Wisdom Teeth Infected?

Hi all...

Sorry I haven't been around much; things are going well here so we like to pretend that Crohn's is a figment of our imagination for brief periods of time.

Taking DS in to the dentist this AM for an unplanned visit. The last two days he's had very swollen gums around his last bottom tooth, can't chew, swallowing isn't great and he's in pain. From what I could see, it almost looks like his wisdom tooth might be erupting (he's 17).... or infected... or something. Tyleonol did help with pain. His mouth is far too small for wisdom teeth.

I emailed with his GI last night assuming the dentist might want to do an antibiotic. He said to avoid abx and do chlorhexidine if possible. He thinks an abx might trigger a flare in DS. He said he'd also prefer if the tooth came out vs risk of getting infected in the future.

So... what do y'all know about chlorhexidine? And what do I need to know about Crohn's, Remicade, methotrexate and wisdom teeth removal?

Last Remi was 11/10 and next is 12/22.

I'll check back after the appt. Thanks!!!

Chlorhexdine is an abx mouth rise if I remember correctly
Not an oral (pill) abx

The wisdom teeth are probably pushing through
They should have taken mouth X-rays a while ago which would tell you if they are coming in side ways (horizontally) or vertical

Good luck

If he has an infection, they need to do an antibiotic. My daughter had the same issue - wisdom teeth coming out, got infected. She was given both chlorohexadine and an antibiotic. The antibiotic is important because otherwise an abscess could form.

I can't remember which antibiotic my daughter was given but I don't remember her having diarrhea from it.

After the infection cleared and the school year was over, we got her wisdom teeth removed. Back then, they made her stop Humira for 3 weeks and she flared. Same thing happened to my other daughter too - she stopped Humira for several weeks when she got them out and flared. MTX was also stopped.

Since then we have been told that for minor surgeries, staying on biologics is ok. But it depends on the situation obviously and your GI's preference. My younger daughter has had several surgeries while on biologics including an open abdominal surgery. No issues with healing thankfully. She had hip surgery this October too without any problems.

Both girls had all 4 wisdom teeth removed - they both also have small mouths and we didn't want to risk infections in the future.

The surgery itself was not so bad. Both recovered in a week. The first day or two is tough (ice cream helps!!). They were on pain meds for several days and the surgery pain was well-controlled and easy to manage. Just have to eat very soft foods.

Our biggest issue was that they both flared because their biologics were stopped.

I wanted to add - one of my daughters (M, the younger one with Crohn's) had the surgery with only local anesthetic. She did fine during the surgery, but was quite freaked out by the whole thing and fainted after the surgery.

My older daughter was given sedation and she does not remember it.

In retrospect, given the number of medical procedures M has gone through and all the trauma they've caused, I wish we'd at least given her laughing gas!! The oral surgeon pushed us to do it with only local anesthetic because she was so complex but I really wish they'd at least given something.

Thanks for the info!

The dentist took an x-ray of the tooth today (prior x-ray was spring of 2016) and it is erupting and is infected. They referred us to an oral surgeon and I need to call on Monday. He has a prescription for the chlorhexidine to get him through until he sees the oral surgeon. The dentist seemed ok with just the chlorhexidine... but he might also have been considering that we'd likely be going in on Monday versus weeks from now? I have another email in to the GI asking if he HAS to do an abx, which he'd prefer.

Maya - Did the infection have to clear before they'd remove her teeth? The dentist didn't say anything about an abscess - yet?

And good to know about the biologics. If we can get him in this week, the timing with Remicade on the 22nd might all work out okay barring any post-surgery issues... right?

Wisdom teeth removal was most definitely not on my calendar for this week!

Yes, we did have to wait till the infection was gone. And it does take a week or so to recover (or at least, it did for both my girls), which is why we scheduled it over the summer. The infection was in February and we did it after school ended which was mid-June for us.

When they do wisdom teeth, they tend to just remove them all vs. just the infected one. Did the dentist say how many he has? I always assumed everyone had all 4 but one of nieces had 3 and the other only 2!

If it's just one tooth, he might be perfectly fine with local anesthetic. My daughter is on the anxious side, which is why I mentioned sedation. Pretty much ALL her friends got their wisdom teeth out the summer after high school and every single one of them had some kind of sedation or laughing gas at the very least. She was the only one who did it completely awake.

