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urgent: preventing a flare from dental extraction?

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Hi all,


DS16 needs a baby canine extracted (yes, at 16!) later today. His PANS is mostly stable but he is in a mini-flare (high anxiety, pessimistic, bit paranoid, OCD). DS is already on NSAIDs, zithromax antibiotic, probiotics, anti-anxiety meds. The flare is despite that.

This morning I'm worried, really worried about a further setback from the dental extraction scheduled for this afternoon. Either from bacteria having access to his blood, or just the stress of it.


We're to fly across the pond in a couple of weeks, and I need him in the best shape he can be.


Next week our insurance will decide our appeal for IVIG. So he's possibly/hopefully having IVIG before our flight. Should I delay the extraction (again) till after the IVIG, and/or after our travel?


Or what else can I do to prevent a flare from dental work?




PS. His PANS began a couple of weeks after he'd first gotten braces, and all adjustments cause a setback of at least a week. His permanent upper canine is sitting next to a retained baby canine, it came into the gap where his upper lateral should be. The ortho says "out with it!" and the DDS says "I can get it out easily". But they don't have a kid with PANS.


PPS. Some folks on previous threads talk about strep on teeth, but he's already on zithro, and never had strep, so hopefully that's a non-issue?






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I believe the strep that impacts the mouth is not usually GAS. It is usually strep mutans. I do not know whether azith kills that - that would be something to look into. There is an herbal product that does kill strep mutans called flavescent sophora root (a.k.a. sophora flavescens, a.k.a. ku shen; FWIW, I have the one by Nature's Health. In our house, this product has been helpful for mouth germs.)


Good luck with the extraction. We have not had a problem with braces causing a flare though ds has been in a two-year-long flare at this point, so who knows. He seemed to do very well back when he had his palate expander, which was removed a few months prior to PANS onset (hmmm...).

Edited by jan251
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Jan251, thanks for the reply, and the clarification about the strep mutans. I'll certainly do mouth rinses, look into the flavescent sophora root. How does it taste?


And how long has your DS had braces? Mine's had a flare since pretty much when he got braces on, which I've assumed is a coincidence, but....


Well I'm trying, though I had promised I won't force him. (Not that I could, really; he's taller than I am and weighs 30# more). Anyway, knowing that he has a choice helps reduce his panic to a dull roar.


Gotta go -- he's still not dressed.

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I thought I'd post an update:


I got kiddo to the dentist, who upon hearing his updated Dx, including IgA and IgG subclass deficiency, decided that he'd rather the extraction be done by an oral surgeon.


Not because it's technically complex, but to reduce the risk of either infection or an immune flare:


that an oral surgeon will give a mouth rinse to seriously reduce the oral bacterial load beforehand, can pack the wound with antibiotics, and add a few stitches to close the wound. And perhaps also do the extraction more quickly, with less tissue trauma, which also reduces inflammation....


He said "I'm a parent too, and this is what I'd feel better about".


I love our dentist.

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