Anyone having problems with their teeth after surgery?  I'm a few months shy of 3 yrs out and they have just been rapidly rotting/falling apart right out of my head!  I can't eat alot of stuff because my teeth have broken off.  Unless I have them all pulled the dentist is telling me it's going to cost about $12,000.00 dollars to fix them and if they keep doing what their doing I can't see it stopping at that.  I can't even afford to have them all pulled and get falsies let alone pay $12 grand!

 I had major dental problems post op and had to get a full set of dentures at the age of 35.  My dentist told me he could keep fixing my cavities, but if I continued to throw up the way I did then it wasn't worth fixing them. It was a difficult decision to make!  I don't regret it now.  I was always hiding my teeth and got tired of not being able to smile.  

Wishing you the best of luck!

Stephanie E

Could it have something to do with calcium deficiency?  Do you take calcium citrate?  Have you had a bone-density test?

First my DSer statement:  One of the things that REALLY ****** me off about the "RnY is the gold standard, b;ah, blah, balh" stuff is that the surgeons cut and the PCPs are clueless as to what to test for and tell their patients to take a tums and some gummi vitamins.  Meanwhile, over in DSer Land we were warned that we were going to malabsorb everything, so we test everything.  (At least, those of us who have been paying attention do.)

Moving right along:  You MUST find Andrea and VitaLady.  (If no one posts links to theem soon, I'l go find something.)   If you don't you will be like my mother who, although she didn't have wls, has many of the same problems we (all) have.  She was 5'4" and is now 4'11."  He spine is caving in and the messages from her bladder don't get to her brain so she's in diapers.  Most of her teeth are gone and she'll probably lose the ones that the bridges are attached to pretty soon.  She's on a ****load of drugs which make her crazy and, most of the time, she can't tell you where she is, what day it is and what it is she had for breakfast.

AND...it gets worse than "just" losing your teeth and bones.  You can completely lose your mind and I'm not exaggerating.  The condition is called Wernicke Korsakoff syndrome.  And another name for some of this stuff is "Bariatric BeriBeri."

You MUST have labs.  You MUST test a whole pile of values.  You MUST treat the ones that are out of range.

Please, get help right away.  The first thing you need is blood work to see how much trouble you're in .



~~

 

Obes Surg. 2002 Jun;12(3):328-34.

A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit.

Chaves LC, Faintuch J, Kahwage S, Alencar Fde A.

Obesity Surgery Group, Hospital Ofir Loyola, Belem, Pará, Brazil.

Abstract

BACKGROUND: Wernicke-Korsakoff syndrome and peripheral neuropathy are very uncommon in bariatric surgical practice. The literature indicates that these complications tend to strike patients receiving unbalanced diets or undergoing rapid weight-loss.

METHODS: In a retrospective analysis of the initial experience of a bariatric team in the city of Belem, Pará, in northern Brazil, 5 cases were diagnosed in the first year, 4 of them following gastric bypass and the last one after therapy with an intragastric balloon.

RESULTS: All episodes followed periods of severe vomiting, which certainly interfered with intake of food as well as of routine vitamin supplements, resulting in severe polyneuropathy and other neurologic manifestions, mostly damaging motility of lower limbs. Therapy consisted of pharmacologic doses of vitamin B1 along with restoration of adequate diet and multivitamin prescriptions. Physical therapy was employed to prevent atrophy and accelerate normalization of muscle strength. All patients responded to this program after variable intervals without significant sequelae.

CONCLUSIONS: Thiamine-related neurologic derangements were a cause for much concern and prolonged morbidity in this series, but responded to vitamin B1 replenishment. A high degree of clinical suspicion in bariatric patients and urgent therapeutic intervention whenever postoperative vomiting persists for several days, especially during the first 2-3 months after operation, are the safest approach to these uncommon episodes. It is speculated whether peculiarities in the regional diet of this area in Brazil could have influenced the high incidence of the neurologic aberrations.

