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Problems with teeth after radiation

MLC53's picture
MLC53
Posts: 109
Joined: Sep 2007

I was just wondering if anyone could comment on their experiences with teeth issues after radiation.

Has anyone been lucky enough NOT to have any teeth problems?

If you have had problems, what kind were they? Any experiences with HBO and ORN? I still have all my teeth but will need some dental work soon and am concerned about infection.

Anybody use flouride trays daily?

jkinobay's picture
jkinobay
Posts: 245
Joined: May 2007

For comparison, my cancer was HPV 16 positive Squamous Cell Carcinoma originally found in lymph nodes left neck with the primary site found in the left tonsil. I had 35 IMRT treatments and 7 concurrent weekly Cisplatin Chemo treatments.

For oral care/dental care, I was lucky in that my regular Dentist had 13 years working at the VA Hospital with Head and Neck Cancer Patients. So, he already knew what I would go through and how to minimize the impact. He gave me a very strict regimen which I followed religously and thankfully now almost one year post-treatments, I have not had any dental problems.

Some of mine was luck and the fantastic technology of my Oncology team, but the majority of it I owe to my Dentist who had seen hundreds of patients before me and knew what to look for and how to avoid as much damage as possible.

Be Well..................JK

lindab4's picture
lindab4
Posts: 6
Joined: May 2011

Hello

Could you share with all of us what the very strict regimen you followed was?
So that we could try it and maybe do as well as you have.

Thank you.
Linda

soccerfreaks's picture
soccerfreaks
Posts: 2801
Joined: Sep 2006

I had 33 rads following surgery for tongue and neck cancer (squamous). Beforehand, I had extensive dental work done, including a cleaning that took three trips, as they worked on a quarter at a time before finishing up the upper half, along with some guy basically using pliers (or so it seemeed) to yank a molar with a problem.

All of this helped a great deal, and your post provides the opportunity to let others know that they absolutely MUST get their dental work done well prior to treatment.

To answer your question, I got a false positive for additional head/neck cancer when a PET scan showed a spot in my mouth. Fortunately, my doc had me go to dentist (and subsequently to oral surgeon) and they discovered an infection beneath a filling. No cancer there!

Otherwise, I note that from time to time I feel as though my teeth are sort of disintegrating, even though I have no evidence of that. It just seems on occasion that I can FEEL pieces, small pieces, of tooth coming away.

I do not do the fluoride treatments, but have heard greats thing about them. Instead, I still use the toothpaste and mouthwash I was provided when leaving the scene of the crime (:)), the Oasis mouthwash and the Biotene toothpaste.

I still get my teeth cleaned as well, because, like you, I would like to keep my teeth.

From everything I've heard, the fluoride trays are great stuff. I may look into it myself now that you have brought it up again.

Take care,

Joe

Joe-V
Posts: 1
Joined: Sep 2008

After I was diagnosed and before treatment started I was sent to the dentist. He evaluated my teeth and concluded both left and right molars where tipped into each other. While they did not currently have any cavities, they were considered high risk for post treatment decay. I had all 4 teeth removed as a precaution. I was never compulsive about brushing my teeth, now I am. Due to the thickened saliva and dry mouth I was brushing upwards of 5 timesa day. I can't make it through the day without my waterpick. I use floride trays very speratically. I am 2yrs 6mon. post treatment, I did regain limited salivary function. When I do use the floride trays it does have the side effect of making my mouth water. My last dental visit was 1 month ago I had 1 small cavity which was filled.

Hope this helps

JOE

TereB
Posts: 288
Joined: May 2003

I had problem with my teeth after radiation treatment in head/neck area. I was lucky to have a dentist with lots of experience treating patients who had cancer. He also does not like people to lose teeth and will do what he can to save teeth.

I use a fluoride tray every night. It seems to work since I have not lost any teeth. I also have my teeth cleaned every four months. I used the Biotene toothpaste for a while; nothing wrong with it except that it is for people with dry mouth due to cancer treatments, that's me. I just thought that with a Crest toothpaste with extra fluoride plus the fluoride tray I was fine. I am back to using Biotene in the morning.

I think soccerfreaks mentioned that he feels his teeth sort of crumbled. That happened to me, I would find tiny pieces of tooth in my mouth. Some of my teeth were actually falling apart in little pieces. That's when we decided it was better to take them out. An oral surgeon took care of that and my teeth didn't come out in one piece. They would break in pieces every time he tried using those plier things dentist use to pull teeth. I am glad he put me to sleep before the procedure.

