Re: Dental Issues and CLL from a Dentist with Cll

[Guest guest]

Hi my CLL Friends,

As a Dentist with CLL, I feel that maybe I can help with this Dental talk.

If you imagine an area just smaller than the size of the palm of your hand, you have a perception then of the amount of tissue that surrounds your teeth (assuming you still have most of them). Persistent infection not only will push /accelerate some types of CLL, but it has been shown in the last ten years with repeated studies that gum disease (or periodontal disease) can also be the precipitating factor with heart disease, pulmonary infection, and other systemic disease.

Cardiologists "in the know" have starting referring their patients to our offices to clear up their periodontal disease before pursuing surgery. The same for other medical specialties "in the know" as well.

No one would walk around with a long term infection in the palm of their hand, yet many do it regularly for years with their teeth.

If your gums are bleeding when you brush then there's a good chance you have some form of periodontal disease. The fact that your gums are bleeding tells me that they (99% odds in my opinion) are swollen in response to bacteria. It tells me that you possibly are not regularly flossing.

FLOSS IS BOSS when it comes to periodontal disease. I would be foolish to not insist that you get a Dental check up if more than 6 months has passed as well.

Your mouth will always be full of bacteria. Oral hygiene , especially flossing works for two reasons. I'll briefly explain.

1) Bacteria around your teeth and at the gum level over time will thicken into multiple layers and as it thickens microscopically it secrets more toxins that damage tissue. Your gums thicken from the infectious battle going on between your tissue and the bacteria around the teeth, especially to the gums in between teeth. When you correctly floss, you literally are breaking up the layers of bacteria and the ability of the bacteria to produce toxins. It takes about 24 hours for the bacteria to build up again to produce the toxins again.

2) Flossing is beneficial also because the tissue around your teeth is almost always keratinized and your gums thicken with stimulation. Just like the calluses that develop in the palms of your hands when your garden day after day, your gum tissue is the same. By flossing, the tissue thickens and resists bacteria better. This is why for some, a tooth pick can help. A tooth pick doesn't do much to break up bacteria, but it does stimulate the gums enough to thicken them. Brush and floss, not tooth pick and brush. Floss really is boss if you want good dental hygiene.

If you're lucky, a cleaning and regular flossing will be all you need. If you've lost bone support and have deep pockets (not deep pockets as in rich people), but deep pockets between the guma and the tooth, then you'll need more extensive care. Deep pockets are 4 mm and higher and usually occur on the posterior or back teeth.

Deeper pockets of 6 or more mm is a sure sign that you need extra attention starting with root planing, or deep cleanings as some people call them. Some Dentists may refer you to a Periodontist who specializes in Periodontal disease.

Flossing in my opinion will help much more than just brushing. So, if you're obstinate, insist on pushing the boundaries, or just don't like others telling you what to do, or insist on keeping your dental hygiene under a 45 second time limit, choose flossing over brushing. Of course, like we've always heard.............brush and floss.

Good dental hygiene can be done in two minutes when you're well practiced. If you're spending less time then that, you hopefully have just a couple teeth left or................see the part above about obstinate and pushing boundaries.

..

If you bleed when you brush or floss, it simply is a signal that it needs to be done more. Normally, as you start flossing regularly, you will notice that your bleeding will go away after a week or so. Your gums will tighten up and your entire mouth will feel better. If not, find a Dentist.

Better breath will also be appreciated by spouses, family, and friends.

Just a quick side track..........................................

In my own case, my breath was getting pretty foul from the lymph nodes in my throat. I was snoring terribly and was waking up continually (sleep apnea). I had my tonsils out at 50 and it really helped with my breath (extra important when you are a Dentist) and my lymphocyte count dropped from 155 to 90. In my case it dropped my tumor load and the single dose of dexamethasone probably helped as well. It is just now, a year and a half later, that my count has gotten back up past 150.

Over and over in my career I see patients not regularly flossing until its almost too late to save their teeth. Unfortunately, the costs may be much greater than just losing their teeth.

I think you get the message...........if you're not flossing daily............... better start now.

PS ....... Karl & Dr. Furman................Please check the proposed legislation section of

Givepatientsafightingchance.com

would love your input as well as any other CLLers.

