post rad dental care

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caregiver99
caregiver99 Member Posts: 27
in Head and Neck Cancer #1
Does anyone go to dentist for professional flouride treatment? My girlfriend who is 3 months out of radiation therapy. She has been using flouride tray daily but I've read it is also recommended to do professional flouride treatment at the dental office 2 to 4 times a year. The problem is her dentist doesnt believe she need flouride treatment from the dental office. He said the flouride tray she uses at home is more than adequate and he said the flouride gel she put in the tray has more flouride than what he can provide in the office. Is this true? Why do they call it professional flouride treatment if it is same as what you use at home.

I have read alot about doing HBO therapy when a tooth is needed to be pulled. Does general dentist office have the equipment to do this therapy or it needs to be done in the hospital?

Due to the post radiation therapy treatment, I am not too comfortable having her doing x-ray in her dentist office. She already got too much radiation and I am trying to keep her from exposing to additional radiation from unecessary x-rays. Does anyone have this concerns or am I just being paranoid?

Happy and healthy new year to all !!!
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  • djbxray
    djbxray Member Posts: 7
    #2
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    Dental care
    My dentist is recomending X-rays every 6 months for the first couple of years after radiation therapy. She says because of the difficulty of treating dental problems after RT it is much better to catch them early. I have worked with X-rays all my life and the radiation dose from dental X-rays is very low. I will be taking her advise. As for the dental trays I have told to use the fluoride trays at home no need for extra treatment at dental office.
  • djbxray
    djbxray Member Posts: 7
    #3
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    Dental Radiation Dose
    I am including a link to discussion about dental radiation.

    http://hps.org/hpspublications/articles/dentaldoses.html
  • sweetblood22
    sweetblood22 Member Posts: 3,228
    #4
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    Caregiver
    As far as I know, from going to my dentist all the time, that is not true. The stuff they paint on my teeth, is a sticky varnish kind of thing that stays on a long time. They always tell me not to brush until I go to bed, which drives me nuts, because I hate the way that stuff feels on my teeth. Plus I brush like 5-6 times a day. The stuff they use in the office is 2% fluoride, my prescription tooth paste, and what I put in my trays, is 1.1%, regular tooth paste, is like .14 - .25%.

    HBO Treatments is not something that can be done in the dentist office, and there are not a lot of places that do it. I will let others who have gone through it first hand, comment on that.

    IMO, you definitely want to do dental x-rays, and catch anything before it becomes a major problem, and with radiation damage and dry mouth, that can happen quickly. My teeth went to he** in a hand basket in six months. Before that, they were fine.

    I go at least every four months to the dentist, and every time I go, I get a fluoride treatment.

    Your GF, should only go to a dentist that has had experience with head and neck cancer and radiation. Period. If her dentist is not well versed with people like us, find a new dentist. There are other dentists at my hospital where I was treated, but only my dentist touches my teeth, and he does ANY and ALL O&HNC patients at the hospital.

    I am having a very hard time with my teeth, because I have like zero saliva.
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #5
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    HBO
    I've had HBO in advance of getting a molar extracted. The HBO centers are hospital affiliated, and not every hospital has one. Getting these is a pain. 30 sessions, five days a week for six weeks. Each session takes over 2 hours in the chamber, so with the drive to and from, almost a half a day per session. And since you can't take anything with you into the chamber, you can't even read a book. But you can watch the TOday show:)

    However, if you are losing a molar, particularly one of the lowers, youd way rather do this than have osteoradionecrosis. Treatment of ORN isn't just HBO, it's HBO plus a 14 hour surgery and extensive hospitalization.

    HBO effect lasts about 2 years, so it has to be repeated if more teeth are to be extracted on down the road.

    Pat
  • caregiver99
    caregiver99 Member Posts: 27
    #6
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    sweetblood22 said:

    Caregiver
    As far as I know, from going to my dentist all the time, that is not true. The stuff they paint on my teeth, is a sticky varnish kind of thing that stays on a long time. They always tell me not to brush until I go to bed, which drives me nuts, because I hate the way that stuff feels on my teeth. Plus I brush like 5-6 times a day. The stuff they use in the office is 2% fluoride, my prescription tooth paste, and what I put in my trays, is 1.1%, regular tooth paste, is like .14 - .25%.