PMID: 12082882 [PubMed - indexed for MEDLINE]

~~~~

2011 January, Nutritional Considerations in the Bariatric Patient

Bariatric Beriberi: Thiamin Deficiency in the Bariatric Patient

January 2011

This Month’s Contributor: Laura Frank, PhD, RD, CD, MPH

Dr. Frank is currently a Clinical Assistant Professor for Washington State University in the Program of Nutrition and Exercise Physiology. She is also director of clincial sites for the Coordinated Program of Dietetics. Dr. Frank is a clinical dietitian at Madigan Army Medical Center (MAMC) in bariatrics. She also writes articles and presents on nutrition topics related to bariatric surgery.

Bariatric Times. 2011;8(1):14

Introduction
Thiamin (vitamin B1) is a water-soluble vitamin found in many food products, including meat (with pork being the best source of thiamin), legumes, and whole- or enriched-grain products.[1] Thiamin is important for the body as a cofactor in several enzymes associated with carbohydrate metabolism and energy production. Thiamin deficiency historically has been termed beriberi, derived from the Singhalese word “beri," meaning weakness, and refers to clinical manifestations associated with a deficient state of thiamin.[2] Beriberi can present as “wet" beriberi with cardiac involvement including cardiac hypertrophy and dilation, tachycardia, and edema, especially in the lower extremities.[3] “Dry" beriberi is manifested by polyaxialneuropathy, muscle weakness, pain, and paralysis.3 More seriously, thiamin deficiency can manifest as Wernicke’s Korsakoff (WK) syndrome, which is also known as Wernicke’s encephalopathy.[2] Classic components of WK include a combination of ataxia, opthalmoplegia, nystagmus, and mental confusion.[4] A systematic review regarding bariatric encephalopathy after bariatric surgery has been published.[2]

Thiamin deficiency after bariatric surgery has been well documented and has been termed bariatric beriberi.[3] Among the most commonly reported bariatric surgery to be associated with WK is Roux-en Y gastric bypass (RYGBP),[4–9] However, WK has also been reported to be associated with post-adjustable gastric band10 gastrectomy,[11] intragastric balloon (BIB),[4] and gastroplasty.[12] Most reported cases of WK and polyneuropathy after bariatric surgeries are associated with protracted vomiting,[2] typically occurring within the first 2 to 3 months after surgery.[4] Rapid and/or appreciable weight loss and dietary insufficiency have also been implicated in the etiology of thiamin deficiency,[2,4,9] as well as loss of appetite, eating avoidance, and nonadherence to vitamin supplementation.[2]

Thiamin assessment prior to repletion may be used to confirm suspicions of thiamin deficiency in bariatric patients; however, practical limitations may influence the practitioner to treat the patient without confirmation of deficiency and monitor and evaluate resolution of signs and symptoms of thiamin deficiency. Ideally, all patients should be tested for subnormal thiamin concentrations as demonstrated by plasma or urine thiamin levels, erythrocyte transketolase activity or by stimulation of this enzyme using thiamin pyrophosphate (TPP).[13] It is important to note that some of these tests are expensive and may not be readily available.

Computed axial tomography or magnetic resonance imaging (MRI) can be done to search for central nervous system morphology in patients with suspected WK.[4]

There is insufficient evidence from controlled trials to generate practitioner guidelines in the dose, frequency, route, or duration of thiamin treatment in patients with suspected deficiency.[14] Positive diagnostic evidence includes several precipitating factors, specific clinical manifestations, and a favorable response to thiamin repletion. Parenteral doses of 100mg per day for the first seven days followed by daily oral doses 50mg per day until complete recovery have been recommended.[15] There are other reports recommending 100mg thiamin intravenous (IV) or intramuscular (IM) daily until symptoms have improved.[16]

The importance of thiamin’s role in metabolism and neurological function should not be minimized. Multidisciplinary approaches to the prevention, diagnosis, and treatment of thiamin deficiency are important in improving clinical outcomes in the bariatric surgery patient.

