need info on dialysis patients and removal of wisdom teeth

[sullidog]

I need to get my wisdom teeth out. My dentist was just wondering if there's anything special they need to do before they do it like is there a certain type of anasthetic they need to use to put me out with, anything that will enterfeer with me and dialysis? Should I have it done on a dialysis day do to being put out? I've never had this done before and wondering how if at all how it will interfeer with my kidney disease.
Troy

[okarol]

Jenna's oral surgeon required a letter from the doctor saying she could have general anesthesia even though she has reduced kidney junction http://ihatedialysis.com/forum/index.php?topic=19749.0

[ardyce]

sullidog,

You need to take an anibiotic  before you go have your wisdom teeth out.

[RichardMEL]

I think the antibiotic is only if you're transplanted. pre-transplant it's probably OK to go without (but can't hurt I guess!). I had mine all done before I started D (as the transplant guys said it was a good idea to get the mouth sorted out way before...) so I don't have any other specific medications. Obviously run through the idea with your neph and/or dialysis staff and see if they have any suggestions.

[BigSky]

Its recommended that all dialysis patients take a antibiotic for any dental work.  This being due to dialysis patients having compromised immune systems and the mouth being full of bacteria.

Had one wisdom tooth removed and they just numbed it with a local.

There can be concern with renal impairment and anastethetics, your  should check with your doctor on that point.

[okarol]

I found this online:
Dental Management of Patients With Renal Disease
By Grace Keh, eHow Contributor
updated: November 17, 2009

Dental treatment
Treating dental patients with renal disease or kidney transplants requires special care to prevent infection. Dental infections can create serious complications in patients who are undergoing treatment for kidney disease or have received kidney transplants.

If you have kidney problems, your dentist and doctor should develop a plan before any dental work takes place.

Dental Conditions
Kidney disease and the medications involved in treating the disease can cause a variety of dental problems requiring treatment. Due to an inability to absorb calcium properly, periodontal bone loss is common. With kidney failure, the inability to remove urea from the system can cause halitosis (bad breath) due to ammonia build-up, and patients will often report a bad taste in their mouths. Tooth loss, gum disease, dry mouth and jaw pain can all be results of kidney disease, warranting urgent dental treatment.

Dialysis Patients
Generally, any necessary dental treatment should occur 24 hours after dialysis in order to have the heparin (blood thinner) completely out of your system, ensuring minimal abnormal bleeding. You should tell your dentist about all medications you are taking, and share all blood test results.

Transplant Candidates
Patients with end-stage kidney disease who are about to receive a transplant must undergo all dental treatment prior to transplant surgery. Once the patient receives the transplant, the immune system will be seriously suppressed for at least 3 months, if successful, and any dental treatment received during this time could result in a fatal infection for the patient. Therefore, it is vital that all dental conditions be treated prior to transplant to ensure no treatment will be required post-transplant.

Medication Precautions
 
Beware of drug interactions
Patients with renal disease take considerably longer to filter out medications; therefore, dosage must always be adjusted bearing this in mind. Antibiotic prophylaxis may be warranted, and in some cases, a dosage of antibiotics will be recommended by the physician prior to treatment and again after treatment to prevent a systemic infection. Many patients with renal disease will be on anticoagulants, and physicians will at least reduce the dosage prior to necessary dental treatment in order to minimize excessive bleeding.

Other Precautions
As many patients with renal failure develop other diseases such as diabetes, heart conditions and liver disease, conducting a full patient history and discussing all conditions with the physician prior to dental treatment is crucial. Being fully informed of every medical condition and all medications is vital to providing the safest and most effective treatment for the patient with renal disease.


Read more: Dental Management of Patients With Renal Disease | eHow.com http://www.ehow.com/about_5656553_dental-management-patients-renal-disease.html#ixzz114sMAx2h

[RichardMEL]

Interesting. thanks Karol.

I just realised I am due to have a tooth extracted next week (I have an annoying baby tooth that has gone wobbly) and that won't quite be 24 hours after D. Maybe 18 or so. Well, I'll mention it to the dentist.

[Rerun]

Have any dental procedures done on an OFF dialysis day.  The blood thiner (heparin) will make your mouth bleed during and after treatment.  I learned this the hard way.

[RightSide]

My oral surgeon insisted that I start on antibiotics even before the extractions, so that the antibiotic was already in my bloodstream.  If the tooth was abscessed, he kept me on antibiotics for a few more days after that.

