No Clindamycin Today

Well, the dentist poked my teeth, tapped, looked around and ascertained that I didn't have any gaping holes in my teeth. No significant infection, either, that he could find. I do have some cavities, but he said that they didn't look huge and there was no indication of infection. So the cavities could potentially be causing the pain, but there wasn't anything obvious that should be causing that amount of pain.

The dentist I saw today said that his best guess for why my teeth would be hurting so badly was that I've been clenching or grinding my teeth. I know I have a tendency to do that, especially when I'm in pain. I've probably had my jaw clenched most of the time for the last month or more. So I may have cracked some teeth or just irritated them. I need to start wearing my mouthguard again.

He also suspected that I have some fillings that may not be perfectly placed and are throwing off my bite. I'm pretty sure this is the case, also, since particular teeth really hurt if I bite down on them wrongly and I have fillings that aren't even with the teeth or have jagged edges.

Or, of course, it could also just be that the fibromyalgia has decided to have fun this week by making the nerve endings in my head go crazy for no particular reason.

The dentist said that he saw nothing that indicated to him that I needed to take antibiotics. He definitely thought it was a good idea for me NOT to take the antibiotic my dentist had prescribed, given mine and Ebee's health history. So I'm really glad I didn't just blindly start taking it yesterday without asking questions or waiting for a second opinion.

Apparently there's a rather high frequency of cases of serious (or sometimes even fatal) colitis caused by this particular drug, clindamycin. All the sources I've checked advise caution in using clyndamycin with patients with a history of bowel problems.

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Clyndamycin has a black box warning about colitis, and for this reason it carries warnings that it should be reserved only for serious bacterial infections where less toxic antibiotics can't be used. The package insert (PDF) also says it's contraindicated for people with colitis and diarrhea, and should not be used during breastfeeding.

Several sites I read said that a dentist should never prescribe this drug to someone with a history of bowel problems, colitis, or especially antibiotic-induced colitis without first talking to the patient's primary care doctor and determining whether the necessity outweighed the risk and that no other antibiotic would be appropriate.

You are also supposed to stop taking it if you develop diarrhea. That could be why it's contraindicated for people who already have diarrhea, you think?

Oh, and it's been shown to pass through breastmilk. Which is why it's contraindicated for nursing mothers. I can't imagine what it would do to a very young child with chronic bowel problems who currently has severe diarrhea, like Ebee.

I did tell the dentist prescribing that I'd had severe stomach and bowel problems (including diarrhea) from any antibiotics I'd previously taken that didn't give me hives, and reminded him that I was breastfeeding and have IBS/CFS/FMS.

He said that this antibiotic should be fine, but to keep a close eye out for any hives or itching or other symptoms of intolerance. He said nothing about a higher incidence of bowel problems with clindamycin and didn't give me any particular cautions to watch out for signs of colitis. He didn't ask if I currently have diarrhea (because, with the IBS, it's a good chance that I do at any given moment, like now for instance).

I'm rather glad that on Monday I'll be seeing the father instead of one of the sons in the dental practice. I haven't seen the father before, but my dad said he feels the father does a better job with fillings. The last filling I had put in (in February) had a jagged edge sticking out, and broke while flossing a couple of weeks ago (the root isn't exposed, just a chunk of the filling came off).

I hear that composite fillings, especially in back teeth, take quite a bit of skill and art and have a fairly large learning curve to learn how to really do them well.
My dentist (the son) just seems a lot more comfortable doing amalgam fillings, tends to recommend them, and seems to prefer them for back teeth. Since I want composite fillings even in my molars, and want to avoid mercury, it seems that it might make sense to find someone who is more experienced and comfortable with this type of dentistry.

When we had the kids' fillings done, we specifically requested composite fillings and they put in amalgam instead. There was some sort of lapse in communication, I guess.

I'd like to find a dentist who is more interested in doing mercury-free work. But I really don't want to be in this kind of pain while thousands of miles from home. I'm leaving Tuesday and won't be back for almost a week. It seems a good idea to try to get at least the two worst cavities taken care of now, in case they are the cause of the pain. I hope I don't regret it later.

When I picked up the prescription last night, I also told the pharmacist that I had IBS and had a history of hives and/or severe stomach problems with antibiotics, and that I was breastfeeding.

I use this pharmacy because it's very close to us and open late, but the pharmacist always pretty much hands me the medications with little or no instruction and then makes me feel like I'm imposing on him by asking questions and then seems almost dismissive in his answers. He's always in a hurry.

The pharmacist told me that I should be cautious with the codeine with breastfeeding (he said a little would be ok, but to try to limit how much I took. He said that the antibiotic should be perfectly fine.

I know that a dentist, especially one being called at home, can't be expected to know all the contraindications of a particular drug. But a pharmacist certainly should at least check on things like that and ask if the patient has any of the conditions listed as contraindications on the package insert and the BLACK BOX WARNING, shouldn't he?

Surely not every patient has the ability to do their own research to find out whether taking a drug could be dangerous with their particular health conditions every time a doctor or dentist prescribes something? I guess that's what the handouts are for, but what about when the pharmacist and the prescribing doctor say it's ok even though you've asked about the things on the handout?

Or am I just really being over-cautious? The dentist I saw today didn't think so.