Since many times there is not only damage to teeth but also to bone (mandibule bone?), I went to the hyperbaric chamber before and after surgery. It also worked very well for me because it strengthen the bone and I was able to have implants.

Radiation usually causes dry mouth and with a dry mouth you do not have enough saliva to help clean the bacteria that accummulates in your mouth. So I think great dental hygiene is important plus visits to your dentist.

I didn't have problems with infections in my gums. Like I said, I have a great dentist and he took care of everything, prevention and treatment.

TereB

MickDolphin
Posts: 4
Joined: Jan 2013

HI TereB,

I was wondering about your process of getting treatments in the hyperberic chamber.  Did your oncologyst arrange it, or did you have an oral surgeon or dentist help set that up?  Also, are know it isn't an expensive procedure and was wondering if you had issues with insurance not covering any of it.  I am a head and neck cancer survivor.  I have not lost any teeth, but have had a few root canals and now issues that could mean a bone graft of my mandibule.

Any information would be greatly appreciated.

Thank you all,

MickDolphin

coco2003
Posts: 9
Joined: Oct 2007

I use daily Phos Flur from Colgate. It has 4.4 mg of fluoride per each 10 cc of solution. It is more than what you get from the tray and cost less and is a mouth wash. I use it before going to bed. In the morning, I use biotene toothpaste then listerine and biotene mouthwash. Always, after anything that I eat ( I eat about 99% of everyhing - had amifostine treatment prior to every radiation treatment and I opened a discussion board several months ago about the subject: Protecting the Salivary Glands while on Radiation) I floss my teeth. It is very important to maintain a high level of hygiene. I have been on remission since May 2007 and have very healthy gums and strong teeths. I go to my dentist every 6 months.

Listerine is important because it protects you from bacteria and helps prevents periodontal disease while biotene mouthwash won't. I hope this can be of some help. You can also contact me at: coco_scuba@comcast.net.

BugHunter's picture
BugHunter
Posts: 152
Joined: Oct 2007

I had to have all the metal fillings removed and replaced with non metal (not sure what it is) before I started rads. I also had four teeth removed as they could not fill them with anything but metal. Since then I have had issues with hot/cold but no other problems. I use a prescription floride mouth wash weekly and have become a listerine junky.

BILL

paula002's picture
paula002
Posts: 29
Joined: Apr 2007

Hey MLC53,

I had radiation on neck and nasopharynx areas last year.
I started using the fluoride trays at the same time as radiation. Nurse said that if I did not use it, I could lose some teeth (dunno if it was true or not but I didn't want to find out!).
No major problems with teeth now. Dentist said that at this point I could just use the fluoride trays every 2nd day. However, I still try to use it everyday before going to bed. I believe it protects them but also helps provide more moisture at night.
I also try to always brush after meals.
Visited the dentist more often this year, just to make sure things were ok.
Love Biotene products, mouthwash and tooth paste.

All the best to you,

Paula

tci
Posts: 1
Joined: Jan 2009

Just finished 7 weeks of head and neck radiation last Tuesday. Have been using Flouride trays for the whole time, with the idea I would have to use them forever (according to the dentist) mentioned this to my Oncologist, she told me not so, that I could use a high flouride toothpaste and wouldn't need the trays. Made me feel much better but I still worry about it. I have to make an appointment with my dentist now that I am done to do some work not done prior to my treatment, so I will let you know what I find out.

slickwilly's picture
slickwilly
Posts: 339
Joined: Feb 2007

Tci. You didn't say how much of a loss you suffered to your saliva glands. After 25 face radiation treatments I proubly lost 1/2 of my saliva glands. So my mouth felt like it had mud in it. I continued to take many medications for pain and other problems over the last 5 years. My teeth had major problems. Many loose fillings and decay along with problems of thinning at the gum line. Fixing my teeth after cancer cost many thousands of dollars and continues to this day. In fact right now I have an ice pack on my face as I saw the dentist today ha ha. Anything you can use to help your teeth is good and I would not throw out the flouride tray. I also use biotene toothpaste and mouthwash. The mouthwash does not contain alcohol so it does not cause more drying. Best of luck Slickwilly

ratface's picture
ratface
Posts: 1229
Joined: Aug 2009

Radiation is absorbed by our jaw bones and suffer blood flow issues. Our saliva is diminished thus we cannot keep bacteria at bay. We suffer damage from both ends then.Some issues are bound to crop up.