Anesthesia for any type of surgery is tricky for ESRD patients.  Some anesthetics are cleared through the kidneys; take those and you'll be zonked until either your damaged kidneys can clear them, or they dialyze out. For that reason, my surgeons prefer to use gas on me.  Gas is cleared through the lungs, not the kidneys.

Since you bleed for up to 8 hours after an extraction, it goes without saying that you shouldn't have heparin in that time frame.

[RichardMEL]

Just had a tooth pulled this morning. I told the dentist about the heparin (I had dialysis yesterday) and that it might be an issue. He said it should be OK. Numbed me right up and took out the baby tooth (didn't feel a thing - hooray!). I bled for over an hour though so had to stay with a cotton wool gause thingy stuck in my mouth which was not fun. It's stopped though and I could even have some lunch, and I'm not in any pain. he said there was a bit of infection on the tooth when he took it out, so it's good that it's gone - YAY!

[kyshiag]

I think you may need a new dentist.  He should not be asking, you, the patient, what he needs to do.  That question would have scared me.

[kitkatz]

My dentist took my wisdom teeth out under a local. It did not hurt too much and I was fine.

[Stoday]

I don't understand how you could be happy to lose a tooth.

I've preserved all my teeth. OK, I have to put up with root canal work which is a bit tiresome, especially a molar with four roots. But I keep all my teeth!

[rsudock]

A hygenist once told me people who have more of their teeth live longer....wonder what that number looks like if you are a D patient? 

[RightSide]

I don't understand how you could be happy to lose a tooth.

I've preserved all my teeth. OK, I have to put up with root canal work which is a bit tiresome, especially a molar with four roots. But I keep all my teeth!

I've had my share of root canals too, years ago.

The problems start when a root of a tooth that has already had a root canal breaks or cracks, enabling bacteria to infect it.   Because the nerves are dead from the root canal, you won't notice any pain from this abscess until the infection has spread to the surrounding gum tissue, which will start to get sore. By then the infection is pretty widespread.

There's really nothing that can be done to save such a tooth, and it must be extracted, along with the broken root.

That's where I am at right now.  I just had one of those teeth extracted earlier today.

[jo]

My oral surgeon insisted that I start on antibiotics even before the extractions, so that the antibiotic was already in my bloodstream.  If the tooth was abscessed, he kept me on antibiotics for a few more days after that.

Anesthesia for any type of surgery is tricky for ESRD patients.  Some anesthetics are cleared through the kidneys; take those and you'll be zonked until either your damaged kidneys can clear them, or they dialyze out. For that reason, my surgeons prefer to use gas on me.  Gas is cleared through the lungs, not the kidneys.

Since you bleed for up to 8 hours after an extraction, it goes without saying that you shouldn't have heparin in that time frame.

My mother's dentist says he will give her antibiotic right before the surgery. Would that be ok or should she take it in advance before the tooth extraction procedure? Thanks.

[Simon Dog]

I take 4x500ml Amoxicillin 1 hour before dental cleanings on recommendation of both my neph and dentist.

[Charlie B53]

I am surprised to learn that the antibiotics are given only an hour before the actual procedure.

Since my by-pass I have been warned to take them prior to any dental work, even cleaning and inspections as even the poking around measuring the gum depth has a potential for causing infection.   But I was told to always start the AB at least a DAY before, not wait until the appt.

And again, EVERY time an AB is began it must be taken for the prescribed 7 to 10 days, otherwise there is the potential for bacteria to become immune, and this is how so many of the 'super-bugs' have developed.

[Simon Dog]

And again, EVERY time an AB is began it must be taken for the prescribed 7 to 10 days, otherwise there is the potential for bacteria to become immune, and this is how so many of the 'super-bugs' have developed.

The standard of Amoxicillin 2g, once an hour before dental work, is a very common single dose protocol.

[jo]

And again, EVERY time an AB is began it must be taken for the prescribed 7 to 10 days, otherwise there is the potential for bacteria to become immune, and this is how so many of the 'super-bugs' have developed.

The standard of Amoxicillin 2g, once an hour before dental work, is a very common single dose protocol.

The dentist said he will be giving Penicillin right before the surgery. I believe it has the same effect as Amoxicillin?

[Simon Dog]

The dentist said he will be giving Penicillin right before the surgery. I believe it has the same effect as Amoxicillin?

Don't know.  I'd have to ask a licensed plumber I know who has a dental practice (yes, he has a dental license, dental anasthesia license, master plumber license and journeyman plumber license)