How serious is tooth extraction for dialysis patients. Very worried. Please help

[jo]

My mom has been having a very painful toothache from yesterday and we took her to the ER when the pain got worse today. The ER doctors think it is probably a tooth abscess as she was very sensitive to the touch and put her on penicillin (500 mg 4 times a day) for the next 14 days. We have to call the dentist on Monday to set up an appointment for the tooth extraction. Currently there are 2 tooth causing severe pain and they both need to be extracted.
How does tooth extraction affect dialysis patients? Any care recommendations before and after the procedure?
Is it painful?
They were saying a resident dentist would probably do the extraction but I am re-thinking this. I would definitely want a oral surgeon to do it based on her case. She just got off the antibiotic (cefazolin) yesterday for her staph infection, and again, she is on penicillin now.
Does the nephrologists and cardiologists need to be there during the procedure?
Sorry I have a lot of questions. We are very worried. Please help us. I really appreciate everyone's time.

[kitkatz]

I have had four wisdom teeth pulled while on dialysis. Just had to take antibiotic before the appointment.  Seemed to be no big deal to my dentist.

[jo]

I have had four wisdom teeth pulled while on dialysis. Just had to take antibiotic before the appointment.  Seemed to be no big deal to my dentist.

So you didn't take antibiotics after the teeth was pulled out? Are the antibiotics prescribed to my mom too much?

[PrimeTimer]

My husband's Nephrologist told him to call her first ASAP if any of his other doctors or dentist want to put him on any medications.

[kristina]

Sorry jo,
I don't know anything about ESRF-tooth extraction,
but I was told many years ago by my "twice-yearly-teeth-check-up-dentist", that ESRF can have a very painful influence on early tooth-decay ...
... My dentist recommended at the time that I must brush my teeth "religiously" half an hour after every meal ...
... and never brush my teeth instantly after a meal ... but it is also vitally important to wait about half an hour before brushing the teeth after every meal
and never ever to "forget about it" because otherwise ESRF would assist early tooth-decay and life could become unnecessarily extremely painful ...
I wish you and your mom all the best luck,
best wishes from Kristina.

[Michael Murphy]

I have not had any tooth extractions on dialysis but I have had several abcesses in my life.  They have your mother on antibiotics because abscesses are infections under the teeth. Just as a boil on the skin swells and hurts the abcess forms a pus sack which pushes on the teeth.  It is very painful.  The cure is antibiotics to fight the infection and the dentist may need to pull the tooth but usually just drilling into the infection works like lancing a boil, it releases the pressure and 99% of the pain goes away.    The drilled hole is usually left open for a time to allow draining and eventually it's filled like a cavity. 

[noahvale]

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[Michael Murphy]

In the past I have had dental work done on non dialysis days however I no longer allow the heparin since it has caused me eye problems. Now I go to the dentist after dialysis.  The only downside is the clinic needs to flush my lines every half hour with 100 mg of saline. But my eye stopped bleeding and I only kill one day instead of two.

[jo]

I have not had any tooth extractions on dialysis but I have had several abcesses in my life.  They have your mother on antibiotics because abscesses are infections under the teeth. Just as a boil on the skin swells and hurts the abcess forms a pus sack which pushes on the teeth.  It is very painful.  The cure is antibiotics to fight the infection and the dentist may need to pull the tooth but usually just drilling into the infection works like lancing a boil, it releases the pressure and 99% of the pain goes away.    The drilled hole is usually left open for a time to allow draining and eventually it's filled like a cavity.

So they didn't had to get your tooth pulled out when you had several abcesses? They just drained the infection?

[jo]

My mom has been having a very painful toothache from yesterday and we took her to the ER when the pain got worse today. The ER doctors think it is probably a tooth abscess as she was very sensitive to the touch and put her on penicillin (500 mg 4 times a day) for the next 14 days. We have to call the dentist on Monday to set up an appointment for the tooth extraction. Currently there are 2 tooth causing severe pain and they both need to be extracted.
How does tooth extraction affect dialysis patients? Any care recommendations before and after the procedure?
Is it painful?
They were saying a resident dentist would probably do the extraction but I am re-thinking this. I would definitely want a oral surgeon to do it based on her case. She just got off the antibiotic (cefazolin) yesterday for her staph infection, and again, she is on penicillin now.
Does the nephrologists and cardiologists need to be there during the procedure?
Sorry I have a lot of questions. We are very worried. Please help us. I really appreciate everyone's time.

NO, neither a nephrologist nor a cardiologist needs to be present during the extraction.  However, you absolutely need TO CONTACT your mother's nephrologist to let him/her know what is going on with her oral hygiene care.  Let the neph know she just finished taking one antibiotic and was immediately placed on another.  Make sure this is OK, because standard protocol is for hemodialysis patients to take a round of penicillin right before having tooth extractions.  Have your mom's neph CONTACT the dentist to determine optimal dosage, especially since she has been on so much antibiotics already.  Plus, patients with compromised renal function might have to be on lower doses of certain antibiotics.