    HBO Treatments is not something that can be done in the dentist office, and there are not a lot of places that do it. I will let others who have gone through it first hand, comment on that.

    IMO, you definitely want to do dental x-rays, and catch anything before it becomes a major problem, and with radiation damage and dry mouth, that can happen quickly. My teeth went to he** in a hand basket in six months. Before that, they were fine.

    I go at least every four months to the dentist, and every time I go, I get a fluoride treatment.

    Your GF, should only go to a dentist that has had experience with head and neck cancer and radiation. Period. If her dentist is not well versed with people like us, find a new dentist. There are other dentists at my hospital where I was treated, but only my dentist touches my teeth, and he does ANY and ALL O&HNC patients at the hospital.

    I am having a very hard time with my teeth, because I have like zero saliva.

    thanks sweetblood
    I agree I think my GF needs a new dentist. Her dentist only prescribed her with fluoride toothpaste until I asked about the tray with fluoride gel 5 weeks into her rad treatment. I was very upset with him, hope damage was not done.
  • caregiver99
    caregiver99 Member Posts: 27
    #7
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    longtermsurvivor said:

    HBO
    I've had HBO in advance of getting a molar extracted. The HBO centers are hospital affiliated, and not every hospital has one. Getting these is a pain. 30 sessions, five days a week for six weeks. Each session takes over 2 hours in the chamber, so with the drive to and from, almost a half a day per session. And since you can't take anything with you into the chamber, you can't even read a book. But you can watch the TOday show:)

    However, if you are losing a molar, particularly one of the lowers, youd way rather do this than have osteoradionecrosis. Treatment of ORN isn't just HBO, it's HBO plus a 14 hour surgery and extensive hospitalization.

    HBO effect lasts about 2 years, so it has to be repeated if more teeth are to be extracted on down the road.

    Pat

    thanks Pat
    Hi Pat, does HBO required for all Head and neck patients who had rad treatment? Who determine this...dentist, ENT, or the rad doctor?
  • ljoy
    ljoy Member Posts: 94
    #8
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    Dental Care
    I'm six years post treatment for tonsil cancer. Under went HBO at five years for radiation damage to jaw bone and teeth. It is important that you have a dentist who knows the risks and problems associated with radiation treatment. I have a dentist who specializes in comprimised dental cases. I see her every four months for cleaning and checkup. I have x-rays every year to keep track of bone structure and tooth decay. I don't receive any additional floride treatment other than those at home.

    It is important you take extra care in brushing and keeping your mouth as clean as possible. Rinse and or brush after eating. Not everyone will have extensive radiation damage depending on how many total rads they received and the area of radiation. I hope this helps.

    Wishing you the very best in your recovery.
  • caregiver99
    caregiver99 Member Posts: 27
    #9
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    djbxray said:

    Dental care
    My dentist is recomending X-rays every 6 months for the first couple of years after radiation therapy. She says because of the difficulty of treating dental problems after RT it is much better to catch them early. I have worked with X-rays all my life and the radiation dose from dental X-rays is very low. I will be taking her advise. As for the dental trays I have told to use the fluoride trays at home no need for extra treatment at dental office.

    thanks djbxray
    I can now sleep better knowing other dentists also recommending x-rays twice a year.
  • caregiver99
    caregiver99 Member Posts: 27
    #10
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    ljoy said:

    Dental Care
    I'm six years post treatment for tonsil cancer. Under went HBO at five years for radiation damage to jaw bone and teeth. It is important that you have a dentist who knows the risks and problems associated with radiation treatment. I have a dentist who specializes in comprimised dental cases. I see her every four months for cleaning and checkup. I have x-rays every year to keep track of bone structure and tooth decay. I don't receive any additional floride treatment other than those at home.

