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Tooth care after radiation

delnative's picture
delnative
Posts: 452
Joined: Aug 2009

When I was undergoing treatment for Stage III tonsil SCC at Johns Hopkins (Cisplatin, rads and surgery) I had a dentist, a specialist in this field, assigned to my case.

Among the things he told me was to instruct my local dentist and dental hygienist to always remove the plaque from my teeth manually (manual scaling, they call it) -- and not to use a Cavitron to remove plaque. The Cavitron is a machine that removes plaque by ultrasound.

Now, more than a year out, I notice that my teeth are getting stained. I had my teeth cleaned today, as I do every four months, and the hygienist wanted to know why my chart said I couldn't have my teeth cleaned with the Cavitron. I told her that my dentist at Hopkins was emphatic that it not be used, so she did the scaling manually.

My question: Have any of you had similar instructions? The hygienist wondered if the no-Cavitron instruction was a lifelong thing or only applied during my treatment. I told her I had no clue, but to do the manual scaling just to be safe.
Anyone?

-- Jim in Delaware

Kent Cass's picture
Kent Cass
Posts: 1746
Joined: Nov 2009

No, to the Cavitron, Jim. The Periodontist the Rad Dr. sent me to advised I use Prevident, long-term, but I have stopped- use Colgate, instead. I stopped because of the continued loss of gum tissue, Jim, which continues as an issue that the Colgate replacement is not helping. Even the Glutamine seems to be lacking in help.

What kinda condition are the tops of your lower-front teeth? When you look at them- does it appear that there's no tooth on those tops/there's discoloration, like maybe all there is= the insides of the teeth? Does get to me.

This thread of your's does give me cause to set-up a Dental appointment. I have been very negligent, since my Periodontist experience, to keep up with the dental care.

Thank you, Jim.

kcass

delnative's picture
delnative
Posts: 452
Joined: Aug 2009

I use Prevident, which the dentist told me I should continue for the rest of my life. It hasn't bothered my gum tissue in the least.
The staining wasn't on the surface or tops of the teeth, but in between the teeth. It rather looked like I was a heavy smoker or drank a lot of tea or coffee (and I do none of that).
The hygienist was able to remove the staining, but she had to put a little more elbow grease into it than she normally would. She wondered if the Prevident was causing the staining, but she said that it shouldn't, because it's sodium fluoride. Stannous fluoride, she said, will cause staining.
By all means Kent, don't neglect your teeth. Get thee to a dentist.

--Jim in Delaware

Kent Cass's picture
Kent Cass
Posts: 1746
Joined: Nov 2009

Jim- did have to go to my Dentist on Wednesday/yesterday, due to a Crown detachment. He checked my mouth out in the process of getting the Crown problem taken care of. Should have gone to visit him sooner. He did say he thought things looked good- better than he expected. The "loss of gum tissue" thing I've expressed concern about, which less than a week earlier my Oto saw and said he wasn't concerned with, but didn't explain why- my Dentist did explain it: what I am now seeing is the reality that had been hidden by swelling of my gums and other mouth tissue. Or, I am not losing more gum tissue- the swelling has finally been reduced to the extent that I can see just how much gum tissue was lost with my treatment. I do have cause to question that, however, but only to a partial degree: seeing the white of bone in my lower mouth behind my teeth has gradually moved from my back-left inner gum to behind my front-lower teeth on my right side. My Oto just spoke of it as "thinning" of the tissue, and he says he wouldn't be concerned unless bloodloss begins. And if it begins, Doc? Yeah, it may still be an issue.

Next Monday I get my first cleaning session, Jim. The Dentist visit, in my mind, was a major-plus. Thank you, Jim.

kcass

Onmyknees4U
Posts: 12
Joined: Jan 2010

Was thinking that maybe using a Waterpick would irrigate well and help prevent staining. My dentist wouldnt prescribe a certain mouthwash until I bought one, to prevent staining.

sally

s
Posts: 6
Joined: Apr 2003

I use biotene mouthwash, oral balance for moisture, biotene toothpaste and most important I bought a Sonicare toothbrush. It definitely helped.... I use GEL Cam fluoride treatment.

I did have to have a tooth pulled and because No one would do this locally without HyperBaric Oxygen treatments, I went to Sloan Kettering in New York. I took all records and two physicians decided it could be pulled. I also need a wisdom tooth pulled and a local oral surgeon will perform the surgery, but I have decided to wait until there is pain.

