Dental crown installed after surgery

[Scott]

I just had a total hip done last Thursday. (https://bonesmart.org/forum/showthread.php?t=2966) About two months ago I had two crowns installed. One of the crowns didn't have good contact with the tooth in front of it, so about three weeks before my surgery I had the crown cut out and a temporary put back on.

I'm scheduled to have the new crown put on this week, but as I was reading through my medicine precautions (yes I actually read them ) a couple of them mentioned to notify the surgeon and dentist before having dental work done while taking these meds (OxyContin and Lortab). So, I'm going to call my surgeon on Monday and see what I need to do, but I thought I'd ask on here to try to understand the concerns better.

I've searched threads on here and most of the concern about dental work is related to things like extractions and root canals. With a crown I won't be prescribed any medicine, but I get shots for numbing the area. Is the main concern the risk of infection because of the bacteria present in the mouth? The temporary crown works fine and it won't bother me to keep it in for however long I need to, but I wanted to get some opinions as to what I might expect.

 

[nickji]

Hi Scott,

Josephine or Jamie will know better, but I imagine the reason to tell your dentist about taking these drugs has something to do with any analgesic they may be using, since both the drugs you are taking are opiods. If your dentist uses an opiod for anaesthetic (like Lignocain), then they might need to know that you're already taking two opiod drugs.

The risk of infection, as far as I know, is indeed from pathogens in the mouth. IF all your dentist does is remove the temporary and put on the new, with no drilling etc, then I can't imagine how that could cause any problem - but what if they do need to do some additional work? Personally I'd rather be safe and take prophylactic antibiotics.

Incidentally, I'm surprised that you're on two different opiods. I'm not a doctor, and I'm sure yours knows exactly what (s)he's doing. I'm just curious why two opiods. Do you have a stomach problem that stops you taking ibuprofen or another of the NSAIDs?

If I was prescribed Oxycontin I'd definitely look it up on Google, by the way. . . there's been a lot of fuss about that particular drug.

Enjoy it all,

Nick

 

[Peta]

I'm not familiar with the drugs you are on Scott so I'll leave it to Jo to comment on that. As far as having your crown inserted - I would definitely think you will need to take antibiotics an hour beforehand. Far better in my book to be safe rather than sorry. Even though you aren't having anything invasive - there is still the risk of abrasions to the soft tissues which would be fairly difficult to avoid when trying to remove a temporary crown. And as for the temporary crown - they will last for an extended period of time but not forever! The main problem with them is that you can't clean around them as easily as you can a porcelain/gold crown. I'd contact your OS and ask his advice.

(I've been a dental nurse for 34 years by the way......

Peta

 

[Scott]

I'm not familiar with the drugs you are on Scott so I'll leave it to Jo to comment on that. As far as having your crown inserted - I would definitely think you will need to take antibiotics an hour beforehand. Far better in my book to be safe rather than sorry. Even though you aren't having anything invasive - there is still the risk of abrasions to the soft tissues which would be fairly difficult to avoid when trying to remove a temporary crown. And as for the temporary crown - they will last for an extended period of time but not forever! The main problem with them is that you can't clean around them as easily as you can a porcelain/gold crown. I'd contact your OS and ask his advice.

(I've been a dental nurse for 34 years by the way......

Peta

Thanks, Peta. I thought I had read in one of the posts that you were a dental nurse, so I hoped you would respond. You've given me information to ask the right questions. Thanks!

Also, Nick. Appreciate the feedback and the note on OxyContin. I'm somewhat familiar with OxyContin and some of its problems. There was a radio host in Dallas, when I lived there, who got horribly addicted to it and it led to even worse addictions. It sounds like a bad drug if abused. I don't normally take medicine, so I'm not real familiar with a lot of the drug names, other than the ingredients in stuff like Advil, Tylenol. Aleve, etc. Here is what he has me on:

Lortab - (for pain every 6 hours)
Fragmin - (once a day for 7 days and then 81 mg aspirin once a day for 6 weeks for anticoagulant)
Celebrex - (once a day anti-inflammatory)
OxyContin - (once every 12 hours)

So, I found it odd as well that I have Lortab and OxyContin, but again, I don't know drugs that well. I gather that the OxyContin is a time-release drug for fairly severe pain, so I guess that's just to get me through the post-op pain and not the continuing pain that the Lortab will help with. I only have a week's supply of the OxyContin and Celebrex. Hopefully Jo will respond to help clarify.

 

[Peta]

You're welcome Scott! And yes - I am sure Jo will clarify things for you the next time she's online. Let me know how you get on at the dentist!
Just for the record - I actually had a crown prepped and inserted roughly 4 months post-op, and the only precautions I took were prophylactic antibiotics. However at that stage I was only takin Ibuprofin for pain relief.

Peta

 

[Troweltalk]

The use of antibiotics before a dental procedure is to stem off infection; but I have never fully understood the relationship between an infection from a dental procedure and our implants. I'm looking forward to jo chiming in on this one..

(getting my teeth cleaned in 3 weeks, and they want me to take four pills an hour before the procedure)

 

[nickji]

The use of antibiotics before a dental procedure is to stem off infection; but I have never fully understood the relationship between an infection from a dental procedure and our implants. I'm looking forward to jo chiming in on this one..