References
1.    Gropper SS, Smith JL, Groff JL. Advanced Nutrition and Human Metabolism, Fifth Edition. Canada: Wadsworth Cengage Learning; 2009;9:323–333.
2.    Aasheim ET. Wernicke encephalopathy after bariatric surgery. A systematic review. Ann Surg. 2005;248(5):714–720
3.    Gollobin C, Marcus WY. Bariatric beriberi. Obes Surg. 2002;12:309–311.
4.    Lopes Chaves LC, Faintuch J, Kahwage S, de Assis Alencar F. A cluster of polyneuropathy and Wernicke-Korsakoff syndrome in a bariatric unit. Obes Surg. 2002;12:328–334.
5.    Salas-Salvado J, Garcia-Lorda P, Cuatrecasas G, et al. Wernicke’s syndrome after bariatric surgery. Clin Nutr. 2000;19(5):371–373.
6.    Escalona A, Perez G, Leon F, et al. Wernicke’s encephalopathy after Roux-en Y gastric bypass. Obes Surg. 2004;14:1135–1137.
7.    Loh Y, Watson WD, Verma A, et al. Acute Wernicke’s encephalopathy following bariatric surgery: clinical couse and MRI correlation. Obese Surg. 2004;14:129–132.
8.    Worden RW, Allen HM. Wernicke’s encephalopathy after gastric bypass that masqueraded as acute psychosis: a case report. Curr Surg. 2006;63:114–116.
9.    Juhasz-Pocsine K, Rudnick SA, Archer RL, Harik SI. Neurological complications of gastric bypass surgery for morbid obesity. Neurology. 2007;68:1843–1850.
10.    Bozbora A, Coskun H, Ozarmagan S, et al. A rare complication of adjustable gastric banding: Wernicke’s encephalopathy. Obes Surg. 2000;10:274–275.
11.    Koike H, Misu K, Hattori N, et al. Postgastrectomy polyneuropathy with thiamine deficiency. J Neurol Neurosurg Psychiatry. 2001;71:357–362.
12.    Toth C, Voll C. Wernicke’s encephalopathy following gastroplasty for morbid obesity. Can J Neurol Sci. 2001;28:89–92.
13.    Halverson JD. Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg. 1986;52:594–598.
14.    Day E, Bentham P, Callaghan R, et al. Thiamine for Wernicke-Korsakoff syndrome in people at risk from alcohol abuse. Cochrane Database Syst Rev. 2004;CD004033.
15.    Aills L, Blankenship J, Buffington C, et al. Bariatric Nutrition: suggestions for the surgical weight loss patient. Surg Obes Relat Dis. 2008. Suppl;4(45).
16.    Heye N, Terstegge K, Sirtl C, et al. Wernicke’s encephalopathy—causes to consider. Intensive Care Med. 1994;20:282–286.

wlsvitagarten.com/

Demineralization. If your body is robbing calcium from your bones to maintain your blood calcium levels, it is also stealing calcium from your teeth. [...] What were your last calcium, D and PTH values on your blood tests? You may need to take more calcium citrate and D3. The sooner the better. [edited to remove personal information] Also, see if your dentist will prescribe a prescription strength flouride toothpaste for you. Flouride will help to remineralize your teeth and prevent weakened enamel from getting cavities.

Oh, I can so relate to this.  I currently only have 14 teeth left in my mouth.  I suppose I am lucky because they are the ones people see when they look at you so at least I have no gaps in my mouth.

I will soon be seeing the dentist for many many visits.

Jillie, have you had labs drawn lately?  Do you have the list of what you need? 

Actually, had them drawn a week or so ago (first time in a long time other than the anemia part of testing) and hIave an appointment the 19th to go over them.  I am pretty sure it is a comprehensive draw.  My pcp, although a new doc to me, says that his mom had WLS so he knows just what to look for with me.  Keep your fingers crossed for me!!!

Hello:  I thought it was just me!! My friends laugh at me saying I'm eating too many sweet thingsw after my surgery  8/08 (rny) however, my teeth were  always good prior to surgery -I was llucky they were about the healthiest thing in my body at that point! So I developed cavity after cavity, some gingivitis, etc. I was at a loss as to why all of a sudden this was happening and then started to wonder if it could be surgery related??
I see from other posts that this can occur.  I will be following up with both my dentist and my pcp and start the ball rolling as far as what blood work needs to be tested for.  Thank you for your post and also to other posters for the information.   Mary