Also, the extractions should be done on a NON DIALYSIS day because heparin (used to prevent blood clotting while getting dialysis) may cause EXTRA BLEEDING.

I already contacted my mom's nephrologist and without even looking at what the ER doctor prescribed, his answer was: "GO WITH WHATEVER THE ER DOCTOR PRESCRIBED. THEY ALWAYS DO THE RIGHT THING." Is 2000 mg of penicilin per day for 14 days too much for renal patients?

[noahvale]

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[jo]

I already contacted my mom's nephrologist and without even looking at what the ER doctor prescribed, his answer was: "GO WITH WHATEVER THE ER DOCTOR PRESCRIBED. THEY ALWAYS DO THE RIGHT THING." Is 2000 mg of penicillin per day for 14 days too much for renal patients?

I am not a doctor and cannot answer that question.  I can only make suggestions.  Ask the ER doctor if this is the usual dose of penicillin for someone with renal failure.  Also, ask your pharmacist what is the standard penicillin recommendation for a tooth extraction for someone with your mother's problems - diabetes and renal failure - and should someone on hemodialysis take that amount or a reduced dose.

From a quick internet search..........

"Patients undergoing renal dialysis require special management. The timing of appointments in regard to dialysis scheduling, as well as the dosage and types of medicines used are issues that must be managed. " 

Full article - http://www.animated-teeth.com/tooth_extractions/t2_teeth_extractions.htm


"Management during Dental Treatment - 2. Use caution and alter dosage form when using drugs eliminated by the kidneys i.e. penicillin (often reduced to 500 mg. two times per day versus four times times per day).  3. If patient on renal dialysis, dental appointment should be done on the day following dialysis." 

Full article (see page 26) - http://dental.pacific.edu/Documents/dental_prof/Medically_Complex.pdf


"Kidney patients are advised to tell their kidney doctor when a dental procedure is required. The doctor may recommend antibiotics be taken prior to the procedure to help guard against infection. The dentist should be made aware that their patient has kidney disease or is on dialysis. Ideally, dental procedures, such as tooth extraction, should occur on a non-dialysis day for those on hemodialysis. Heparin, administered during hemodialysis, may cause some people to have extra bleeding."

Full article - http://www.davita.com/kidney-disease/overview/symptoms-and-diagnosis/dental-health-for-people-with-kidney-disease/e/4731

Thank you. Yes, I read this (penicillin (often reduced to 500 mg. two times per day versus four times times per day)) and that is one of the reasons I decided to ask someone here. As you suggested, I already asked the nephrologist who gave me the answer I posted earlier. Also, I talked to the pharmacist and they said they were not sure about the dosage for patients on dialysis and said that the ER doctors know better than them. I can't imagine how much time I spend around the hospital talking to the nephrologists, ER doctor, pharmacist, etc., trying to figure out if the dosage is too much. I am still researching everywhere. Thanks for the articles.

[jo]

After going through my experiences with doctors especially at the hospital where my mom is being seen, I am wondering if the doctors treat patients based on what they learned in school or by using google as a tool to treat patients. Whenever I ask a doctor a question, 95% of the time I will get this answer: "SORRY I DON'T KNOW. WE WILL HAVE TO DO SOME RESEARCH ABOUT IT". Are all the doctors trained the same way or is it just in this hospital? Sorry I am losing my confidence on doctors day by day and I am just curious to know this.

[Michael Murphy]

To answer your question I have had5 abscesses in my life, they were in three teeth.  Two had only one access and were drilled, to this day I am anazed how much the pain dropped after the drilling.  One tooth had three it turned out one of the past dentists had nicked the outside of the tooth when filling a cavity and created a place for the infection to hide and start up again after I stopped the antibiotics.  So no it is as far as I know unusual to remove a tooth for the first access., by the way the pain from a abscess is about the worst pain I have ever felt.

[jo]

To answer your question I have had5 abscesses in my life, they were in three teeth.  Two had only one access and were drilled, to this day I am anazed how much the pain dropped after the drilling.  One tooth had three it turned out one of the past dentists had nicked the outside of the tooth when filling a cavity and created a place for the infection to hide and start up again after I stopped the antibiotics.  So no it is as far as I know unusual to remove a tooth for the first access., by the way the pain from a abscess is about the worst pain I have ever felt.

Thanks. The ER doctor thinks she has abscess in 2 of her tooth and says they need to be extracted but no x-rays or dental exams have been done so far. I believe the dental exams will be done on Monday if we get an appointment with the dentist. Based on your response, if she has one abscess in both of her tooth, they can just drain the infection and not remove the tooth. Is that right?

[Michael Murphy]

Unless the abscess is huge, have you ever seen a picture of some one with the side of their face swollen that is what happens when the access has pushed out to the side, it decreases the pain but makes it more difficult to treat.  The only one who can  really say is the dentist,  there is a chance the tooth can be saved.  The only reason I had a tooth pulled was it had a recurring abscess and after it was pulled it was obvious it had to be pulled do to the damage done by a earlier dentist.  Thing only thing you should tell your mother is that after the dentist treats her the pain will go away. 