About the abscess - M did not want to have her wisdom teeth removed - she had watched her sister stop Humira and flare. Her rheumatologist was the one who told her she had to have them removed because they would likely get re-infected and an abscess could form.

Incidentally, my husband, who never had his wisdom teeth removed, did have an abscess a couple years ago - his face was HUGELY swollen. He ignored the initial pain (he has AS and is extremely "tough" by which I mean not very smart about these things) and let it get really bad before he went in and by then he had an abscess that had to be drained twice.

I asked both my girls and both said they remember it taking them about a full week to recover. M says she remembers have her first "real" meal on a Friday - hers were removed on a Monday.

But my daughter said one of her friends had hers taken out during her first semester of college and was fine after two days.

I guess it will depend on if they want to remove them all right now or just remove the infected one.

I would also guess they won't make him stop Remicade but will make him do it in the middle of the cycle. I really, REALLY regret stopping Humira for both my girls - the oral surgeon didn't even want them to stop it, but their rheumatologist was being extra cautious.

Remember to tell the oral surgeon he can't take NSAIDs. They usually give a pain medication like Tylenol with Codeine or Vicodin but sometimes they will give just NSAIDs if the surgery is not bad, teeth weren't impacted etc.

The dentist said it would be all four (and he has four), which is what I think we’d all prefer. He also didn’t specifically say why, but I sensed there was some urgency to getting this done and that’s why he recommended a certain surgeon over another option. It was crazy busy at the dental office today (kid day) and he squeezed us in as an emergency appt so I didn’t get to ask as much as I probably should have.

I emailed the GI again and he’s given his approval. He’s still encouraging us to skip oral antibiotics and only do the rinse if at all possible. He says they could trigger a flare, and I get that, but at the same time, it makes me nervous too.

No sense in worrying until we talk to the oral surgeon.

Lots of iconversations today with DS about what he would have done had this happened next year at college (not called me, but seen a doctor because of the pain). I’m finding it very interesting what he thinks is important about his Crohns (wouldn’t have asked about abx or mentioned Remi). We still have a lot of work to do. Being dx’d so young, he says he doesn’t remember a lot about the pre-Remicade days and all that he went through whereas I could tell you exactly how many times he’s thrown up on me since dx and what I was wearing. *LOL*

It would make me nervous too to skip antibiotics. I understand they could trigger a flare but generally if there is an infection and you have a kid on Remi and MTX, they want the infection taken care of quickly, before it gets worse and you end up in the hospital for IV antibiotics.

Glad you are seeing the oral surgeon so soon. Hopefully they can fit him in for surgery quickly.

For what it's worth, my daughter has had antibiotics MANY times in the last couple years and they have only triggered a flare once and that's because she got CDiff from them. Normally, she does have diarrhea with them, but it settles down as soon as the antibiotics are stopped.

My daughter has been on antibiotics many times too, without any problems yet. Also, she had a minor surgery a couple of years ago while on Remicade, and her surgeon asked her to stop mtx for 2 weeks, but we didn't have to stop Remicade. We did schedule the surgery for 4 weeks after an infusion, so her immune system would be relatively strong during the 2 weeks of recovery.

Good luck--hope everything goes well.

Same here definitely want abx
Our GI is all about getting abx in clearing infection first as top priority
Ds has been on iv abx twice -not fun
And no flares
Plus additional oral abx

He takes erythromycin daily for gastroparesis as well
Again no issues

He also takes vsl #3 prescription strength to keep c diff etc at bay due to abx

Good luck

A had an infected molar once (had trouble breaking through the gums, gums swelled, food got trapped, etc.). They cut the gums to drain the infection and from there we used the mouthwash. Worked well and no further issues. At the time she was untreated for her immune issues and still the mouthwash was enough. I think antibiotics are often overused.

I would just check with the oral surgeon. You do not want an abscess - trust me - it was miserable for my husband and he is very tough when it comes to pain (he has about 12 surgeries including multiple hip replacements because of AS starting at age 30).

It was many visits to the oral surgeon before he was cleared and draining the abscess was very painful too.

I am SURE if he had been on biologics he would have been admitted for IV antibiotics. Luckily, he was only on an NSAID at the time.

We have dealt with CDiff twice from antibiotics so I understand your hesitance. But because with Remicade and MTX, your kiddo is at risk for opportunistic infections, I would just be really careful.

Going to tell you a friend story. This not meant to scare you but he was not given antibiotics for a small dental procedure whilst on Remicade.