I have pain getting my teeth cleaned , Jaw pain from trying to keep mouth open.....

I still pray for a salivary gland transplant...... Why not...... Stem cells may be our answer for new saliva.....I hope.

debbiejeanne's picture
debbiejeanne
Posts: 2259
Joined: Jan 2010

Hi all, I'm just wondering if the teeth trouble is just for the people who had tounge/tonsil/neck cancer? I had throat (vocal cord) cancer but nobody ever mentioned me getting my teeth pulled or needing sprecial procedures.
Thank you in advance for your replies.

Debbie

Glenna M's picture
Glenna M
Posts: 1580
Joined: May 2009

Hi Debbie, I could be wrong but I believe it is anyone who receives radiation to the neck that is susceptible to problems with their teeth after treatment. I have SCC of the larynx (voice box) and was told by my radiologist prior to treatment that I would need to get my teeth checked and cleaned prior to receiving any radiation. He also recommended I have any teeth pulled that might cause a problem in the near future, fortunately I did not have to have any pulled. The dentist gave me a prescription for flouride trays to help protect my teeth since radiation often destroys the salivary glands.

Hope this helps,
Glenna

debbiejeanne's picture
debbiejeanne
Posts: 2259
Joined: Jan 2010

Glenna, I had the same cancer you did and went thru radiation. I now have a tooth that is bothering me that didn't bother me before. I go to the dentist next week.
I will post what he does/tells me.
Thank you for replying.
Deb

debbiejeanne's picture
debbiejeanne
Posts: 2259
Joined: Jan 2010

Glenna, Thank you for your post. I'm sorry but I made a mistake about my cancer. Mine was vocal cord cancer. I apologize.
Sincerely,
Debbie

Scambuster's picture
Scambuster
Posts: 975
Joined: Nov 2009

Hi All, Just back from my second Dentist visit in as many weeks as it appears the old Amalgum fillings were giving way and also she noticed I have 2 teeth cracking. unsure how much is due to the Rads (70 IMRT Sept-Oct 09)

I use biotine toothpaste and mouth wash and also at night now apply GC Mousse which is supposed to help recalcify your teeth as the dry mouth/ no saliva effect can cause erosion. GC also make a great mouth gel similar to Biotine to moisturize your mouth.

Cheers
Scambuster

delnative's picture
delnative
Posts: 452
Joined: Aug 2009

It's amazing, and, to be frank, infuriating, that so many people aren't told about the damage that radiation does to your teeth. (You did have rads, right?) I would assume -- always a dangerous thing -- that radiation to that part of the throat would have the same impact as radiation to the tonsil, which is where I had mine. Maybe I'm wrong, and if so I apologize.
I and many of us here were told before we began our treatment that we had to have a comprehensive dental checkup and that any teeth that might need to be pulled had to be pulled before treatment began. (I've always taken care of my teeth, so that was not a big deal for me.)
During my treatment I had a specialist dentist who checked me regularly and instructed me about proper care after treatment ended. That included fluoride trays that he made for me, and the instruction to treat my teeth once a day with Prevident until the day I die. (After that I can discontinue treatment.)
That's how it should be done. For any patient about to undergo radiation NOT to be told borders on malpractice.
Yet the dental hygienist at my regular dentist told me that she has a lot of people come in a year or so after rads because their teeth are literally falling apart. She said that no one told them about the effect radiation has on teeth or how they should care for their teeth. She was impressed that I'd been given such good instructions.
That's pretty sad.

--Jim in Delaware

Kent Cass's picture
Kent Cass
Posts: 1746
Joined: Nov 2009

Jim- had my first "cleaning" done today, as well as a $43 thorough check-up by one of the three Dentists where I go. He, also, thought Prevident is the way to go, so to speak. The cleaning went well- only four teeth that look to be future hassles, but none are immediate. Pressed my luck by waiting so long for a dental follow-up, but figured the Periodontist and root canal was enough (last rad was just shy of 10 months ago). This was the first cleaning, and have the next scheduled for just 3 months down the road. Long as I'm alive, and can eat, I'll be danged if I shouldn't take care of the teeth used to chew that food I can taste, again.