    It is important you take extra care in brushing and keeping your mouth as clean as possible. Rinse and or brush after eating. Not everyone will have extensive radiation damage depending on how many total rads they received and the area of radiation. I hope this helps.

    Wishing you the very best in your recovery.

    thanks ljoy
    Thanks for the info, it helps a lot.
  • sweetblood22
    sweetblood22 Member Posts: 3,228
    #11
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    caregiver99 said:

    thanks sweetblood
    I agree I think my GF needs a new dentist. Her dentist only prescribed her with fluoride toothpaste until I asked about the tray with fluoride gel 5 weeks into her rad treatment. I was very upset with him, hope damage was not done.

    If you've not checked out
    If you've not checked out the HNC Superthread, that is always located on the first page of our board, I've compiled a great deal of info on various places relating to dental issuses, and radiation side effects here is just one piece of it:


    DENTAL ISSUES AFTER RADIATION FOR HNC:
    -----------------------------------------

    Osteoradionecrosis of the Mandible
    Talks about ORN and whether HBOT work when having to extract teeth after radiation.  Some pictures, you may not want to see if you are squeamish. 

    IMPORTANCE OF A DENTAL APPROACH IN HNC THERAPY

    RADIATION THERAPY AND ORAL CARE

    Tooth removed today POST radiation


    There are also more articles and info about dental and mouth care throughout the thread.

    HNC  SUPERTHREAD
  • fisrpotpe
    fisrpotpe Member Posts: 1,349 Member
    #12
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    treatments
    my hygienist does not do fluoride treatments in the office, she does not think they are needed since i do my treatments at home 2-3 times a day.

    hbo is only done in hospitals, do not know where you live but for many years until 2007 they did not have the chambers in my town and the closest one was in chicago about 2 1/2 hours away. they are not cheep. i have had 6 teeth removed without hbo but 4 weeks of antibiotics and watched closely every week for 6 weeks for infection.

    i have x rays about once per year and check ups every 3 months, the amount of radiation is so very minor i have never been concerned.

    john
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #13
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    caregiver99 said:

    thanks Pat
    Hi Pat, does HBO required for all Head and neck patients who had rad treatment? Who determine this...dentist, ENT, or the rad doctor?

    Good question
    Here's how it was presented to me: my ENT oncologist stated clearly at the time of my radiation that if I ever needed teeth extracted I would need HBO. It wasn't ever NOT considered. I had standard radiation for BOT cancer.

    When I needed a molar extracted on the mandible, the local dentist wouldn't touch me. The ENT oncologist referred me, and I made my own arrangements for HBO locally. The treatments are standardized. When I showed up at the referral denstist's office for extraction, he didn't know I had HBO in advance, and he was very nervous about the situation, clearly greatly relieved to hear me say I'd already done the first 20 treatments.

    When he pulled this tooth (number 18) I bled ONLY TWO DROPS OF BLOOD! And the local anesthetic (novocaine with epinephrine) lasted 13 hours! It was mind-bogling how little blood flow there was to my jaw. I healed just fine, but it took months, not weeks.

    I'm not an expert at this, but my opinion is that this is is really not negotiable. There is no way to predict who will get ORN, but if you do, you are really pretty screwed. The treatment isn't something you want to do. Having said that, I know a couple of people who have been through extractions without HBO and have not had a problem. I'm not willing to chance that.

    Something they didn't warn me about before HBO: don't get your glasses changed during treatment. HBO changes your lense curvature temporarily. I had new glasses right before treatment. My vision went to hell during treatment and the re-refracted me and changed my lenses. Two months after treatment my vision returned to how it had been before treatment, and back to the old lenses I went.
  • D Lewis
    D Lewis Member Posts: 1,581 Member
    #14
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    longtermsurvivor said:

    Good question
    Here's how it was presented to me: my ENT oncologist stated clearly at the time of my radiation that if I ever needed teeth extracted I would need HBO. It wasn't ever NOT considered. I had standard radiation for BOT cancer.