(getting my teeth cleaned in 3 weeks, and they want me to take four pills an hour before the procedure)

Hi Mudpro,

Jo will correct me if I'm wrong, but I assume it's because an implant can't set off the immune response that the cells of the body, including bone cells, can. So bacteria etc. can settle on the implant and GROW



Nick

 

[prairienut]

Nick is right. As I understand it, the bacteria that normally reside in the mouth can be released in large numbers into the bloodstream during a dental procedure. These can then travel to the site of the prosthesis and lodge there. I have been told not to have any dental procedure for 2 months following surgery. Then for 2 years, I need to take antibiotics prior to any dental procedure.
Gail

 

[Josephine]

Well, there's a lot that is right here and some that is almost right but not quite. For starters there is a lot of confusing information about dental work and joint replacements and the circumstances under which the one is a hazard to the other. There are so many different opinions between the surgeons/dental organisations and in different countries. One says antibiotics 2 days prior and several days after, another says just one dose 1-2 hours prior. Some say forever, another says for the first 2 years. Some people also include other things like colonoscopy, colonoscopic biopsies or polypectomies, etc., while others say they are not a hazard. It's a right royal mess and no-one seems to have any specific data to back up their own point of view so at the moment that's pretty much all we have to go on - people's points of view.

What we do know is that some dental ailments like abcesses, extractions and root canal work, also urinary tract infections, can dump a whole load of active bacteria into the blood stream which can (note 'can' not will) deposit itself onto the surface of a metal implant. Added to this is that the nature of the metal being biologically inert, the immune system cannot 'see' the bacteria there so the bugs are not attacked by white blood cells in the usual way. Over time a kind of fungus-y sludge develops which interferes with the cement or bone to metal bonding, thus causing the implant to become loose. When this substance is investigated in the lab, the origins of the pathogens can be identified somewhat, meaning that they can tell if it's oral or urinary, for example. Hopefully the patient will then be able to back it up with information but it's not exactly a pure science.

So truth to tell, we have no idea how many thousands of people have dental work and never have a problem, nor how many have a late stage infection in their joint replacement and no idea where it came from. Or how many had prophylactic antibiotics that worked or didn't work. In the end, we're pretty much left with the BSTS philosophy (better safe than sorry).

But I quite liked how my surgeon put it - he said even on odds of 1,000-1, what is the cost of a thousand doses of antibiotics compared to having to do one revision? (He was talking pure accounting there!) Personally, I think I'd sooner go with that philosophy than spend months of anxiety wondering if I was going to be the unlucky one!

 

[oldbones]

I was reviewing the medications that you're on and it sounds like your OS is right on track. You mentioned that you weren't sure why you were on both the Oxycontin and Lortabs but the Oxycontin is a long acting pain med and the Lortab (aka Vicodin) is for any breakthrough pain that you may experience. For example, if you are having PT then it would be advisable to take the Lortab 30-60 minutes prior as an extra "boost" for pain control. Oldbones

 

[Scott]

Jo - I bow to you. You have outstanding information. Thanks so much.

 

[Scott]

Talked to the OS today via the nurse. They want me to cancel the appointment and reschedule after I see the OS to get the staples removed. Said they would prescribe antibiotics to take 30 minutes before seeing the dentist. Called the dentist to cancel and tell them why. They've dealt with this quite a bit and had procedures in place as well, so I'm all covered. Got worried about nothing, but I'm sure glad I read the warnings on the medicine. Whew!

 

[Judles]

All these directions can drive anyone nuts Scott!!! Always better to err on the side of caution!!!

 

[Peta]

Good to hear its all sorted Scott. And yes.....just as well you were proactive enough to read the warnings!
I know I'm "old school", but I always think it's better to be safe than sorry!

Peta

 

[Scott]

Funny thing is the dentist part was in all caps, luckily, or I may have missed it. I was being watched over!

 

[Peta]

I've just finished through your entire blog Scott and all I can say is.............I'm off for a walk! I can't believe what you were able to do physically prior to your THR!!!! It makes me feel totally lazy in comparison! You've inspired me to do a lot more than what I have been! If you could do it with all your limitations - then I can do it with a brand new hip!

I think I'll have to check back into your blog on a daily basis to stay motivated!

I thoroughly enjoyed reading it all Scott - you write very well and I was totally engrossed in reading it! Keep it coming.......!

I'm off for my hip x-rays so enjoy your day/night! Talk soon,

Peta

 

[Scott]

Very kind of you to say. You just made me smile. It has been therapeutic for me to write that.

Good luck on your x-rays. See if your OS will get you a copy. I have one of my old ones and my new OS said he would get me a copy of the one he takes at six weeks. It's fun to look at it sometime down the line or use it for show and tell

Can't wait to hear how your appointment goes!

 

[Judles]

Peta! Its sooo weird that we're all on different time zones! Hope your xrays turn out well! When I had mine this morning, the tech asked if there was anyway I could be pregnant!!!! I said,,,Oh, just what my grandbabies would need! She said I looked like a "baby!". Boy did she make my day! Or maybe she just needed eyeglasses! . Good luck and hope to hear more good news from you!

 

[YoungM]

Judles -see, you are not only young at heart, but young looking too!

 

[Judles]

Oh M!!,, how adorable are you!!!! I've been thinking of you today! My OS even said not to worry if I hear the occasional "clunk!".....that it should go away....I better go to bed,,,,,everyone's been so supportive of me today!