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1711722 tn?1356487554

How are your teeth post triple tx??

Knock, knock, Penny?? Knock, knock, Penny??
Hi there everyone.  Haven't been on the boards in awhile, as I have been dealing with multiple health issues since tx (which failed for me).  My doc doesn't think it's due to tx, since  the drugs are out of my system.  I am a little past 1 year post tx w/Victrelis, Peg & Riba.  Because we ALL have had some ailment in our lives before tx, and because I definitely have pre-existing stuff, I don't want to jump to blame everything on the tx meds.

That said......I just found out that I need Major dental work. Multiple cavities, holes, and missing pieces of a tooth.  Granted, I have not been keeping up with regular dental visits but I certainly do not believe I have done anything that would cause something so drastic.  So, for the Post Treatment folks, please share if you have experienced unusual dental changes that lead you to believe it could be Interferon related, or the other tx meds.  And if you have links to any fact based articles, please include those too.  Quite embarrassing to think this is my doing, so if I could provide my dentist with another valid reason.... Too sleepy to research tonight.

Thanks in advance.
Sending a big HI!!! to all my old MedHelp buddies (2011-2012).
Be Blessed,
Bee :0)
Best Answer
1815939 tn?1377991799
I am posting several links to articles which mention the teeth and dental problems associated with treatment. Each of these articles discusses the dental problems somewhere in the article, often under complications or warnings:


5.7 Dental and Periodontal Disorders

Dental and periodontal disorders have been reported in patients receiving ribavirin and interferon combination therapy. In addition, dry mouth could have a damaging effect on teeth and mucous membranes of the mouth during long-term treatment with the combination of ribavirin and interferon alfa-2b.

http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=9ed7adc9-bd0c-41af-b34c-43d15a7799d1


Teeth and gum disorders, which may lead to loss of teeth, have been reported when this medicine is used in combination with interferon alfa or peginterferon alfa.

http://www.netdoctor.co.uk/infections/medicines/copegus.html


This medicine may cause teeth and gum problems. This medicine may cause dryness of the mouth, and a dry mouth may damage your teeth and gums if you take the medicine for a long time.

http://www.mayoclinic.com/health/drug-information/DR602577/DSECTION=precautions-


Dental and periodontal disorders
: Dental and periodontal disorders, which may lead to loss of teeth,
have been reported in patients receiving ribavirin and peginterferon alfa-2b or interferon alfa-2b
combination therapy. In addition, dry mouth coul
d have a damaging effect on teeth and mucous
membranes of the mouth during long-term treatment with the combination of ribavirin and
peginterferon alfa-2b or interferon alfa-2b.

http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/001018/WC500056547.pdf


Severe Stomatitis Complicating Treatment With Pegylated-Interferon
-2a and Ribavirin in an HCV-Infected Patient

http://health.usf.edu/NR/rdonlyres/F05CA297-F2AA-4F28-8B76-5A65378B24A6/44993/IFNStomatitis.pdf


In a Japanese Phase III trial of Peg-IFN alfa-2a and ribavirin involving 199 patients with chronic hepatitis C, including 99 patients with IFN treatment-naive genotype 1 and 100 patients with patients whom had not had a SVR after IFN therapy, the oral side effects were: gingival bleeding and gingival swelling (6%), toothache (4.5%), gingivitis and periodontitis (3%), dental caries (1.5%), stomatitis and cheilitis (19.1%), disorder of taste (15.6%), dry mouth (6.5%), glossalgia and glossitis (4.5%), perioral paresthesia (2.5%), oral pain (0.5%), oral mucosal damage (0.5%), oral lichen planus (0.5%), oral hemorrhage (0.5%), dry lip (0.5%), and bulla of lip (0.5%). On the other hand, in a Japanese Phase III trial of Peg-IFN alfa-2b and ribavirin involving 332 chronic hepatitis C patients, including 269 patients for 48 weeks treatment duration with genotype 1b and high virus load, and 63 patients for 24 weeks treatment duration with others, oral side effect were: dental pulpitis, gingivitis, and periodontitis (8.9%), toothache (7.1%), dental abnormity (1.1%), stomatitis and cheilitis (26.8%), disorder of taste (26.8%), dry mouth (15.6%), glossitis (5.9%), oral discomfort feeling (2.6%), oral hemorrhage (0.4%), oral pain (0.4%), dry tongue (0.4%), decreased secretion of saliva (0.4%).

http://www.virologyj.com/content/7/1/192


Hope this helps some.
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253566 tn?1219679699
I think I posted previous...

