Dental Cleaning

[h202]

Son (7) had his pandas onset in February 2018, treatment starting in April 2018, and mostly in remission by June.  He was on abx until September with no problems.  Had a dental cleaning in November 2018 and a few days later we were pretty sure he was having a flare.  That said, we think the flare probably started the week prior to the dental cleaning.  Being honest, we have no idea if the teeth cleaning had any correlation to the flare.  In any event, once the flare was obvious, we started abx again and symptoms went away in a day.  

In February, his bloodwork showed low neutrophils so his doctor took him off abx again.  He's been going strong without abx since then!

He is scheduled for a dental cleaning on Wednesday.  As noted, i have no idea if his previous flare was correlated to the dental cleaning.  

Should we be taking any precautions in advance, during or after the appointment?  I'd prefer the least intervention as possible, but am open to advice. 

[MaryAngela]

I believe the PANDAS Physician Network recommends full strength abx before (not sure how long before) and 7 days after dental cleaning or dental work.  My DS had his first major onset within 48 hours of dental work in 2012.  

[Cmac]

This happened with my son, too—his first dental cleaning since being diagnosed with PANDAS seemed to set off a flare—but like you I think he was already in one due to loose teeth. A couple of days after cleaning, the teeth fell out and then a week later the adult teeth started coming in. All this to say that loose/lost teeth/cutting new teeth and cleaning seemed to set off the worst flare we’ve seen since the initial onset. I’d consider the antibiotics as well as a couple of days of Motrin to help with inflammation. Best of luck and glad he’s doing so well otherwise.

[4Nikki]

Strep bacteria is known to hide in the tonsils. I'm guessing the same can be true with plaque. Cleaning dislodges the plaque and releases bacteria hiding beneath it.