    When I needed a molar extracted on the mandible, the local dentist wouldn't touch me. The ENT oncologist referred me, and I made my own arrangements for HBO locally. The treatments are standardized. When I showed up at the referral denstist's office for extraction, he didn't know I had HBO in advance, and he was very nervous about the situation, clearly greatly relieved to hear me say I'd already done the first 20 treatments.

    When he pulled this tooth (number 18) I bled ONLY TWO DROPS OF BLOOD! And the local anesthetic (novocaine with epinephrine) lasted 13 hours! It was mind-bogling how little blood flow there was to my jaw. I healed just fine, but it took months, not weeks.

    I'm not an expert at this, but my opinion is that this is is really not negotiable. There is no way to predict who will get ORN, but if you do, you are really pretty screwed. The treatment isn't something you want to do. Having said that, I know a couple of people who have been through extractions without HBO and have not had a problem. I'm not willing to chance that.

    Something they didn't warn me about before HBO: don't get your glasses changed during treatment. HBO changes your lense curvature temporarily. I had new glasses right before treatment. My vision went to hell during treatment and the re-refracted me and changed my lenses. Two months after treatment my vision returned to how it had been before treatment, and back to the old lenses I went.

    Thanks, Longtermsurvivor!
    This information is really helpful. My SCC was BOT also. I'm guessing that the radiation fields for BOT involve a lot more of the lower jawbone that the rads for other types of head neck cancers. I received all the same warnings about tooth care as you did.

    So far so good for me. I am midway through the replacement of a very shallow old filling with a crown, and I did notice that the novocaine took a long time to wear off. Also, I noticed that the needle stick area was swollen and uncomfortable for about a week before it subsided.

    Deb
  • caregiver99
    caregiver99 Member Posts: 27
    #15
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    fisrpotpe said:

    treatments
    my hygienist does not do fluoride treatments in the office, she does not think they are needed since i do my treatments at home 2-3 times a day.

    hbo is only done in hospitals, do not know where you live but for many years until 2007 they did not have the chambers in my town and the closest one was in chicago about 2 1/2 hours away. they are not cheep. i have had 6 teeth removed without hbo but 4 weeks of antibiotics and watched closely every week for 6 weeks for infection.

    i have x rays about once per year and check ups every 3 months, the amount of radiation is so very minor i have never been concerned.

    john

    thanks John
    Great info from everyone.
  • hawk711
    hawk711 Member Posts: 566
    #16
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    fisrpotpe said:

    treatments
    my hygienist does not do fluoride treatments in the office, she does not think they are needed since i do my treatments at home 2-3 times a day.

    hbo is only done in hospitals, do not know where you live but for many years until 2007 they did not have the chambers in my town and the closest one was in chicago about 2 1/2 hours away. they are not cheep. i have had 6 teeth removed without hbo but 4 weeks of antibiotics and watched closely every week for 6 weeks for infection.

    i have x rays about once per year and check ups every 3 months, the amount of radiation is so very minor i have never been concerned.

    john

    Question
    I just went to the dentist today and all is good for now. What is HBO????? Not really sure what you are all talking about.
    thanks,
    Steve
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #17
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    hawk711 said:

    Question
    I just went to the dentist today and all is good for now. What is HBO????? Not really sure what you are all talking about.
    thanks,
    Steve

    HBO
    is hyperbaric oxygen, delivered in a "dive chamber," just like recompression for treating the bends. It is useful in treating a number of medical conditions requiring supplemental oxygen, like diabetic leg ulders, and we people who have had radiation compromising our ability to heal following dental extraction.

    Pat
  • hawk711
    hawk711 Member Posts: 566
    #18
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    longtermsurvivor said:

    HBO
    is hyperbaric oxygen, delivered in a "dive chamber," just like recompression for treating the bends. It is useful in treating a number of medical conditions requiring supplemental oxygen, like diabetic leg ulders, and we people who have had radiation compromising our ability to heal following dental extraction.