I was so embarrassed by my teeth during and just after treatment - I had a great dentist. I think some of these people are amazing, how they work in such tiny spaces and all, hehehe...

Anyways, this dentist really did a lot of work, so many root canals and such trying to save my teeth while on treatment!

No one understood, or at least reported to me, what was going on or what might happen with 72 weeks of INT + Riba.

The staff at the dental office said I was taking such great care of my teeth. The office at the previous dentist - five years before treatment - did an amazing job on my teeth!

After all that work the horrors started! I would wake up one day and feel around with my tongue and a major tooth would just drop out! It was like a movie that I didn't want to be in. I was too upset to tell anyone especially the dentist so just let one or two others fall out and did the best with my mouth.

I wish I had known about the fluoride trays but... NOW when I finally heard there was a very good young dentist - went to him... they all say that I am brushing too hard. I try to explain what has been going on with HepC treatment but they don't understand... I brought in the cordless toothbrush I have been using for a long time. Guess what? It is the exact same one the dentist has. It can't brush too hard as it stops when you push too hard! UGH!
Helpful - 0
Avatar universal
No problems with my teeth prior to tx in March 2014 with pegIFN, Ribavarin and Sovaldi.  Since treatment: 5 Root Canal, 5 crowns and 2 additional gum surgeries.  Also got a dx of TMJ.  I have constant toothaches and mouth pain that is causing earaches and headaches.  Excessive dry mouth.  
I am simply miserable and not happy.
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317787 tn?1473358451
To explain, my original dentist sold his practice. The new dentist lied said I needed two crowns and had a cavity. It did not sound right.
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317787 tn?1473358451
Hey there!  I am happy to report the second opinion said I am in great shape. The other dentist was lying. I am glad I decided to go for second opinion. I now have a new dentist. Really happy. Thank you so much for your help. :)
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Avatar universal
No, I put the trays /floride in, left them for 1 minute, took them out, expectorated and then did not swallow, rinse or eat/drink anything for 30 minutes before rinsing well.

I have a friend who had also mentioned the floride treys to me as had used them while on chemo. mHis dentist had him use them 3 x week, leave them in for 5 minutes.  Follow- up was the same.  Don't know what the strength of his floride but mine is 1%.

Glad you are getting a second opinion.  And really glad your gums are doing so well.  Teeth can be replaced, but gums are forever. : -)
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317787 tn?1473358451
So sorry I mis read the post.  Florida trays, sorry, LOL  I have been using a prescription toothpaste with extra fluoride, hope that helps.
So did you sleep with the fluoride in your mouth all night?

It is so odd, my gums are great though appreciate the information about the Vitamin C. I will take extra.  I will do what ever I can to keep what I have.

I am going to get a second opinion about the two failed crowns.

Thank you so much!
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Avatar universal
As I look at your post again, I see I ignored part og it- didn't mean to.

You might ask the Dr if Floride treys at this point would help preserve you natural teeth and imporve the areas under the implants.  

I don't think the decay can be reversed, but, heck, ask anyway.

Hope the work you have to have done is not too extensive.

Pat
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Avatar universal
Oops!  if I typed Florida treys, I meant to type f-l-o-r-i-d-e.    That blue stuff they treat your teeth with to strengthen them.  Of course, Florida treys works, too,if itis filled with lucious ,oranges, mangos, papayas, etc., etc., etc., you get the picture.  : -).      Pat
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2059648 tn?1439766665
Vitamin C is really good for your gums.  
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317787 tn?1473358451
That is really great, I used  flossing, brushing, drinking lots of water as well as the biotene products, the water pick a couple of times a day but have never heard of Florida Trays, I appreciate you sharing.