I had a year long abcess under a filling which was just recently resolved by pulling the tooth. You have to stay on top of dental care. I'm on flouride trays also.

MickDolphin
Posts: 4
Joined: Jan 2013

Hi TereB

I have damage to teeth and to my mandibule (Lower Jaw) bone.  I am on Medicare. Can you tell me if your insurance covered the treatments in the hyperbaric chamber?  I was told how high the cost for that is.

With appreciation,

MickDolphin

denistd's picture
denistd
Posts: 481
Joined: Apr 2009

I have had HBO twice now, and have had all my teeth removed, I am on medicare and highmark freedom blue. They covered the HB and the teeth removal. Onco sent a letter to them explaing that removal of teeth was a medical procedure and neccesary to prevent any jaw damage. All is now well. have dentures and that was not covered.

MickDolphin
Posts: 4
Joined: Jan 2013

Thank you so much Denistd!!!!

MickDolphin
Posts: 4
Joined: Jan 2013

I am also wondering about your process of getting treatments in the hyperberic chamber.  Did your oncologist arrange it, or did you have an oral surgeon or dentist help set that up?  Also, are know it isn't an expensive procedure and was wondering if you had issues with insurance not covering any of it.  I am a head and neck cancer survivor.  I have had a few root canals recently and now issues that could mean a bone graft of my mandibule.

Any information would be greatly appreciated.

Thank you again,

MickDolphin

denistd's picture
denistd
Posts: 481
Joined: Apr 2009

My Onco and Oral Surgeon and dentist did all of the work. Everything was covered at 100%, the teeth removal was done as an out patient. I believe the HBO is around $400 a session but not sure as I saw no bills. Your oncologist is the main man. To prevent any further damage was his tap.

George_Baltimore's picture
George_Baltimore
Posts: 303
Joined: Jun 2009

I will second what Denistd said.  Starting in 2009, I've had a total of 124 HBO treatments.  Each one was covered in full by Medicare and a medi-gap from Blue Cross Blue Shield.  One other thing, PLEASE ask you doctor about bone debridement before you decide on mandible replacement!  There are some on this board who have had no problems with that surgery.  Unfortunately, I am not one of those.  My doctors never mentioned the possibility of debridement of the mandible.

hwt's picture
hwt
Posts: 1816
Joined: Jun 2012

I was told the HBO is $2500 a session if insurance doesn't pay for it. My insuance approved but in the meantime my husband's former employer changed insurance carriers so now starting the process again. Since surgery, rads and chemo, I have had one root canal done and it went without incident. Seems the radiation took the root because there was no decay or cavity on the tooth. Life is sometimes just not fair.

Mikemetz's picture
Mikemetz
Posts: 331
Joined: Nov 2011

I am almost 4 years post-rads and started to have problems about a year later.  I have chronic ORN, and have lost three teeth in that area, with more likely to come out. I've had two debridements.  The first one definitely didn't work, and I'm in a wait and see on the results of the second one.  But lately my signs are better that it did work, so I'm optimistic.  I say lately because I had a lot of swelling and pain for 3 months after, and then on Christmas day a 3/4 inch long shard of dead bone came out, and things have improved a lot since then.  Yes, 3/4 of an inch--think the shape and thickness of a paper clip that big!  Scared the hell out of me!  To put that in perspective, every other bone shard before then was about the size of a grain of rice.  This big one might have been the problem all along, so I have my fingers crossed that my ORN is over.

If not, then I'm looking at having my left jaw resected (replaced).  The message here is to be very patient and let your ORN run its course--even though it can be very painful at times.  It takes a long time for that area to heal, or to show that it won't ever heal.

As for HBO, I had 40 "dives" before my first debridement and 10 before my second.  To be honest, I thought that it was a waste of time, and my insurance company's money.  They paid $2,200 for each treatment.  I know that the effectiveness of HBO varies a lot, but after my experience I can't recommend it.  My oral surgeon prescribed HBO because "It might help, but it can't hurt."  Once it was all over, I told him that next time HE gets to sit in that chamber for 100 hours and lose another 50 hours of time getting there and back!

I now have a huge "crater" in my left jaw from the loss of teeth and bone.  If and when that area stabilizes I'll be looking at a lower denture for sure.  Right now my dentist can't do anything because the ORN might not be over yet and I could still be looking at a resection.

Mike

 

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