    Pat

    Thank you Pat
    that is all good information to know.....thanks

    Steve

    P.S. My dentist said absolutely no "sweets" or sugar. It is the worst thing for us H&N survivors due to no or little saliva.
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #19
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    hawk711 said:

    Thank you Pat
    that is all good information to know.....thanks

    Steve

    P.S. My dentist said absolutely no "sweets" or sugar. It is the worst thing for us H&N survivors due to no or little saliva.

    Hoping you won't need to use this information
    But life is long, and I've learned that despite my best efforts to preserve my teeth, time is definitely an enemy following radiation.

    Best to you
  • ratface
    ratface Member Posts: 1,337 Member
    #20
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    longtermsurvivor said:

    Hoping you won't need to use this information
    But life is long, and I've learned that despite my best efforts to preserve my teeth, time is definitely an enemy following radiation.

    Best to you

    I had #19 removed post treatment , no HBO
    but it was a long fight with my dentist with negotiation back and forth and relationship building. We first tried an experimental extraction device using a rubber band and spring device with mixed results as he just could not get the right tension on it to pull for more than a couple of days. The issue with extraction is damage to the bone and healing. The spring was to be an alternative method with minimal damage over several months. It still has merit but maybe not at this location because of the angle required.

    My dentist told me that the bottom jaw bone is not as dense as the top and therefore absorbs less radiation. Also #19 was on the opposite side of my radiation field and received only 50 grey of radiation. My dental hygiene is excellent and my teeth were in very good shape. The point is that there are variables which would indicate, or not indicate, HBO treatment. I am not opposed to the treatment and would have undergone the HBO if my dentist insisted. In the end he removed the molar in his office with minimal damage and I healed almost normally. Consider location of extraction and level of radiation to that location.

    In my research for HBO chambers I found many hospitals with mono chambers available but found two locations with large chambers that could accommodate groups. You can also double down with a several hour wait in between and cut your days in half if practical. A tidbit of useless information is that head and neck patients who undergo HBO have a greater rate of success with dental implants than non radiated-non HBO patients which speaks to the effectiveness of the treatment.
  • longtermsurvivor
    longtermsurvivor Member Posts: 1,842 Member
    #21
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    ratface said:

    I had #19 removed post treatment , no HBO
    but it was a long fight with my dentist with negotiation back and forth and relationship building. We first tried an experimental extraction device using a rubber band and spring device with mixed results as he just could not get the right tension on it to pull for more than a couple of days. The issue with extraction is damage to the bone and healing. The spring was to be an alternative method with minimal damage over several months. It still has merit but maybe not at this location because of the angle required.

    My dentist told me that the bottom jaw bone is not as dense as the top and therefore absorbs less radiation. Also #19 was on the opposite side of my radiation field and received only 50 grey of radiation. My dental hygiene is excellent and my teeth were in very good shape. The point is that there are variables which would indicate, or not indicate, HBO treatment. I am not opposed to the treatment and would have undergone the HBO if my dentist insisted. In the end he removed the molar in his office with minimal damage and I healed almost normally. Consider location of extraction and level of radiation to that location.

    In my research for HBO chambers I found many hospitals with mono chambers available but found two locations with large chambers that could accommodate groups. You can also double down with a several hour wait in between and cut your days in half if practical. A tidbit of useless information is that head and neck patients who undergo HBO have a greater rate of success with dental implants than non radiated-non HBO patients which speaks to the effectiveness of the treatment.

    Mr. Ricky,
    You've clearly done a bunch of reading on HBO. I didn't know about the twice daily treatment. That would have saved me time when I went through it. Do you have a reference you could share?
    I'm likely to have to undergo HBO again next year, so I'm going to start getting prepared.

    Also, if I get a tooth extracted without HBO and just get "close follow-up," how do they decide when healing is faulty enough to warrant HBO intervention, post extraction? And am I taking additional risk by doing it this way as opposed to just going ahead in advance of extraction and getting the treatment?

    I have heard the implant thing from the dental hygienist at the dental school in St Louis. It's probably not for me as I've reabsorbed quite a bit of mandible since my original treatment 13 years ago.

    Hope things are going well for you.

    pat

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