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Hepatitis C: Post Treatment Issues Community
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1711722 tn?1356491154

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)
45 Responses
1815939 tn?1377995399
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.
1840891 tn?1431551393
Yes indeed, I finished tx and found I had three new cavities appear during tx. I wouldn't say its your doing though, its the interferon-caused dry mouth and dry mouth is famous for producing cavities. My husband took an altogether different kind of med for a totally different problem, it caused dry mouth and he ended up even worse off than me. He needed three crowns and one with a root canal first! If only we had known in advance it could have been prevented, at least to some degree, by using a special fluoride paste after brushing each night – NOW they tell us! Anyway, I'm sorry you were hit by the dental problems, and even sorrier that tx didn't work for you, but none if this calls for feeling like it was your own fault!
Avatar universal
I did protect my mouth from dry mouth during tx, I just finished up with much dental work. (1) I think we do neglect our teeth during TX for obvious reason and second, I think the medicine does create problems. I spend about three months with various problems but luckily my mouth is healthier than ever and it was a wake up call to make sure I get to the dentist every 6 months.
Avatar universal
One other point, I know my doctor made me get a heart check and eye check approvals before TX, but we all should remember that even if our doctors do not require it, we should have all dental work up to date and get to a psychiatrist for a mental evaluation so you get the proper medication and help to get you through TX. The later two would have prevented a lot of problems for me, but because my doctor didn't mention it, I didn't have the common sense to realize how important those two things were going to be to help in my recovery.
Avatar universal
  Hi Bee, and it is nice to hear from you again :)
I went to the dentist right before I had my 28 wk Tx w/Victrelis, and I wasn't having any problems, and was all "up to date" with my teeth,as in regular visits every 6 months, for the past few yrs, etc (because of my age, I'm 50 yrs, so I have many root-canals w/crowns)
  That being said, I have just had a full set of xrays done, and one of my
teeth actually shattered under the crown, a giant molar, which will have to be yanked.  I am going to have to have it preped for an implant,it is going to be a major pain, physically and financially.
   Also, my other two crowns will have to be "redone" and there appears to be some decay there. But...I am happy to report I have "no periodontal disease", even though I have a gapping hole, where the fractured tooth is, I kept the area veryclean, via about 3 different kinds of mouth-wash, and tons of flossing.
   My dentist said Cosco has a "high volume" fluoride toothpaste, that is cavity preventitive.
   The Interferon causes bone loss~
1711722 tn?1356491154
Wow.  I did have dry mouth during tx, and used Biotene.  I remember getting uptodate on all of my doctor visits, pre-tx but will have to search my old posts to see if I went to the dentist.  I have decay underneath a crown, which just seems unfair.  I have recommendation for multiple root canals and other stuff.

It just seems as if my all old fillings all need to be replaced, plus root canals and periodental issues.  Thanks for your input on this!  My pain level has gone up since the dentist went poking round in there.

Thank you all!!  Good to hear from you :0)
163305 tn?1333672171
Tx is he!! on our teeth. It took it's toll on mine as and I didn't do the triple tx. This is why it's so important to do all necessary dental work prior to tx, and take extra good care during tx including taking calcium.

I know this is moot for you bee but I write this as a warning for those who haven't begun tx yet.
Avatar universal
         i am having periodontal problems during and post tx.  i will need some root planing done to get my gums to grip better.  as Ohawk said, "a warning for those getting ready to treat".
                                            barry
1815939 tn?1377995399
Sorry to hear you are having these problems, Bee.

I started noticing gum problems during the last three months of treatment. My gums were red and inflamed. They were very tender and they were receding. I went to my dentist 6 weeks before Tx ended and, at that time, it was mainly 1-2 teeth involved. By the end of treatment it was a lot worse and more teeth were involved. She put me on a course of antibiotics and sent me to a gum specialist. He wanted to do a gum graft. I wanted to wait until the meds were out of my system and until my Hepa gave approval for the surgery.