Thanks again, Jim.

kcass

debbiejeanne's picture
debbiejeanne
Posts: 2259
Joined: Jan 2010

Jim, I did have radiation (35) but nobody in the oncol office told me anything. What I know now is from the posts I read here. I didn't know there is a primary, different types of radiation, etc. I didn't know it affected our teeth. What I now know about my cancer and treatments, I've learn from the postings on this site and thank everyone of you for educating me. It is great knowing I can come here and ask questions and most will know what I'm asking. I don't feel all alone any more because I now have the family here.
Thank you all very much! May God bless you and keep you well.
Deb

D Lewis's picture
D Lewis
Posts: 1521
Joined: Jan 2010

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D Lewis's picture
D Lewis
Posts: 1521
Joined: Jan 2010

Thank you all for your postings. This information is tremendously helpful. So far, I've only received the diagnosis of metastatic squamous cell carcinoma in a neck lymph node. No idea about the primary cancer, or about any other mets, until I get full scans in the upcoming couple of weeks. I was able to see my dentist yesterday and today, got a full oral cancer screen, full X-rays, cleaning and scaling, and I'm halfway through an expedited replacement of an aging crown. They tell me that with proper care, and with the use of the rinses and washes that you've discussed in this thread, my teeth are healthy enough to withstand just about anything they throw at me. Prior to joining this group, I hadn't had any idea, either. I'm a lot more prepared now. I even have my hygenist's home phone number for mouth-gum emergencies that may arise after hours.

Deb L.

micktissue's picture
micktissue
Posts: 432
Joined: Dec 2009

My understanding is that the teeth problem is mainly from the rads destroying salivary function. The fluoride trays are to limit the loss of dental material that saliva normally protects. Because the teeth are bathed in saliva, they are protected from this loss. Without saliva, teeth degradation will occur. Fluoride acts as a restorative agent (to some degree) but my dentist admitted to me it is more or less palliative, not a cure for tooth and gum damage due to reduced or non-existent salivary function.

Staying on top of it by doing the fluoride trays, brushing with fluoride TP and mouth washes will limit the impact on teeth. I spent 3 hours at the dentist yesterday getting this low down and I asked a lot of questions.

Another reason for getting the dental work prior to starting rads is that recovery is longer and problematic on tissue that has been irradiated. If they need to yank during or after rads it will cause some major problems from bleeding alone.

It all pretty much sucks, but I did get some *benefit* to chemo information today. I was told that chemo reduces cholesterol. I had to laugh at that.

Best,

Mick

debbiejeanne's picture
debbiejeanne
Posts: 2259
Joined: Jan 2010

Mick, I am with you, I would have to laugh. But with what we face everyday, that's a good thing I guess. I am so thankful that a fried told me about this site because without coming here, I'd still be as ignorant as I was the day I heard I had cancer (vocal cord).
I want to thank you and everyone who posts on here. Reading the posts that each of you take time to type is much more information than I received from my doctors. Each of you here is very valuable and thank God for each of you everyday. There is no way to express what your posts have done for me and how they have educated me and kept me from feeling all alone and I thank each and every one of you and ask that you conitinue to post as we have new people joining every who will also need your knowledge.
THANK YOU ALL !!
Deb

delnative's picture
delnative
Posts: 452
Joined: Aug 2009

I'm so happy this site and this thread have proved to be helpful to you.
I started the thread by asking a simple question, figuring the discussion would end after a couple of replies. And yet you and maybe some others wound up learning from it and can put that knowledge to good use.
And I think that's pretty cool.

--Jim in Delaware

Tanager75
Posts: 86
Joined: Aug 2009

Jim, it not only helps me learn but helps reinforce what I know and challenge what I remember incorrectly (chemo, rads, pain, have all impacted a memory that was questionable to begin with).

peace mark

Kent Cass's picture
Kent Cass
Posts: 1746
Joined: Nov 2009

Pretty cool is right. Since my last dental visit I have been chewing/eating better just from having the confidence that my teeth are okay to use them more. Do think this is of significance- if one's Dentist says the teeth are okay, then that goes a long ways. All of us gotta be cautious, post-treatment, with the possibility of tooth problems that will create bigger problems/hassles, because of treatment complications. Exceptional thread, Jim.

kcass

Monikat
Posts: 2
Joined: Feb 2010

Hi Jim,

Thank you for the useful information on dental care. My father has tonsil cancer and has started radiation (2 weeks so far). All they told him was that he could have tooth loss, but nothing about how to really take care of them and I didn't realize that there was actually a protocol out there for care during radiation. I'm definitely going to ask about that tomorrow and find out if there is a dentist around that deals with cancer treatment issues.

Best,
Monika

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