A few week late during a routine GI appointment he mentioned severe back pain and GI ordered a MRI.

The technician performing the MRI left the room to consult with the specialist at the MRI clinic. When she returned he was told go to hospital next door and admit himself to hospital via the ER department.

He spent a 4 weeks in hospital and had 12 weeks in total off work.

Infection/bacteria had enter his bloodstream via open wound in his mouth and had begun to eat two vertebrae in his lower back.

Someone remind me... can he be on abx at his next infusion on the 22nd?

Got an appt with an oral surgeon (had to call three!) for Thursday and he's on their cancellation list for sooner. She said they generally don't prescribe abx and do Vicodin for pain.

Theoretically, Remi would be 15 days post-op. I have a call in to the GI nurse.

Both the GI and surgery office have said once the tooth is out, the infection will go away. Again, I'm not sure what to think??

Aside from the abx thing, what else do I need to know or am missing?

Feeling pretty flustered right now.

Is that is his first appointment or the appointment for the surgery? Generally, they do a consult and examine him and look at his x-rays and talk about the plan for surgery.

I don't know about the infection because we did it differently - first my daughter was given antibiotics to clear up the infection and then months later we removed her wisdom teeth.

I can't remember if either of my girls was given antibiotics with the surgery.

I would ask the GI nurse about antibiotics - given that he is immunosuppressed, does he need them? And if he does, can he have his infusion? Also, does the infusion need to be delayed at all?

I would also make sure you're seeing a good oral surgeon - we went with someone who had an MD in addition to a DMD. Our dentist insisted on it and I figured it was a good idea given that both girls were on biologics + MTX.

Also ask the surgeon what the plan is for sedation - do they give it and what kind. Some give laughing gas, some give conscious sedation (so he'd be awake but relaxed) and some use local anesthesia (so many shots of Novocaine).

Both of my girls have been on antibiotics for one thing or another and our GI has at most just delayed infusion by a day so they were more than a day from starting the antibiotics. Smart to double check with GI office.

I had my wisdom teeth out with infection. No oral atx and recovered within days but everyone is different.

I talked to the GI nurse just now and they are still saying no abx and that the oral rinse should be fine. I asked about opportunisitc infections and she said they still believe triggering a flare is of greater concern. She also said to keep the Remi as planned, but to call her Monday with an update on how he’s doing. Sooo...

The oral surgeon consult appt is combined with the surgery, so we are to assume it’s happening Thursday. If something comes up during the consult, surgery may get postponed, but this office usually does it all in one appt.

I sort of feel like there isn’t much more I can do except roll with what’s happeneing.

I guess then they do it with local anesthetic?? If they were giving sedation there are special instructions - NPO after midnight etc. And you definitely have a consult then.

I think you have to trust your GI at this point.

Good luck!

Got bumped to Tuesday/tomorrow. Wish us luck!

Good luck

Good luck!! Let us know how it goes.

The first day is kind of hard - it was the hardest day for my girls.

But it is easy compared to a "real" surgery as my daughter says (she means compared to an abdominal surgery) and I know your son had surgery for a stricture.

My girls just watched a lot of TV for the first few days.

Make sure you have soft foods and liquid foods (broth for example).

Vicodin can cause nausea and constipation - it did for my girls.

Glad it could be moved up! Good luck.

Thinking of you and L. Good luck today

Started the day with a snowstorm. Nice. :-|

The patient is home and groggily humming Christmas music through a mouth full of gauze. I can't understand a word he's saying, so I gave him a pen and a notebook. He's writing sloppy messages to me in Spanish; which he hasn't studied in four years. It's going to be an interesting day.

While in the waiting room, we were watching the news on tv and, of course, they ran the story of the girl who died last year getting her wisdom teeth out (anesthesia issue). Thankfully, he was playing on his phone and didn't see it. I did tho!!

Everything went well. I was glad that I didn't have to explain Crohn's, Remi, etc. The dr was knowledgeable and spoke our (IBD) language. He did decide to give him an IV antibiotic, which I thought was an ok idea? Skip the gut. He is supposed to try and stick with Tylenol, but has a prescription for Norco, if needed (keeping track of combined acetaminophen). Fingers crossed this is a quick and uncomplicated healing process!

:lol: Was he given sedation? That sounds like something a sedated kid would do !! I'm glad everything else went well and they decided on an IV antibiotic.