[jo]

Unless the abscess is huge, have you ever seen a picture of some one with the side of their face swollen that is what happens when the access has pushed out to the side, it decreases the pain but makes it more difficult to treat.  The only one who can  really say is the dentist,  there is a chance the tooth can be saved.  The only reason I had a tooth pulled was it had a recurring abscess and after it was pulled it was obvious it had to be pulled do to the damage done by a earlier dentist.  Thing only thing you should tell your mother is that after the dentist treats her the pain will go away.

Ok thanks. The ER doctor has prescribed oxycodone for the pain.

[Michael Murphy]

Check with your nephrologist about the oxycodone its metabolized by the kidneys and its effects last longer in patients with ESRD.  The one time it was prescribed for me I was talking to my iPad, it wasnt turned on, apparently I was.  One day a proper tiny lady came to dialysis drugged to the gills.  Her doctor had prescribed oxy one pill a day on Friday. By Monday she was high as a kite.  After dialysis the drugs were gone she was fine,

[jo]

Check with your nephrologist about the oxycodone its metabolized by the kidneys and its effects last longer in patients with ESRD.  The one time it was prescribed for me I was talking to my iPad, it wasnt turned on, apparently I was.  One day a proper tiny lady came to dialysis drugged to the gills.  Her doctor had prescribed oxy one pill a day on Friday. By Monday she was high as a kite.  After dialysis the drugs were gone she was fine,

Thanks for mentioning that. Yes, my mom was nauseated and feeling funny earlier today and we stopped giving her. As I mentioned in my earlier posts, there is no point in talking to the doctors and getting them to adjust the dose or whatever. That's why I had to ask people's experiences and suggestions here. We are planning to go to a different hospital once my mom feels better. What pain medication is usually recommended for ESRD patients? Thanks again.

[Michael Murphy]

Oxy is ok but don't repeat the dosage until after the nex dialysis.  Every time you get prescribed a drug run it by your nephrologist, if that is not possible remind the doctors that the patient is on dialysis and what does that mean to the drug.  Most doctors know but since it is not obvious they forget. I have thought about taking a marker and writing dialysis on my forehead but settle on asking the doctor about drug metabolism on a dialysis patient this seams to cause them to focus and take the dialysis into account.. Hope your mother feels better I wouldn't wish a abscess on any one.  But on Monday after the dentist she should feel much better. While the treatment can hurt a little it much less then the abcess.

[obsidianom]

Lot of misinformation on this thread folks. 
1. Penicillin is not effected by the kidneys . The dose is the same for dialysis patients as anyone else The only difference is the dose should be given AFTER dialysis on dialysis days. A standard dose is ok .
2. Oxycodone is not effected by the kidneys much either., It is LIVER metabolized. My wife takes massive doses of it daily for years with no issues on dialysis.
3. Dental abcesses can be treated by simple endodontics which is a drainage of the infection then a root canal. I just had that done myself to save the tooth. Pulling the tooth is NOT required unless you don't want to save the tooth. Pulling it is forever so a root canal can be a better choice. It is expensive but you get to keep the tooth.
I agree with calling the nephrologist about any new meds but in general dental abcesses are very common and very easy to treat.
(I have pulled a couple of my wifes teeth and that is easy too, but don't try this yourselves).

addendum; oral penicillin like pen v/k is the usual penicillin and it is not kidney excreted. the older pen g which is IM/IV is different and the dose has to be cut for kidney patients.  However most presciptions are ORAL pen V /k  and those are fine on dialysis .

[Michael Murphy]

The only accessed tooth I had pulled was because the abcess reoccurred every time I stopped the antibiotics.  After the third time it was pulled. Afterwards it was apparent that the tooth had been damaged by a earlier dentist. The root curved and that dentist drilled right through the tooth creating a pocket that the infection was in.  The antibiotics could not eliminate all the infection so it came right back.  If the tooth was not pulled I wold have had a forth abscess. That's for the correction about the oxy maybe what I was on was Vicodin.

[jo]

Lot of misinformation on this thread folks. 
1. Penicillin is not effected by the kidneys . The dose is the same for dialysis patients as anyone else The only difference is the dose should be given AFTER dialysis on dialysis days. A standard dose is ok .
2. Oxycodone is not effected by the kidneys much either., It is LIVER metabolized. My wife takes massive doses of it daily for years with no issues on dialysis.
3. Dental abcesses can be treated by simple endodontics which is a drainage of the infection then a root canal. I just had that done myself to save the tooth. Pulling the tooth is NOT required unless you don't want to save the tooth. Pulling it is forever so a root canal can be a better choice. It is expensive but you get to keep the tooth.
I agree with calling the nephrologist about any new meds but in general dental abcesses are very common and very easy to treat.
(I have pulled a couple of my wifes teeth and that is easy too, but don't try this yourselves).

addendum; oral penicillin like pen v/k is the usual penicillin and it is not kidney excreted. the older pen g which is IM/IV is different and the dose has to be cut for kidney patients.  However most presciptions are ORAL pen V /k  and those are fine on dialysis .

Thank you.