Dental work while on Reclast

Dear Lori,
I have been dealing with Shingles for the past month. I was diagnosed April 30th after a week of severe ear pain.
I am healing well and all of my blisters are scabbed over. My doctor wants me to take lyrica for the remaining nerve pain. I really do not want to take anymore drugs, but I am still taking tylenol #3 twice a day for the nerve pain. I am now trying to switch my focus to my upcoming teeth extraction on June 17th.
I hope there is no conflict with having my remaining four teeth removed and having Shingles. None of my doctors have an opinion about the safety of this. My dentures were made in October, so I really hate to put this off any longer. But I am not looking for any more problems. I hope you are well and I look forward to the guidance from you that I have found so very valuable. I will keep you updated. Please let me know how to prepare for the extraction on the 17th.
Thank you so very much,
Holly

Holly, my gosh gurl! Like you needed more craziness glopped onto your dinner plate! I’m so sorry to see you’ve been dealing with shingles. This is one area where I have no experience but I surely hope you’re over the worst of it now and the nerve pain will ease up soon!

You’ve been waiting such a long time to have those final 4 teeth removed so you’re worried shingles might complicate this procedure. If someone has an active case of shingles with symptoms such as the rash or blisters, it’s prudent to postpone dental treatment because it’s possible to spread the infection through skin contact or by airborne aerosol.

But it sounds like you’re well past that stage. If you have lingering nerve pain, I don’t know how that will impact the denture placement. Meaning, when the denture is in your mouth, it will be putting pressure on your cheeks and the outer side of your upper ridge of the palate. You haven’t had any teeth there for a long time so this will feel much different by not only have teeth but to have a rigid piece of plastic pushing up on the outside of the upper ridge into that tender cheek area. Do you have pain in the jaw area on the side with the shingles?
Maybe a good test would be to use your index finger to gently check your mouth inside your upper cheek. See what it feels like to have something pressing on the area where the denture will rest back there…where upper cheek meets the upper jaw ridge. That may give you an idea if this will irritate your ear/cheek or mouth.

Have you discussed this with your dentist or the oral surgeon who’ll be doing the extractions?

Dear Lori,
Thank you so much for your reply ! I plan to call my oral surgeon by Tuesday and inform him of the fact that I have had Shingles. I do not have any remaining symptoms except itching and some residual pain on my breast and under my arm where the blisters were the last to appear. I do not feel any tenderness in my jaw. My cheek on the side where my ear pain was so severe feels slightly numb, but not tender. I am so worried that the surgeon will decide to postpone the extraction, but I know I must give him the information he will need. I asked for instructions about how to prepare for the extraction when I was there for a consult and they said there were no instructions. I wonder about the fact that the denture has been sealed in a bag for several months. This seems as though it will not be good for the placement. I will ask if it should be "soaked" or something. They said to just bring it with me when I come for the extractions. I saw a specialist at the ear clinic on Thursday to have my ear examined. There have never been any visible blisters near my ear. The doctor said there is no sign of anything wrong with my ear. I worry about the trigeminal nerve being involved, but I did not get any answers. So the Eye doctor says my eye is ok, and the ear doctor says my ear is ok, so then why was I in severe ear pain until I got antivirals ? I am trying to not worry. I know that is not good for Shingles. I do like to get clear answers and clear cause and effect explanations, but I feel as though I don't understand most of what my situation is. My Dear Lori ! you are the only one I understand and who answers my questions ! Would you send me a list of what you would tell the oral surgeon and what you would ask him. You are such a blessing ! I am so grateful for your help. Thank you

Hi Holly! I’m sitting here on the couch, curled in a blanket, with a hot cup of tea this morning. I don’t know where you are but I live in the north woods of Wisconsin and my gosh, we have the fireplace going! It was 34 degrees when I got up this morning…on June 10!!! What the heck! So get comfy with me and let’s chat about the big adventure coming up for you!

First let’s talk about the oral surgeon appt. My gut feeling is that this project will be a ‘go-ahead’ for the 17th so you can be all smiles!! By that time you’ll be 1.5 months past the initial shingles onset, you’re taking antivirals, no new blisters and you’ve been cleared by 2 doctors. The pain symptoms are waning and you don’t have any pain in your jaw, so it doesn’t seem like there’s any reason not to go ahead. But I’m not a dentist so it’s important to still call ahead to the OS office.

