Gum disease and joint surgery

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louisarm
louisarm Member Posts: 52
edited 1. Oct 2013, 11:03 in Living with Arthritis archive
Dear All,

I have O/A and will need a hip op soon. I saw a surgeon and he did not see any contraindications for my surgery and recommended a certain implant (Furlong uncemented hydroxyapatite stem). Which basically means the hydroxyapatite is a biologically inert material which helps to stimulate bone growth on the prosthesis.

I thought this surgeon was very good but decided to get a second opinion as I thought knowledge is power.

It did not go as well. The second surgeon thought he would have problems fitting an implant because I am so small framed. He said the implant above would be no good for me because if I got a dental infection it could travel and affect the new implant. He said he may have to use an implant that has not been around so long, because if I needed a revision it could be removed sooner.

It was only when I got home that I realised that I did not ask why he thought I would get a dental infection. The aforementioned implant has been around for a long time with good results.

This has fed into my paranoia about my teeth. Until about 10 years ago I did not look after them very well. I cleaned them constantly but my technique was poor and I have lots of recession and gaps. I am very conscious of this, I know it is shallow but it does affect my confidence. I go to the hygienist every 3 months now.

When I got home I Googled (mistake) about gum disease and implants and apparently it is a big no no. I can understand why as it would transmit infection, however, I have not got gum disease.

Has any body on here been advised on oral hygiene before a procedure?

Told to take antibiotics before the dentist?

Infections in other parts of the body caused problems?

I have sent him an email asking why he said I was not suitable for this implant, I know I am not a mind reader but I cannot think of any other explanation, except he things I have poor oral hygiene.

Sorry for the long whine but this has set my mood back again and fear about the surgery going wrong.

Any feedback gratefully received.

Louisa

Comments

  • stickywicket
    stickywicket Member Posts: 27,710
    edited 30. Nov -1, 00:00
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    I'm strongly reminded of the old Irish joke where someone asks directions and the reply is “If you want to go to X then I wouldn't start from here.”

    I think it's all to easy to overthink these things. I've always trusted my allotted surgeon and they have aways done an excellent job. I was told, after my knee revision op, that there was a greater and ongoing risk of infection than with a simple TKR. I've had no problems at all to date.

    Dental neglect can result in all sorts of problems elsewhere whether or not we have implants. An extremely healthy friend nearly died as a result of a dentist not dealing thoroughly with an abcess. These things can happen but they are unlikely to do so. If they do happen there is usually a means of dealing with them.

    My advice would be to go with the guy you trust most, keep looking after your teeth, do all you can to maintain a healthy lifestyle and forget about the rest.

    (My TKR was 27 yrs old when it was revised. There was no problem.)
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    There are some key words in your post, one of which is 'if'. There are many ifs in the world - you have improved your dental hygeine so may be able to avoid a gum infection by maintaining those good habits you have formed. Have you ever had one before? You don't mention it so, if you are 'behaving better' with your dental care there is no reason to get one now.

    Knowledege can be power but only if one is able to use that knowledge constructively and with full understanding. One of the problems we face is that we are always on the receiving end of opinions - show three doctors the same set of medical test results and it's more than likely that three differening opinions will be proferred. Another 'problem' we have is that none of us are doctors or surgeons. Both professions have a responsibility towards their patients in informing them about possible risks and complications, it could be that the first surgeon did not see your small stature as a difficulty but the second does. (Speaking as a hefffalump I rather envy your delicacy.)

    In this modern age I rather think that 'Thous shalt not wikigooglebingaskjeeves' should be the eleventh commandment. I understand from your previous posts that you are nervous and unsettled about this OA diagnosis and apprehensive about surgery so this won't help. I went to see a dentist last week for the first time in at least twelve years. In those twelve years I have had five operations and no dental problems at all until last week-end when a mahoosive filling fell out. As Sticky said it's best not to over-think issues (I tend to go the other way, I don't think at all) and stick with the surgeon you like the most. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • barbara12
    barbara12 Member Posts: 21,281
    edited 30. Nov -1, 00:00
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    Hello Louisa
    I had a THR replacement around 10 weeks ago now, at the pre-op they asked about my teeth and said my surgeon would not do the op if I had any cavity's that wanted seeing to or any mouth infections..apparently the infection can travel to the implant site...so you make sure all is well in your mouth..and I do wish you well with it all..mine is brilliant.
    Love
    Barbara
  • louisarm
    louisarm Member Posts: 52
    edited 30. Nov -1, 00:00
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    Dear All, Thank you for your replies, helpful and supportive as ever.