Thanks,

Leo

[Guest guest]

Pat and fellow CLLers,

I can think of no reason why practically speaking teeth would be more brittle with chemo. Since teeth are formed permanently when we are young, Chemo therapies literally have no way of getting into the bulk of our tooth structure.

Teeth do weaken over time, especially if they have been root canalled or crowned. On the other hand Pat, I haven't worked with any CLL patients and maybe a CLL expert will offer more informed opinion. There is a somewhat rare condition called internal resorbtion that sometimes happens in vital teeth. I've only seen it a couple times in my 20 year career. I guess its theoretically possible that some chemo cocktails could demineralize tooth structure but,again, a CLL expert would know more if that is the case.

The need to further pre-medicate for CLL patients is an interesting concept. Currently, that decision is a decision that would have to come from a physician and your Dentist legally can't make that call definitively. Where and when we Dentists prescribe antibiotics seems to change on an almost yearly basis, yet always that decision should be made by the cardiologist or now....in our case, the CLL expert.

I know of no literature that deals with this issue. Another example of living in un chartered territory. Personally, I support your idea and your rational that goes with it. Not sure that I'd dramatically change decision making if I were a physician, but I'm not so that's all I'll say.

just my quick response, two cents worth.............. as a practicing Dentist................................... And not even two cents worth if I'm wrong! If so, I'll just stick to the flossing talks and of course my conviction that we can get life saving medicine technology into patients better than how we do it now. Check out the proposed legislation section of the web site Givepatientsafightingchance.com

Regards,

Leo

[Guest guest]

I just got back from a session with an endodontist for a root canal

-- my first -- so this thread is very timely.

The dentist told me I have some resorption; before reading this post

I didn't know this could be caused by CLL.

At my appointment, I told the dentist about my CLL and he phoned my

oncologist to see if he needed to take any special precautions. The

answer was no.

My referring dentist (who I saw yesterday) started me on amoxycillin,

and I'll take the course that's prescribed.

I apparently had an abscess for more than a year, but it didn't show

up on an X-ray when I went to my dentist 15 months ago with the same

symptoms (pain) or at a more recent general checkup .

My advice to CLLers with toothache is to check it out promptly and

make sure the tooth is X-rayed.

If there is any other advice people have about root canals, I'd

appreciate hearing it. I go back next week to complete the root

canal (hopefully). The dentist told me it's a very difficult RC; on

a scale of 1 to 10, a 50.

Schaffer

[Guest guest]

Having treated patients for over 25 years I can tell you that root canals for the most part are not the horror stories you hear about. There are the occasional nightmares but most often they are associated with infection that has gone untreated for an extended period. My advice is that you visit your dentist on a regular bases (3- 6 months) and have recommended x-rays that look for root infections. If your dentist diagnosis a potential root problem don't wait until it starts hurting to proceed with care. Early intervention is the key in prevention of bad results and post operative pain. Re: Dental Issues and CLL from a Dentist with Cll

I just got back from a session with an endodontist for a root canal

-- my first -- so this thread is very timely.

The dentist told me I have some resorption; before reading this post

I didn't know this could be caused by CLL.

At my appointment, I told the dentist about my CLL and he phoned my

oncologist to see if he needed to take any special precautions. The

answer was no.

My referring dentist (who I saw yesterday) started me on amoxycillin,

and I'll take the course that's prescribed.

I apparently had an abscess for more than a year, but it didn't show

up on an X-ray when I went to my dentist 15 months ago with the same

symptoms (pain) or at a more recent general checkup .

My advice to CLLers with toothache is to check it out promptly and

make sure the tooth is X-rayed.

If there is any other advice people have about root canals, I'd

appreciate hearing it. I go back next week to complete the root

canal (hopefully). The dentist told me it's a very difficult RC; on

a scale of 1 to 10, a 50.

Schaffer

[Guest guest]

,

I just made an appointment for my third root canal (in about 15

years), without any problems and without antibiotics, even though the second

was after diagnosis 6 years ago. It sounds like your dentist would rather

err on the side of caution, however, and that’s a good thing sometimes.

There’s no need to expect problems. Rather, the procedure should

mean a welcome end to your pain.

Best,

Karni