Obviously I haven’t seen you in person, but from what we’ve discussed, I believe those 4 remaining teeth are what’s referred to as simple extractions…meaning they should be easily removed with no complications. So I don’t anticipate your having any issues with the procedure. Also, where these teeth are located, there shouldn’t be any impact from the local anesthetic and not near the trigeminal nerve area. You’ve had numerous teeth extracted before, these should be easy peasy. This won’t be any different that what you’re used to except that you’ll have a new smile when you walk out of the office. ☺️

What your oral surgeon will tell you is to not remove the plate for 24 to 48 hours. That’s to stop any bleeding and to prevent any swelling that might interfer with the denture fitting the next couple of days. It also helps the newly healing tissue to conform to the shape of the denture.
It’s a lot to get used to though, so….shhh… it’s ok after a few hours to remove it for a COUPLE MINUTES ONLY, rinse it off and reinsert it. Gives you a little break. But if you can keep it in full time it’s the best.

The biggest adjustment will be with the denture itself. It’s new and takes getting used to, physically, mentally and visually. You’ll likely have excess saliva and maybe even feel a little gaggy. Your general dentist will see you in a couple days to check on the fit and can trim away any excess plastic that may be rubbing on gums or palate, or if it feels to ‘thick’ or full around your lips and cheeks. Your dentist will help you get the best fit. Remember, for the first 6 months there will be changes to the tissue and bone. So the denture may get looser as weeks go by. That’s where the adhesive will be a comfort fix. When your dentist feels the time is right, they will most likely do a relining with a new layer of plastic to conform to your mouth once it’s stable.

A reminder of a conversation we had a while ago, about removing and cleaning the denture. Make sure you fill your basin with water!! That way in case you drop your denture it doesn’t land in a porcelain sink and chip the teeth or crack the plastic. You can also get denture cleaning kits at a drug or grocery store. It’s a little plastic container where you can place the denture and add water/cleaning tablet to soak for a minute or so. Brushing with a regular toothbrush and toothpaste is fine too. Whatever works for you. It’s important to clean not only the teeth but to brush all the plastic, even in the inside of the palate.

The denture is basically a non-porous plastic and has been sealed in a baggie since October. It’s pretty customary that before placement it will be removed from that bag, soaked in an antibacterial solution and rinsed to make sure it’s been disinfected for you. They may also have you swish with an antibacterial product before you have the extractions.

So, this week, call your OS office.
1. You can say, I’m calling to confirm my appointment on June 17th.
2. Then add, “Oh, by the way, I wanted to mention that I HAD shingles in April and have been taking antivirals for over a month. There’s no evidence of infection and I’ve been cleared by my eye doctor and ear specialist. I’m assuming we can go ahead with my appointment?”
(Something like that. Don’t be timid about it, just state as a matter of fact)

Other than that, Holly, I don’t know what else you’d need to ask at the appointment. You’ve had extractions before. This is only different because of the initial concern for being on Reclast. This is a very low risk procedure so that shouldn’t even be a worry at this point. You’ll get post extraction information and really, this should be a breeze for you. It’s the excitement and anticipation and anxiety for waiting all this time that has you feeling all heebie jeebie inside. Been a long time in coming! Try not to overthink this because you have good instincts and a great dental team between your OS and general dentist. You can ask them anything too. In our office we appreciated our patients asking questions instead of sitting in silence and worrying. But we wouldn’t know their concerns unless they’d tell us. Because even if we asked if they had questions, most would clam up until we got them talking! LOL. So try to relax and trust them, trust the process and you’ll be great!

I think you’re going to enjoy your new smile. As always I’m here if you have questions or concerns. Huge hug, Lori…now breathe!! Hehe.

In response to Lori,

I have been following your comments and everyone else who has commented on reclast and dental procedures.
I had a fall and hit my mouth on the sidewalk which caused some very old crowns to break off immediately. I live in northern Wisconsin.
I walk 3 to 4 miles daily on city streets. The day I fell there was no snow on the sidewalks, so I hit bare concrete when I fell. I tripped on the curb rescuing a gentleman's dog that was out in traffic on a busy street.

Two good things I want to mention. In October I had my last fusion of reclast and my bone density has gotten so much better! This reassures me that my fall has prevented broken bones.

The other thing is that the dentist I saw sent me to an endodontist because of two root canals I need. Because of the rclast injections he is concerned. After much studying and doctor visits I feel less anxiety about the prognosis.
On July 1st I have my root canals. There is an excellent prosthodontist who I am working with to replace my four front teeth. Unfortunately, he can't replace crowns as the roots of my teeth are above the gumline.
I can't wait for the work to start and end. The flipper I wear is not that great.
The best thing is this procedure and inconvenience is so minor to what a lot of 76-year-olds are facing in life. I express gratitude every morning that I am so healthy and active!
Another great blessing you have given to me today Lori is your sharing the shingles part of your life. Because of you I am going to get my shingle shots which I have procrastinated receiving.
Please keep your postings on your journey, This lady is so full of gratitude for your sharing.
Karen

Hi Karen, I remember your story about helping the dog out of the road and the fateful fall in the rescue attempt. That was so unfortunate but frankly I’d have taken the same chance. I swear we don’t deserve dogs…they’re just the best.

Just to keep things honest, I haven’t had shingles myself but I think I see where the mixup may have happened, where I signed off to a member telling her to breathe and signed my name, Lori. I did have leukemia and a bone marrow transplant. Because of that I did require having all my vaccinations repeated from childhood to adult, including the shingles vax. So I’m happy to hear you’re going to get yours. Shingles is horrible disease that can be prevented through the vaccination. Like any vaccination, it may not totally prevent you from getting it but if you do the reaction should be much milder

Having worked in the dental field for 30+ years, I’ve been helping Holly @hlp123 through her Reclast/dental journey. Though I’m retired now, I miss working with people, so I try to use my knowledge and experience to help with sporadic dental question where I can. I’m primarily mentoring in the Blood Cancer support group and Bone Marrow Transplant group.

I’m really happy for you that you’re able to go ahead with your root canals so you can get your smile back! I know those flippers aren’t the best but at least it fills the gaps in front while you’re waiting! You have a wonderfully positive attitude…filled with gratitude! I’m with you! Every day is a gift to treasure.
You said you live in Northern Wisconsin. Are you near Minocqua?

Dear Lori, Thank you for your reply and all of your invaluable information and guidance ! I plan to call my oral surgeon tomorrow and I will let you know his response. I feel so very much better about the extraction, now that I have your outline to follow. I did want to clear up one fact that I think I must have told you about incorrectly. I am no longer on antivirals. My primary physician prescribed them for me and she said that one cannot take them for longer than one week. So just to be clear. I took Valacyclovir HCL 1 gm q 8 hours from May 7th to May 14th. I then took Doxycycline 100mg q 12 hours from May 15th to May 25th, to address secondary skin infection around the healing blisters. Everything appears to be healing well and the pain is diminishing each day. I do want to encourage anyone to have the Shringrix vaccinations. I did have the two vaccinations as recommended and still I got Shingles. I choose to believe that I would have gotten a much more severe case, if I had not gotten the vaccinations. My real concern with vaccinations is that now my allergist is convinced that I got the Shingles because I got the latest Pfizer 23-24 COMIRNATY vaccine, only two weeks before I got Shingles. But, that does not mean that this would happen to anyone else. I would never want to discourage vaccinations! One thing at a time. I keep trying to check off boxes and accomplish" Good Progress" on my journey. Thank you, again Lori !!!!!
I keep copies of your replies next to my bed and whenever I get anxious I read your reassuring words !
Stay warm ! I am in Detroit and one day here it is 40 degrees and the next day it is 80 degrees. I am very grateful for my furnace and my air conditioner.
Holly

Good morning, Holly. I really think your Shingles episode is fading into the background now. You’ve had no new blisters or any evidence of an active case for several weeks. I’ve had nerve damage on my spine and know from experience it can take months for nerves to heal/regenerate. I remember my mom having had shingles after my brother died. After the blisters and outward signs were gone, she was still having the nerve pain for quite a long while. So hang in there!
And realistically, if your oral surgeon suggests waiting another couple of weeks there’s no harm to you or the denture except mounting frustration. 😉

Not sure why your physician said Valacyclovir HCL can be taken for only a week. I was on them for almost 3 years post transplant. I know quite a few people who take them as part of their prophylactic protocol for avoiding viral infections with their weakened immune system. Well, no matter, you have jumped that hurdle and now sprinting to the finish line. 🙃
Sending you a hug this morning!!

Dear Lori,
You are amazing ! I did not know about the health challenges that you have faced. I am so glad that you survived and recovered from Leukemia and a bone marrow transplant. What an incredible health journey you have been dealing with. I did call the oral surgeon this morning (Tuesday), and found out that he is on vacation. I remember that I had to postpone making the appointments with the surgeon and the dentist back in March, because they both were taking their vacations in May-June, and I needed to coordinate the two back to back.
As a result the office manager said she would relay my message and call me by Friday with the doctor's decision. I find this less than optimal because I wanted to talk with the doctor myself. Especially with the perfect outline you provided, and this way I really have no control over what the manager will tell him. She was very vague about exactly when doctor would be back in the office and just kept repeating that I should not expect an answer before Friday. I normally try to avoid making Monday or Friday apts. with any of my doctors because I like to have the opportunity to discuss any questions before and or after the apts. I am tempted to call the office on Thursday and ask if I can talk with the doctor. He just might be back by then. I don't know. She was very firm and said she would handle it. It is such a comfort to me to know whatever happens I have you to guide me through it all. One of my precious grandson's told me on Sunday that when he had his teeth extracted to make room for incoming teeth, the dentist told him to drink pineapple juice for days before and after the extraction and that it was wonderful for preventing swelling of the gums ! Have you heard of this ? I hope your weather is warming up and that you are well. I really appreciate your guidance. As soon as I read your replies I become more calm. Thank you, Many Hugs !

Mornin’ Holly. Yep, I’ve had my own medical adventure with a bone marrow transplant from a donor. I’m now a Chimera with 2 sets of DNA. Although my husband prefers the definition from Greek mythology that I’m a fire-breathing female monster with a lion's head, a goat's body and a serpent’s tail. 😂

It’s good that you called the oral surgeon’s office to let them know about your shingles episode. I’m not sure calling again would get you a response any faster than Friday, as the office manager stated. When our doctors came back from vacation, that first day back was hectic. It was a day of catchup on paper work and messages and prepping for cases. Your doctor may not even be back in the office before Friday.
Certainly if you’re concerned you can call and ask to speak with their assistant and give the list of questions. That way your doctor will be prepared to answer at your appointment. But from my perspective on your upcoming procedure, I’m comfortable that this will be a relatively “straightforward, no surprises” extraction of those 4 remaining front teeth and the placement of your denture. This isn’t a complex oral surgery and the risk for infection is very low. There shouldn’t be excess bleeding or much discomfort.

When you get to your appointment and hand over the denture to the assistant, that will be a good time to ask “ Will this be disinfected first?”
The numbing will be routine with using a topical anesthetic first to numb the tissue. Then the area around each tooth will be injected with the anesthetic just as you’ve had in the past.
If these teeth are already loose because of lack of bone structure, they should slip out easily. Anterior teeth seldom pose an issue with extraction.
You’ll have some gauze placed for a few minutes to stop any bleeding. Then the doctor will removed the gauze, wet the denture and place it in your mouth. Ask to sit up for that so you don’t feel gaggy with this new feeling in your mouth.
It should fit relatively well. Keeping in mind this isn’t the final fit for this denture.
There will be tissue modifications over the course of weeks. So you’ll most likely need adhesive after the tissue heals. Then your general dentist will help to ensure the fit for the future. Over time, there may need to be occasional relining of the denture.

Ah, your grandson or his dentist has been watching TikTok videos…there’s a lot of hype going around about drinking 64 oz of pineapple juice starting days before having wisdom teeth out. While pineapple does have anti-inflammatory properties there isn’t any proof that this has an impact on the extractions. What it can do is mess with blood sugar for anyone with diabetes and can cause some gastric issues for others.
Honestly, Holly, at this point I’d not rock the boat with any abrupt changes to diet or supplements. Stay the course. You’re very close to the finish line for your new smile!

Enjoy the warmer weather heading your way! We’re not too far apart as the crow flies! 🐦‍⬛
Just try to relax, my friend. I seldom have anxiety about anything so let me reach through cyberspace to put my hand on your wrist. My daughter says I have magical calming powers. Tee Hee, maybe it’s because I’m a fire-breathing female monster with a lion's head, a goat's body and a serpent’s tail. 😂