Going to the dentists as well as proper dental care for people with neuropathy is somewhat muddled as far as appropriate care.

I created this thread to address ANY dental and dentist related issues about PN and how to deal with proper dental care precautions and dentist issues for sufferers of neuropathy. I'm starting out with 2 big questions that I, and others, seemed quite confused over.

I need to try to get some clear answers on a few things that have been eluding me and many others suffering from pn. I hope that someone, possibly MrsD, could unravel this puzzle.

First question: Does any type of dental anesthetic cause or worsen PN? I had heard some rumor that it does and this causes some anxiety, since sooner or later, we all got to go back to the dentists. I'm trying to figure out just what is fact and what is fiction on this. I'm sure many others want to know as well.

The second question is more specific regarding, Cipro and Flouroquinolone induced PN. Does fluoride toothpaste irritate, or cause more damage to PN?

I heard 2 theories on this, one was that since fluoride is in Cipro and such other antibiotics that cause neuropathy, that it should be avoided.

While others contend that fluoride toothpaste is harmless, that it is not the agent in the Cipro/antibiotics that cause nerve damage, so it would not be a problem in toothpaste. What is known is that fluoride does help "penetrate" into cells, and to the nerves, so that's why it's so well revered in toothpaste to begin with. But is this a bad thing for people with PN?

I don't know which is true and would greatly appreciate any answers on these two important questions for us.

As it is, there is a fluoride-free toothpaste called "Tom's Main" (you can buy this at CVS/Walgreens/Walmart for 4 bucks) which I do use, but when sensitivity in my teeth are an issue I often switch to fluoride "Sensodyne" brand to deal with it. Obviously I need help getting these answers, so please let me know what you all think.

from what i have read nitrous oxide the gas used by dentists for analgesia and sedation is known to deplete vitamin b12. the more you get or the number of times it is given the more b12 is depleted.

I never heard of that -that is interesting. Still, I figure since most of us are taking large amounts of b-12 daily, a normal visit to the dentist shouldn't cause much of a problem concerning b-12, right???

I am going to the dentist tomorrow to have 2 molars removed. They have cavities. So far no infection, but one tooth is pretty fixed to my jaw, so I was referred to an Oral surgeon. However I can not get him because I do not have the medical coverage.

Anyway, I am just really nervous about going to the dentist as it will be the first time I have to go since I got PN over a year ago.

I am concerned about many things, one is the pain from pulling the teeth, the needle anesthetic and other stuff.

More so, even taking antibiotics after the tooth extractions, which I hear is not needed by many dentists in the field.

Please, help me with these concerns and help put my mind to rest on this. I suspect, maybe all will be fine, and perhaps there is no more reason for me to be concerned about dental issues anymore than I was before I got PN, which I do hope is the case.

Please let me know what you all think. --Jesse M.

Hi, Jesse. In answer to the first question that you raised in your original post about dental issues--dental anesthetics: I was concerned about this too when I was scheduled to have a wisdom tooth removed soon after my PN diagnosis. And I too was not going to have it done by an oral surgeon, just a good dentist. I learned that anesthetics now used for dental procedures contain epinephrine, and that can interact dangerously with some PN medications (such as neurontin)... BUT the danger arises only if it's a general anesthetic; dental injection should pose no problems. And indeed, having my wisdom tooth out (while no picnic) didn't seem to interact with my PN or my medications at all. (I'm not sure about the antibiotics. You might search the forum under the name of the antibiotic that you're being told to take.

Good luck! And go, Cubs and Bears! (Sorry if you're a WhiteSox fan.)

Lynn

The injection the dentisr uses for ruotine aneasthetics, such as when pulling a tooth or "fixing" a cavity by drilling, is the drug Lidocaine. And Lidocaine comes with or without Epinephrine. I do think that mostly the needle you get is with Epinephrine. I have often asked the dentist to use without, but he often says that there is better effect with the Epinephrine.

I did not know the interaction between Epinepgrine and Gabapentin.
That is a good thing to know!

I do not see an interaction between gabapentin and epinephrine listed at drugchecker.com

http://www.drugs.com/interactions-ch...t=989-0,1147-0

There could be a possible reason not to use epinephrine on Epilepsy patients, as it might trigger a seizure (that is a medical reason). But a classic interaction with gabapentin itself does not show up on this checker.

Here is another problem regarding peripheral neuropathy and dental issues.
Be aware, any one that is on any immunosupressive meds for their neuropathy, say for example your condition is a combination of both autoimmune disorder and neuropathy:
If you need any invasive dental procedures or oral surgery , eighter by the oral surgeon or periodontist, you might not be able to have the procedure while you are on this med. But it is possible that the prescribing doctor, neurologist or rheumatologist, to tell you to hold the immunosupressive med such as steroid or other, for 2 weeks or so.
So always tell the Dental provider to check with the other prescribing doctor.

Woops--thanks, Mrs. D, for catching my mistake. I'd forgotten that when I had the tooth extracted, I was taking only Nortriptyline (not Gabapentin), and it was the Nortriptyline / Epinephrine combination that produced the warning on Drugs.com.