I had all this work done pre treatment, now it seems to be failing, i.e. crown margins are off so food is getting underneath and can cause decay. I have to have my crowns replaced.

I asked my dentist what I could have  done to prevent these failed crowns, he said nothing.

Now that I look at this I realize I should have asked a new question.
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Avatar universal
Last year when I was getting ready to start tx, I was on the Forum read a thread discussing dry mouth and its resulting dental problems.  My dentist happened to be in my church for Father's Day, and heard me say that I was starting tx.  He came over and asked if I had talked to my hepa about Floride Trays.  I called the hepa the next morning and was told it was a good idea.  Dentist had them made and ready so quick!  I used them faithfully, every night, all the way through 6 mo of tx w/ sol/riba.

I have had two visits one while on tx and one within a month after.  The Dentist is very pleased!  By the first visit (3 mo into tx) my gums had gone from always red and inflamed to pink and healthy!  I can't remember when that was the case.  I believe that it was a residual of INF tx in the 90s, but who knows?  Anyway, my gums were still in excellent condition a month aftex end of Tx.

I truly believe the combination of careful mouth care, including the waterpik 2 tx a day, and the floride tray every night, made a big difference.  NO gum or dental problems to date, 3 months after EOT.
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317787 tn?1473358451
I am having a lot of dental problems, came on here to see what others have experienced, found this older thread so am bumping it up.
I hope that is all right.
I  found an article from 2013 that talks about how HCV can affect the mouth.
It also talks about extra hepatic manifestations.   Before I treated, I had a lot of dental work done, during tx I was so careful with my teeth but still had to have two crowns redone during tx.
I am now having to have more work redone, bad dentist or my system? I don't know.  I have great bone structure per a recent bone scan so just not sure.
Is anyone else having problems?  Thank you, Dee

http://www.journal-imab-bg.org/issue-2013/issue4/JofIMAB2013vol19b4p377-379.pdf
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Avatar universal
I Can't Comment On My Teeth Post Triple Therapy Because I Had To Have all My Teeth pulled during My Short Term Disability Leave taking Peg IntRon/ RiBavirin In 03/04. UP Until That Time I Had Good Teeth with Just 3 Fillings. During Treatment At.That Time All My Teeth Started Hurting.Toward The End Of 48 Weeks Of Tx, I Was Eating Dinner And Teeth started breaking Up. I Ultimately Had All  27 Teeth removed And Now Have 32 That Were Bought Locally. I Suspect Treatment had A Large Part To Do with Their Loss.
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317787 tn?1473358451
Hi thank you for mentioning the gum recession. I thought that my problems with my teeth were due to having  the HCV for 30 years.as I had problems before tx.  After tx I had problems with receding gums.

Before getting HCV I had never had a cavity.  Now I fear losing all of my teeth.
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1815939 tn?1377991799
I finished treatment Aug. 25, 2012 and my teeth and gums are back to normal now. The mild very gum recession that occurred during treatment won't reverse, but otherwise my gums are very healthy. I continue with teeth check-ups and cleanings twice a year. I brush at least twice a day. In addition, I d use mouthwash. So, other than the very mild gum recession, my mouth, gums, and teeth seem to be doing well 14 months post treatment.
Helpful - 0
1751426 tn?1399007484
Again, I have just returned to the old medhelp out of curiosity and found this new forum.  I too found my teeth affected by tx.  I have a dental plan and go twice a year like clockwork - love my dentist.  Since tx I have had two cavities filled and a tooth pulled that was beyond saving.  My teeth are also super sensitive now.  I have had some exposed dentin for some time and regularly use the sensodyne repair toothpaste but this is in addition to that.  Ah the joys of old age plus a 38 yr case of Hep C and one failed tx.  Good to know that most of you are still kicking :)
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Avatar universal
I've been in HCV forums for a little over 10 years; since Aug 2003.
I've seen quite a few threads and posts in various forums which have talked about tooth issues and so I think I've seen a tremendous amount of anecdotal evidence that SOC can cause or precipitate dental issues.

I know many people will say it's HCV related, and perhaps it is..... but as with some Post TX issues.....  the problems did not seem to be existing before TX, but they were in great evidence afterwards.

I will also mention that it is also true that tooth issues do not visit everybody, so the action does not seem to be evenly distributed upon everybody.  It could pertain to diet, genetics, preconditions, immune response or the flora in ones mouth.  

No clue but I saw this written by another member of another forum.  They have also "been around" for a few years and I thought I would dump it here.  : )

=================
http://forums.delphiforums.com/n/main.asp?webtag=hepatitiscen&nav=messages&msg=42986.1&prettyurl=%2Fhepatitiscen%2Fmessages%2F%3Fmsg%3D42986.1&gid=2060349541

   "I never did the Peg/Riba tx, but can tell you that I've read probably hundreds of posts over the years from folks that did, and who had serious dental problems afterward. Many, whose teeth were fine prior to tx (successful or not) have ended up wearing shiny new dentures within five years of finishing.

Possibly 'dry mouth' has added to the damage, and nowadays a lot of folks depend on the Biotene products to help prevent such damage . .

So far, among the few who have tx'd in trials (without Ifn/Riba) have reported no dental 'leftovers' from the new drugs . . "
======================================

I mention this partially due to the dental issue itself, but also as there are also many reports of osteo type issues, such as osteoporosis or some degree of bone loss.  

It could be that the newer forms of treatment may account for less damage, either due to being interferon free...... or due to a much shorter period of treatment, or both.  Less anemia may also play into this as well.

I'm not sure I have ever seen the mechanism by which this (may) happen explained.  The dry mouth is one possibility. A change in bacteria in the mouth is one that I wonder about, (as well as in our complete ecosystem, such as in our gut as well).

When you also read about people on TX who feel as though they have "aged" many years, it is possible that the teeth may also go through that sort of change, and most of us know that tooth and gums do not always just revert back.  Maybe they have a duty cycle and may wear out as the rest of us ages as well.
Maybe we would have had these issues down the road anyway, but the TX sped things up.

willy
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4705307 tn?1447970322
Great thread, I will be careful not to sound off, Last night I took shot # 48. Been awake all night wondering was it worth it?  
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317787 tn?1473358451
Hi Frank, thanks for suggesting this be moved to the Post tx forum
I asked that one of your posts from 2005 or 2007 be moved, it was.
Emily can help with any of that

I wanted to add to this.  I think having HCV for 30 years probably added to my problems with my teeth.  I never had a cavity until after my first child, then after my second child I had 11 more.  So much for losing a tooth for every child.
In 2006 and 2007 I had to have root canals and or crowns on every molar.

I was dx with HCV late 2007.  I can not blame this on tx.  It was awful to go through, I had no choice because I was in pain and it went from one tooth to another.

While I agree that tx could have affected our mouths Rivil has helped me to realize that a lot of this is the HCV, at least for me.
Rivil has treated her HCV without interferon and she has quite a few of the symptoms that we have.

I know how you feel, I always had great teeth until 1979 when the cavities started.  Back then the dentists would feel the teeth with large fillings.  As time went on with the large cavities, my teeth started to break.

I did not help myself by eating caramels or gum.

I have days where I don't want to smile any more.

I hope you can get some help/validation for your problems
My very best to you Frank, Dee
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253566 tn?1219679699
Hey everybody, just thought I would dig up this thread!
... and before I forget *It should be moved to the "Post Treatment Issues" Community...

I was riding to my GP and overheard that there was a really excellent dentist at the clinic. I asked my GP about him and he was recommended. I called up and was surprised to get an appointment pretty quickly.

I was pretty nervous going in & explained to the assistant how I hadnt seen the dentist for a very long time due to PIS and teeth just falling apart overnight! I guess she made note of that... she took x-rays and took off & I waited for the dentist...

Well, this great dentist was having none of this PIS stuff! I was the cause of my poor dental health! I was brushing too hard and I should buy soft tooth brushes! and when I explained that I only bought soft tooth brushes and was very careful and that I had an electric toothbrush that stopped if you pushed too hard... To which the dentist said "Well, that is a good start". UGH! I have been using that system for about 6 years! But it was obviously useless trying to educate this doctor.

It really doesnt matter, I know my teeth are in a very poor condition - 5 will have to be removed - but this is the first doc who I have confronted in many years who was so unwilling to be open to a new concept but then he is a dentist so???

I met the Oral Surgeon and explained the same to him and found him very understanding and open to the concept of Interferon of causing such damage! This specialist seems to use sleep therapy widely for surgery (not sure if that is a good or bad thing)... and hopefully insurance will cover the bridges - but there is the possibility that the supporting teeth will fail so this first dentist better do a very good job with the remaining teeth and bridge!

I dont know if it would do any good to bring those links to that first dentist, there is just so much great info there Pooh! I did write a letter of complaint with a note that I wanted someone to get back to me and that was just a day or two ago so...

take care all,
frank
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Avatar universal
Thanks for the kind words folks....

I *had* thought when I first found out that it must have been sexual, because of some unfounded fear. When I went to the doctors they really pushed the drug idea, so I presumed some wild youth thing.
In reality..... not of my friends have this, so I later thought..... well maybe not.

In digging up my medical records I found a record that showed pristeen LFTs 20+ years ago.  I started doubting my so called wild youth- maybe it was wildish but I had no damage via LFT's 15 years after it. Even w/ social drinking my ALT was in the teens.
A few medical procedures, dental work, aiding a bloody injured worker.... and I had high LFT's about 10 years later.

One often does not know the infection vector.  Even today people continue to acquire the infection (at far lower rates than in the good old days) in medical settings w/ poor cleaning and sterilization techniques, sometimes workers "share" a dose of a drug, taking a hit and then administering to a patient.

Even where they "know" they caused it like air gun injection, they have denied it. As late as 2005 there was no mention of airguns transmission in the VA handouts on hep C-not at my local VA anyway....

Off to my trial center; 3:30 AM, long drive for 4 week labs.

Take care,

willy
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1711722 tn?1356487554
Hi Willy -- Thanks for your posts.  I hear you.  Curious though, what did you mean by -- "I think that they favor that topic so as to take some of the emphasis off of the medical field as a vector."??  I have no idea how I got Hep C and it was only discovered from routine intake by a new doctor.

Hey Frank -- I hate what you have had to go through.  I agree that "they" do need to take all side effects into consideration.  But more than that, I am pleased to hear that the newer meds are more focused on fewer to no side effects, and shorter tx times.  It pains me that on the whole (in my opinion), emphasis seems to be put on things no concern (i.e.; 3 in 10 people prefer crackers with soup, or something mindless like that), as opposed to pushing to make more meds that work, without harming something else.  I am learning that from meds to food, "they" will give us anything.

I am so glad you did clear the virus.  I, unfortunately did not, and am very grumpy about it some days. I hope my grumpy didn't spill onto you. Today I had to have a tooth pulled because it was beyond saving.  Not something I expected or realized could be a result of tx.  Time to change the gauze again in this now gapeing hole in my gum.

Thank you all again for being the best bunch of online cheerleaders ever!!

Bee
Oceanus -- Your kind words make me blush :0)
Helpful - 0
2059648 tn?1439766665
Interferon is a chemotherapy drug.  See  "chemocare.com" drug information.
You should be using a soft tooth brush during treatment so you don't brush your teeth to hard.  Side effect of interferon is bleeding and bruising.

Cancer, hepatitis and twice chemotherapy survivor.

Best to You

Helpful - 0
317787 tn?1473358451
Bee, I have always taken care of my teeth, had work done right before treating.  After treating I had to have scaling done for the first time in my life. My dentist said  that I should not blame myself for the problems I was having.

Dear Frank, I understand how you feel and I know what you meant.  After all the time and money spent on my teeth over the years you would never know it now.  It makes me feel  bad about my appearance.

Willy you are the best, I loved what you wrote.  You always seem to be able to size up a situation and lay it out for others to understand, Thank you.

I wonder if their is a correlation between Hep C and tooth loss, gum problems.
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