    Barbara did they say you always had to be vigilant about infection post op? I mean people must get tooth infections/root canal work after THR surely!

    I am pleased you are doing well.
  • barbara12
    barbara12 Member Posts: 21,281
    edited 30. Nov -1, 00:00
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    No they didnt, just while I was having the op....must say I was worried has to how the wound would be when I got home...but the dressing is left on till the staples come out 6 days later and the wound was healed nicely by then..if you meed any info you are welcome to PM me..x
    Love
    Barbara
  • stickywicket
    stickywicket Member Posts: 27,710
    edited 30. Nov -1, 00:00
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    Please don't let this new fear put you off surgery, Louisa. There are all sorts of things that can go wrong every day before we even set foot out of the door. Most accidents occur in the home.

    Infection, during any op, is a real possibility but that doesn't make it likely. I think the fear of infection, either during or after a joint replacement might seem bigger to those with OA. Those of us with an auto-immune arthritis, taking meds to suppress our immune systems, live with this problem all the time. I used to throw colds off easily. Now I try not to go near anyone who might have one. We catch infections easily and get rid of them with some difficulty. That must make us more of a risk for operations but I still wouldn't let it hold me back. I've had several infections since my first joint replacements but not one has threatened any of my TKRs or THRs.

    If you go with a good hospital (teaching ones should be the best and I personally have a low opinion of private ones) you should be fine before, during and after your op. Good surgeons care and don't take unnecessary risks.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • knuckleduster
    knuckleduster Member Posts: 551
    edited 30. Nov -1, 00:00
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    When I first read this thread I thought "oh, lordy me". I had a THR at the end of 2010 and had a massive infection in a root canal filling my dentist insisted on doing six months later. I kept saying to him "take it out", but dentists seem intent on saving every tooth they can regardless of the pain they inflict on you along the way. He and I got there eventually, but in the last month I've had an infection in it again and he is now saying "next time, it will have to come out".

    Anyway, I now feel relieved after reading DD and stickywicket's comments.
    I'm still here and my hip is still working.

    Janet xx
  • louisarm
    louisarm Member Posts: 52
    edited 30. Nov -1, 00:00
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    Dear All,

    I received an email off the surgeon today (how good is that).

    The reason that the he did not recommend one particular type of implant for me is because it is only put in for really sporty people, it is much more difficult to get out. He said I was no more likely to get an infection than anybody else.

    He said for anybody with an implant the risk of infection gets lower the longer it is in.

    So in effect my paranoia about my teeth led to me imagining the worst.

    I wish I was not such a nervous nelly (believe me I try not to be) but I am.

    Thank you all for your kind replies and I will try and chill a bit.

    Louisa

    xx
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    Of course you feel apprehensive - that must be natural and normal, especially if you are coming at this from a healthy background. One of my problems is that I have no idea what good health feels like so I don't get too worked up about this kinda stuff. Life began to suck when I was eighteen months old and has never really let up. :lol: We will be here to support you no matter what your decision but please be reassured by Barbara12's experience: it took her a good long while to come to terms with her need for surgery but she has not only surprised us, she has surprised herself with how well she coped and is coping.

    This can be fixed. That is a good thing so hang on to that very good thought, OK? DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • stickywicket
    stickywicket Member Posts: 27,710
    edited 30. Nov -1, 00:00
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    Let us kno2 when the op is, Louisa. I'll be cheerleader for you :)
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • louisarm
    louisarm Member Posts: 52
    edited 30. Nov -1, 00:00
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    Dear DD and SW,

    I cannot begin to imagine how horrible it must be to never have had good health. So hats off to you both (and all on the forum) who try to help people like me who till up to now has had good health.

    As for the op I can go on the list whenever I want. It was very reassuring to hear Barbara's story but obviously I am still frightened.

    Anyway, I was prescribed Amitriptyline and Zapin today for the night pain.
    I am hoping that these will buy me a bit of time till after Christmas.

    Thanks again.

    Louisa x
  • dreamdaisy
    dreamdaisy Member Posts: 31,520
    edited 30. Nov -1, 00:00
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    Well, I can't imagine what good health feels like. :lol: The last time I felt something approaching well was in late October 2001, I was recovering from having an ovarian cyst (which weighed 3.8 kilos) removed and I only had the one fat knee to deal with. Oh, happy days. :? It is true, you don't what you'll miss 'til it's gone but when you've never had it in the first place, well, what's to miss?

    I hope you get on OK with the new meds - the amytryp should be taken at least two hours before bed-time, or possibly a little earlier than that, so you don't feel too 'hung-over' in the morning. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
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