routine cleaning), so I am following their orders.

I would check in with both your surgeon and your dentist. That being said...the antibiotic is given in one large dose (mine was 1000 mg of amoxicillin) 2-4 hours before the dental work. So hopefully you could easily get that prescription filled and take it quickly if needed.

Best of luck!

[Pat Walter]

Anna

Don't panic, but I would ask your family doctor for a round of antibiotics.  Donna posted her story about a cracked tooth and bad infection.  Her story is here

http://surfacehippy.info/hipresurfacing/revisions-complications/398-donna-tooth-infection-hip-resurfacing-dr-su-2012

I personally would not do any dental work without antibiotics - even though many suggest it is not needed.  No point taking any chances.

I hope that helps.

Pat

[Juno]

Pat-- that is a scary story! Thanks for sharing.

[Anna]

Eeeeeeek, that is a scary story Pat! I would know if my tooth was infected right? I keep rinsing my mouth out with salt water and I will ring round tomorrow, ask my surgeon and try get an emergency appointment at the dentist. WORRIED!!!! 

[lgbran]

All will be o.k. Anna. no need to worry,
I visited my dentist prior to surgery ( have been advoiding for as long  as possible) and bombarded her with questions. I was advise that prior to any dental work simply call into the dentist and as long as it was taken 1 hour beforehand it would be fine.

My brother in law had. Metal on metal THR and wasn't advised anything.I am sure before long  a antibiotic or 2 , some dentistry work and your worries and pain will be gone.
Cheers and all the best for the new year. Have a good one

[Pat Walter]

Don't Panic.  You'll be OK.  I don't think you have to keep rinsing your mouth. Just try to get hold of your family doctor tomorrow.

Most dentists and doctors don't recommend the antibiotics any more, but as you read - things can happen.  I like to be on the conservative and careful side.

Relax - try to enjoy your evening.  It does seem to take time for an infection to occur.

Pat

[Reno]

Oh No, Anna!

My surgeon requires that I take an antibiotic prior to any dentistry work.  And, like Pat, why not err on the side of caution. After all, the antibiotics won't hurt you, but an infection potentially could. Please don't worry yourself to death tonight. All of the input you've received here seems to concur. Do call your doctor in the morning and get his or her input. Also, like Juno suggested, check with your surgeon for guidance.

I hope you have a restful night. And, I will be sending well wishes your way for tomorrow!
Reno

[Anna]

Well, I'm panicking even more now!! 

I went to the dentist today who basically said that my tooth needs extracting. Not only that but that it looks like it may already have a small infection. I cannot get my tooth extracted until the 8th Jan. I'm super worried now. Although my dentist is pretty darn good, I'm not sure they seem to understand what this means for me and my hip. They have said they don't want to give me antibiotics unless absolutely necessary. Is this not necessary? I'm mortified.

I have an appointment with the family nurse this afternoon for further advice but I cant say I'm not worried all of this. 

Anna

[luann again]

Hi Anna, I am not a Dr but a registered dental hygienist. If the dentist told you that you don't need antibiotics yet, then most likely you don't (not clear from your posts if you're in the US or not) In the US, antibiotics aren't routinely given for a small tooth infection (only for an abscess that is on the end of the tooth root-visible through x-Ray OR if your jaw is swollen, sore, and you have a draining "pimple" on the gum). As long as none of that is happening, you should be fine until the extraction. Just be sure, if your ortho and dentist require it, take an antibiotic "premedication" before it is pulled. Usually taken approx. one hour before appointment. The Dr's will decide what kind of antibiotic and in what amount.
Interestingly, many dental Dr's and professionals (I learned this at a US dental convention last year) believe that joint replacement "premed" is not warranted anymore (via American Heart Ass.). I did notice,  although this is to be strongly considered, the Drs were still reluctant to actually recommend this. Perhaps in the future, with further research, none of us will have to take it. In the meantime, call your ortho Dr or his/her nurse and see what they want you to take before your next dental appt.
Good luck, you should be fine. I understand that a joint infection from dental problems is actually pretty rare. I take continuing education classes for my license on a regular basis. It is still better to error on the side of caution, of course!
Lu

[Reno]

Hi Anna.  Hopefully, by now you have been able to speak with your family nurse and ortho doctor, and have clear direction regarding whether or not antibiotics are required for your dental work. It is amazing, the extent of impact our hip issues have on every aspect of our lives. In the case of your dental problem, while it has thrown you into a panic, I too would have the same response as yours. And, based on Luann's knowledgeable input, everything should work out okay, with no negative results for your new hip.

I know it is easy for me to say, but know that you will be okay. You are doing the right thing in getting guidance from the experts and you have the support of all of us, many who are quite knowledgeable like Luann, pulling for you.

Take care and keep us posted when you can.
Reno

[whyme]

Hi Anna,

My surgeon says to be careful with bacterial infection for the first 6 months, this includes taking antibiotics if dental work is required.

It seems things are not clear cut in medicine sometimes.

It's natural to be worried. We tend to over think this. I do. A month ago I picked up a cold and got paranoid about having an infection, as I tend to get either sinusitis or chest infection after.
I usually visit my dentist at the end of the year for a routine checkup, but as I'm only about 4 months post op now this time just decided to skip it.

Try to find answers from the pros, that will reduce anxiety until you get this resolved.

[Jason0411]

This subject always made me wonder as there was never any mention about dentistry. I reckon us Brits must be a hardier bunch than them namby pamby colonialists. Don't Panic Anna.

[Anna]

Ha ha, Jason, don't be 'dissin' my new American friends 

Well, I have calmed down a bit now. I was not happy with the advice from my dentist as he did not want to use antibiotics and seemed more concerned about preserving my smile and charging me a lot of money for it (My tooth is right at the back of my mouth and cannot be seen!) than showing any concern for my new hip. As such I found a new dentist who I visited today.

My surgeon got in touch with me and advised that whilst antibiotics is not automatically prescribed in the UK, in my case he would err on the side of caution, especially if there is any sign of an infection. He advised to take penicillin on the morning of the extraction and for a few days after.

I visited my new dentist who covered my tooth to protect it from bacteria for the next week and will be taking it out on Monday. He has prescribed penicillin and to start taking it 2 days before. He explained that there is a lot of disagreements between surgeons and dentists in the UK regarding antibiotics. The dentists have been told that they are not allowed to routinely give antibiotics purely because a patient has a replacement. If they do, they can get into trouble, especially if the patient then has an allergic reaction. He stated in my case, that because I am showing signs of infection, he has a reason to prescribe.

The situation is not ideal and I'm still a bit worried but at least now my surgeon and my dentist are all singing from the same song sheet and am I covered as much as I can be!

Fingers crossed and thanks for all your advice .... and Lu for the expert opinion. It's great to have a mixture of people on this site! 

Anna

[Pat Walter]

Glad to hear you found another dentist who wants to take no chances with your new hip.

I am glad you posted because sometimes we have to take our own health into our own hands.  When you are worried or have that nagging inner voice telling you something might be wrong - listen to it.  Doctors are not Gods - as many of us have been taught.  Someone had to be at the bottom of their class,  not want to keep up on what is new or just not be as experienced as others.  We need to know that we can and should change doctors sometimes or at least get another opinion.

Good to hear you have a temporary cap and will have your tooth taken care of soon.

Happy New Year!

Pat

[Anna]

Well said Pat!

Happy new year to you too

Anna

[Reno]

Hi Anna. I am so happy to hear that you have an answer and confidence in that answer from your doctors. Now you can relax and enjoy the remainder of the holiday, looking forward to a new tooth next week.

Happy New Year to you and yours. And, talk to you next year!

Reno