In the meantime, I was trying to get my insurance to cover the surgery. I asked my gum specialist to please write to the insurance company and tell them that my gums developed gingivitis and my gums receded due to the Hep C treatment with the Interferon and Riba. Even though gingivitis is listed as a side effect, he said he would not write a letter to the ins. co. because he did not think the drugs caused it. Instead he thought I had gum recession due to brushing too hard. I told him I have never had gingivitis or any gum problem in 66 years and I never brushed too hard before, so why would I suddenly start brushing to hard and develop gingivitis. I told him it was from the Hep C Tx meds and was a side effect of Interferon. He would not write a letter because he said it was my fault (for brushing too hard). (What an idiot.)

Well, I figured, if he did not know that Interferon causes gum problems, then what else does he not know. So I dropped him and started looking for another gum specialist who would help me with the insurance co.  In the meantime, I went back to my regular dentist for another cleaning and she was amazed at how much my gums had improved, just by being off the meds. So, now the gum surgery is on hold. I may not need it because my gums have improved dramatically.

I am telling you this story so you will see that others (me) had a lot of problems too, but also so that you will see that my new gum doctor also blamed me for my gum problems when he should have been smart enough and knowledgeable enough to know that the Interferon causes a lot of gum and teeth problems and that I did not cause them through faulty brushing. (My own dentist knew that I did not cause the problem because she has been my dentist for years and I get my teeth cleaned twice a year and I never have had any gum problems whatsoever. I had great teeth and gums before Tx.)

Best of luck with your teeth and any other problems you have.
1711722 tn?1356491154
Yes, thank you again my friends.  But does anyone have articles or stats/ links to back this up??  I need something to show my doctor, from a known/reliable source.

Thanks,
Bee
253566 tn?1219683299
Thanks for this post and those links/articles!

I have always had sensitive teeth but always tried to take care of them.

I was with a great dentist during treatment and he really was taking sensitive care of my teeth but when my teeth started snapping off suddenly I was so embarrassed and so depressed I stopped going.

I had even been prescribed a special mouth rinse for dry mouth but it didnt help!

Now after "the cure" and all these years of being disabled from it all my teeth are still feeling the effects! I fear that if I go see someone they will want to pull them all out. I am probably exaggerating (maybe not)... but it seems very bad to me as a year goes by and one or two break off! It probably looks like I am some drug addict! It is really disgusting! and I am "cured" and have been off the meds for many years! What a mess!
4950316 tn?1394188185
I'm just a little disappointed about your description of '.........probably looks like I am some drug addict! It is really disgusting!.' etc
What does a drug addict look like? Like an alcoholic? A scumbag? A homeless person? A disgusting representative of the human race?
As we are all trying here to repair our bodies from contracting HCV, it is NOT important how we contracted it. We have all been non-judgemental here.
I'm sorry about your mouth problems post TX. I too am having a rough 'mouth' time during Tx, and am trying not to to pre-empt the consequences.
253566 tn?1219683299
I am sorry to disappoint you with my description asle.

I do apologize to you and anyone else if I offended anyone else.

It was very insensitive of me and I hope my apology will be accepted.

I was not thinking and being a bit depressed about it all. Sorry again.
frank
1711722 tn?1356491154
Asle -- Well Said!  I agree.

Frank -- I hear what you're saying in terms of tx related dental complications (you should get that checked out)  but duuuudddde....this is Not a forum for stereotyping remarks.  Venting -- yes.  

Pooh -- Thanks VERY much for these links!!  Things escalated after I posted and I am having oral surgery tomorrow.  So this will be great info to have in hand, especially since they may not have factored in what I went through with the TX meds.

Thank you again everyone for sharing!  I wish you well on your journeys, during and after tx.

Blessings,
Bee
Avatar universal
In defense of Frank..... I think he was trying to convey that in spite of his best attempts to take care of himself......
1) he sought to cure his Hep C
2) he sought to care for his teeth via an oral care professional and used those treatments which are recommended HERE as a prophylactic measure....... and to no avail.

.....he did the best that he could using professional care.....

The end result was that he looked as though he has been indifferent about his outcome or worse, that HE had been the problem with them.

He sounds traumatized by his end result, extremely self conscious. See if your compassion can cut both ways....
He was trying to help, not hurt.

His choice of adjectives may not have been politically correct or accurate, but he was trying to convey an idea.  

I am reminded of a line from a recent Geoge Clooney film (Up in the Air) where somebody chastises him for stereotyping.

http://www.youtube.com/watch?v=_uNPpFZLelE

Of course.... if you want the thread to change topics...by all means....

willy
1840891 tn?1431551393
I don't have any research on hand but there is abundant general knowledge of interferon causing dry mouth (I'm pretty sure it is a universal sx), and I think any halfway decent dentist will immediately connect dry mouth with dental decay. The two different dentists my husband and I see both made that connection instantly. I did use Biotene regularly throughout my tx and it helped a lot with the discomfort of dry mouth but didn't help enough to prevent decay. Well, it may have prevented some - perhaps it would have been worse without the Biotene. After the cavities were found by my dental hygienist she gave me a fluoride gel to apply at night after brushing (while waiting to get the appointment for fixing them), and said it would have prevented them if I'd used it during tx and what a shame they hadn't known to prescribe it. On the other hand, I had so many problems during tx that I probably couldn't have handled one more slightly unpleasant thing!

p.s. Bee, you hold a special place for me, as you were the first to help me when I made my first botched attempt at posting on this forum (instead of the forum I somehow posted on your journal by mistake). Thank you for your guidance then.
1815939 tn?1377995399
What floors me about all of this is that it is obviously known, and has been know for some time, that Interferon and Riba cause dental problems but it seems that very few medical and/or dental people know it. If those medical people we go to for treatment were better informed about the side effects of the drugs they are using to treat us, maybe, just maybe, some of the dental problems (as well as other problems) could be prevented (although I doubt all of it could be prevented).

I also tried very hard to keep my teeth and gums in shape during Tx but the dry mouth was dry as a bone no matter what I did. I often could not swallow because my throat was so dry. I drank water all of the time and 1 minute after taking a few gulps of water, I was parched. I used Biotene too but I still had a dry mouth.

I wish I knew then (starting Tx) what I know now. Treatment would have been easier.
4950316 tn?1394188185
Your last sentence is echoed throughout this forum, and the world.
4950316 tn?1394188185
That's Ok Frank. I think I was being over-sensitive. I guess I took the high road, when I also saw the low road.
I'm not sure what I look like with my ever-bleeding gums and ghostly pasty face. I have to swill and spit before I get out of my car and go anywhere. Smiling is a limited option.

Willy50.
I get it. I did bandwagon jump a little. I can cut all ways.
253566 tn?1219683299
Again, I apologize and appreciate those who have already accepted my apology!

If you know me from this site I really do not mean any harm. This treatment has done me such harm and I have very few next to me that understand and can give support... but then as has been said so many times even the liver gurus "seemingly" dont understand what is going on with their own treatment?!?!?!?!?!

I do really try to keep a positive attitude on everything but when it comes down to it all I really am pretty pissed about the life they took away from me (and many of the good people here).

I think a hellava lot of research should have gone into treatment or at least now that so many have gone thru it all at least it should be time to spend some of the multiple millions on long term problems some people have with treatment.

btw, Hey willy!

frank
Avatar universal
I thought I would add one more thing here..... I didn't yesterday because I felt that I had already possibly gone over the top.

When I got interviewed for my trial, they had to go into the drug interview again.

It always sets me off.  Here I am trying to be likeable, easy going and I went off on a minor lecture to the interviewer. I said that it appeared to me that the only data they were collecting was that supported that people acquired their infection from drugs.  The focus of the survey was to collect data which supported that fact.

I said..... they didn't seem interested about any other vectors for infection, and I mentioned a few recent mass infections that had made the news that were medical practice vectors.

Please believe me..... I hold similar values.  The nurse..... just said that essentially....she was just the messenger.... she had to go through this for the trial sponsor.....and we moved on. I had made my point I think.

Yesterday afternoon it occurred to me again..... every single medical person I've come across has touched on that topic. I think that they favor that topic so as to take some of the emphasis off of the medical field as a vector.

Willy
317787 tn?1473362051
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.
2059648 tn?1439770265
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

1711722 tn?1356491154
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)
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