I'm sure you know this, but stay ahead of the pain. Don't let it get too bad because getting on top of it then will be much harder. If it goes up and it seems like Tylenol isn't going to be enough, give the Norco.

We made that mistake with one of my girls - her pain got completely out of control because we were only using Tylenol and it was miserable. Once we got her on Vicodin (which is the same as Norco) she was absolutely fine.

Yes, he was sedated.

He just tried to take Tylenol, but he's still numb and can't feel anything. The pill fell out of this mouth. Suggestions??

We have to wait for hubs to get home with the Norco in a couple hours, but will def try and stay on top of the pain.

All I can think of is liquid Tylenol - like for babies. Rite Aid or CVS usually has it. Squirt it into his mouth with a syringe?

I can't remember if my girls had that problem...the numbness will wear off though. I guess you could hold off on giving Tylenol till it has worn off more - by then he will be in some pain, but hopefully it won't be too bad.

I was going to tell you to give it through his G tube but then I remembered not every kid has one ! We use a lot of liquid kids meds because M has a tube - it works out fine, you just have to convert the dose and make sure you are giving enough.

Glad that's it's over, and that all went well. Hope recovery is quick!

Hope he feels better soon

Glad it is over and done. I can’t believe they only want him to take Tylenol for the pain. This whole limit the narcotics thing is really getting out of hand.
Hope his pain is controlled and he heals quickly!

wow! Sorry to hear it was so stressful. We just had a consult and scheduled wisdom teeth out for my son in Feb (16 in a couple weeks). Checking in with GI about stopping Humira/MTX and definitely doing abx. This is a great example for why not to wait til it's a problem, yikes. Hope he's better today and heals quickly.

Yes, biggest lesson learned is to take care of wisdom teeth before they become a problem so that you can do some planning. We got lucky with our timing and his Remi schedule. Also learned we have crappy insurance and are footing an unexpected bill this holiday season.

DS did the Norco for one day then chose to do Tylenol only. The Norco did make him slightly nauseous, but I think he made the switch more so because he didn’t want to miss his calc test or give up driving himself to school. I wish we’d have done this during the summer or some other non-school time.

Wow - he is already back at school?? He recovered quickly!! Doesn't he still have stitches in or did they put in the dissolvable kind?

My girls both had their wisdom teeth out on a Monday and didn't leave the house till Friday. But we did the surgeries in the summer, so they didn't have to recover quickly .

Glad he is doing well!!!

Thanks Mehita you've got me thinking about this. I was 23 when I had mine out and hubby was high school. Jack has dentist appointment later this month and my other 16 year old son next week I think we will be discussing this with dentist.

Maya142 said:

Wow - he is already back at school?? He recovered quickly!! Doesn't he still have stitches in or did they put in the dissolvable kind?

My girls both had their wisdom teeth out on a Monday and didn't leave the house till Friday. But we did the surgeries in the summer, so they didn't have to recover quickly .

Glad he is doing well!!!

Click to expand...

They used the disolvable ones. I was expecting him to stay home the rest of the week, but he insisted on going. Today he looked visibly swollen (day 3, expected), but again, he popped some Tylenol and took off even tho pain was a four. English paper due and calc test part two today. . In his mind, the hassle of rescheduling all this school work is worse than the pain. I just hope he doesn’t regret not taking things slower. He’s supposed to work tomorrow too.

Yes - we were told swelling is worst around Day 2-4. My girls got bruises too but not everyone has those (just warning you they may show up!).

I'm very impressed that he is going to school even though he is swollen!! But I hope he's not overdoing it . But it's hard with teens/young adults - they do exactly what they want to do!

Maybe he can text you to pick him up if he's miserable? Sounds like he's pretty determined to get all his work done though.

It is tough having the surgery during school - I think doing it over the summer gave my girls the luxury of recovering slowly.

For those who have not had it done yet, I would definitely do it over a break if possible. And we were told to do it early - it is easier in teens/young adults. In older adults, the surgery becomes much more difficult.

Even though my husband had a majorly infected wisdom tooth and abscess, they would not remove it as his age.

Wow thanks guys! My 23 yr old non Crohnie has been needing her wisdom teeth out for a year now. Never a good time. She sits for OT Boards soon. I am going to push her to get this done before she gets a job!

Glad he's feeling better! And, wow, amazing that he's back at school and writing an exam!!

Of course, they'll do what they want... no point trying to tell them otherwise! :facepalm: