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MicheleS

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Reply with quote  #1 
I've managed to get an abscessed wisdom tooth and there's not a dentist who will yank it...  My dentist has been advising me to have my wisdom teeth pulled for like 10 yrs but they have never bothered me... they are impacted and I have a fear of oral surgery.  Well, my counts got really, really low a couple of weeks ago and I developed an abscess.  Currently, my counts are fine (thanks to neupogen) but the damage was already done.  My whole jaw and sub-lingual area hurts sooooo badly.  The onc on call put me on augmentin but also told me that thre's no way anyone will pull it because 1) chemo, 2) avastin, 3) bisphophonate trial.  What do I do??  I'm going to call my dentist 1st thing in the am to get an xray... maybe it is just a soft-tissue infection, but I don't think so.

Any ideas?? Suggestions?? Anyone have this happen during chemo???  I'm almost done... #12 is next thurs... I can't believe I almost made it and now this.

Michele

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Reply with quote  #2 
Oh Michele!
You are on bisphosphonate?
The only thing I can suggest is get a full head radiograph- that will take a picture of your entire jaw. My dentist wants me to do this for a baseline  because I am on zometa.

That way they can tell how deep the infection is.

If they can treat it with antibiotics and you go off the bisphosphonates for a couple of months, you reduce your risk of ONJ. When was your last infusion?

You need an oral surgeon who is familiar with ONJ and cancer.

I hope you are feeling better soon.
Love
g


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MicheleS

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Reply with quote  #3 
Gina~ I'm on clondronate.  It apparently carries less risk for ONJ than zometa but there's still a risk.  I've only been on it since 5/1 so I doubt it is ONJ (yet). I'm still getting weekly taxol.  This thurs (6/18) is my LAST ONE!!!!!!  The onc on call said that they wouldn't hold chemo for my tooth as long as I'm on antibiotics (I am!) and my counts are OK. 

I'm going to call my dentist 1st thing in the morning.  He can't do the full head radiographs but he can look in my mouth (and do some x-rays) and refer me out...

Michele

kmobley

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Reply with quote  #4 
Michelle,

Hope you are feeling better with that tooth.  Ouch!

Kay
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Reply with quote  #5 
Gina,

With the weekly Taxol dosing, are cell counts usually better?  I know everyone is different.  Michele says hers really got low a couple of weeks ago. I will be starting Taxol on the 25th.  Don't know much about it.

Kay
MicheleS

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Reply with quote  #6 
Kay,
Counts are usually much better on weekly Taxol.  I didn't start having issues until #9 or 10.  Usually, they'll just hold chemo for a week to let you body recover a little.  However, I'm OCD about staying on schedule so I convinced my oncologist to give my chemo anyway.  We did use neupogen (you can't use neulasta for weekly chemo) for 5 days that cycle but it was too late to prevent opportunistic infections at that point.  Now, my counts are fine and other than this tooth, I'm feeling relatively good.

Everyone,
I saw my dentist yesterday and he has referred me to an oral surgeon.  The dentist told me that I either have a diffuse infection, ONJ, or mets to my jaw.  I flipped out at the 3rd choice... Thankfully, I was able to talk to my oncologist and he reassured me that I don't have mets.  He's almost certain that it is an infection but *is* concerned about ONJ.  So, I'm off the clondronate for now.  I see the oral surgeon tomorrow.

Michele
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Reply with quote  #7 
Awwww Michele,

so sorry to read about your troubles.
Does ONJ hurt? I thought it is silent!

I hope for a good old infection (not to be mean of course!)
Hopefully they can yank it and clean it out and put you on a truckload of antibiotics!
Best wishes!!

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Jennine

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Reply with quote  #8 

Whats wrong with that dentist for saying it could be mets to the jaw?...how the hell could he possibly surmise that?? From an infected wisdom tooth?? I bet because of your treatments your gums got sensitive and there ya go. I am by no means a dentist, but I DO have A LOT of experience with dental work, plus mom worked for periodontists for over 25 years, so I have become acquainted. I had my wisdom teeth pulled because of an infection..I could not even open my mouth till I had them pulled.
AGHHHHHHH it makes me mad mad mad..thank God you have an awesome onc...with a brain.

The tooth needs to come out. Wisdom teeth can cause so many problems, that's why so many have them pulled. I understand you can't do that now, but treat the infection and then when your able, pull it out and you'll feel better and bye bye problems with that sucker! Did you see an oral surgeon? They know what they are doing and talkin about. I hope you feel better after you talk to him and I hope all goes well for you Michele..thinking of you..

Love, Jen


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Reply with quote  #9 
Michelle,
I am going to have to start keeping a list of all your doctors who piss me off.
Mets to the jaw????

Geez o pete!

I like that old expression, "When you hear hooves think horses, not zebras"
I am with Jen, go with the infection first- the most obvious choice.

I hope you get help soon.

My dentist told me that ONJ feels like this:

"You go to lean your head in your hands and your jaw breaks under the pressure of your hand"

He didn't say anything about something that feels like an infection.

BIG HUGS to you

I think we need to get the Chopper ready and help Michelle- eh girls???

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MicheleS

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Reply with quote  #10 

awwww Gina... thanks.  I live in deep south AL.  Good MDs are hard to find.  However, you know I have a GREAT oncologist.

Calico

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Reply with quote  #11 
Zebras Gina, lol

lets board the Chopper!!!

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MicheleS

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Reply with quote  #12 
I saw the oral surgeon today.  I *just* have an infection of tooth, gums, and muscle... I am sooo happy 'bout that.  I need to have the tooth yanked.  The surgeon said  that he would do it after talking to my oncologist... even with the Avastin and clondronate. We'll see...

Thanks for the chopper!!!!
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Reply with quote  #13 
Who would have thought that somebody is happy about an infection


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Jennine

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Reply with quote  #14 
Glad you saw an oral surgeon Michele
Here's to you feeling better!!

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Reply with quote  #15 
Yippee for an infection!
I am wondering if they will make you wait a few weeks before you can have it yanked... I heard you have to be on a  break from the bisphosonates for such things.

Everybody who was on the chopper! Where did all that southern food come from???


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onecent

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Reply with quote  #16 
Is this a concern for those on the zomata to protect against future cancers too?


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MicheleS

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Reply with quote  #17 
Gina~ They (both the oncologist and oral surgeon) told me to go back on the clondronate.  They said the risk was the worst for zometa patients who had been on it for years.  But, they both said that a good oral surgeon could minimize risk through technique.  I saw a guy who has done lots of ONJ surgeries (to remove affected bone).  He has both an MD and DMD.  Anywhoo, he seemed knowledgable and admitted that there was a risk but he felt that the benefits of clondronate outweighed the risks.

Soooo.... I'm back on clondronate and I go back to the surgeon in a couple of weeks for a recheck.  My tooth is all better now but my oncologist extended my antibiotics because my neutrophil count was a whopping 1.1 this week.  He gave me chemo anyway because it was my LAST ONE!!!!!! (I begged and begged for him to not postpone!!!!)

Michele


edge

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Reply with quote  #18 

Michele:

 

ONJ is almost exclusively associated with aminobisphosphonates (like the intravenous zoledronic acid (Zometa) and pamidronate (Aredia), and to a lesser extent the orals alendronate (Fosamax), risedronate (Actonel) and ibandronate (Boniva)), that is, with those bisphosphonates having  a nitrogen molecule, and  clodronate (Bonefos) is not an aminobisphosphonate, and reviews including my own (ONJ Watch: Evidence-based Guidance on Osteonecrosis of the Jaw (ONJ)) have shown it to  be  virtually devoid of any significant ONJ risk.  And although there are two case reports of a possible association between clodronate and ONJ development, I do not find these convincing: (1) in the Czech report of Koszumplikova, although the  patient was started on clodronate, he was  actually switched onto zoledronic acid (Zometa) so no clear association with clodronate can legitimately be claimed; (2) in the Montazeri report at Glasgow Royal Infirmary there is no indication of what  other drugs the patient had been exposed to so again a clear causal connection is not established,  and (3) finally I  note that both these cases were in patients with myeloma - there are absolutely no cases of ONJ associated with clodronate in breast cancer patients. 

 

In addition, there is a decided bonus with clodronate (Bonefos), as it is the only bisphosphonate besides zoledronic acid (Zometa) with robust evidence of powerful  antitumor activity;  it is for this reason, and the  absence of significant ONJ risk, and the convenience of oral administration, that it is my favorite bisphosphonate, and had it been available in the U.S. (it  is not at this time), I would be advising  everyone to get on it.  But you can still consult with my ONJ Watch for defensive measures if interested, and in reference to Onecent's query above, everyone on any bisphosphonate - which is all of them except for clodronate (Bonefos) - especially Zometa, should closely follow my guidance there.

 


 

Constantine Kaniklidis

Breast Cancer Watch

edge@evidencewatch.com

MicheleS

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Reply with quote  #19 
Thanks, edge.  I was bummed when I got the clondronate arm and not zometa.  But, it sounds like that was actually a blessing in disguise.  The clondronate has been easy to tolerate as well.
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