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Oral Radiation & Metal Fillings

rickmail9's picture
rickmail9
Posts: 6
Joined: May 2012

I was diagnosed and successfully treated for a SCC on the base of my tongue and tonsil wall about 3.5 years ago. I had 33 radiation treatments. About a year later, I had two molars extracted in the "ground zero" area of the radiation and promptly developed osteoradionecrosis. The ORN has made the cancer seem like a picnic. In September, I had about 4" of my lower left jaw cut out. Last week, I went to see a new ENT/Surgeon regarding a possible fibula flap procedure. After a 2.5 hour examination, the first thing he said to me was, "It is obvious that you have been exposed to excessive radiation."

Now here's the kicker: About half way through my radiation treatments, I mentioned to the technicians that I had a lot of pain all over the inside of my mouth. She had the on-site radiologist examine me and the doctor noticed the metal fillings I had in several of my molars. She said the radiation was being reflected all over my oral cavity by the fillings and ordered the techs/nurses to start softening wax and having me cover those teeth prior to my future treatments. The surgeon I saw last week says that by that time the damage was already done.

The ENT I saw last week is certain about the excessive radiation because all of my remaining teeth are dead. He said that shouldn't have happened. As a result of my jaw bone resection, my lower jaw has literally shifted about 1/4 of an inch to the left, so now my molars don't line up at all. He says that I can forget about eating normal food for the rest of my life as this can't be corrected. In addition, he thinks the ORN is now in my chin. I'm have a CT scan this week to confirm.

Have any of you had a similar experience?

Skiffin16's picture
Skiffin16
Posts: 8058
Joined: Sep 2009

I am pretty close to the same time frame as you and with similar treatment.

I finished up my Tx Jun2009, also ending with 35 rads sessions.

I have had a few fillings nad a crown, but the roots were still good, so no root canal.

I do have a root canal and crown from earlier though.

Going in to Tx, I did have quite a few fillings from over the years as well.

So far I'm not expereinceing the issues as you, and hopefully won't.

I can't really tell you if you were over radiated or not... If I remember correctly, I was somewhere in the area of 70Gy/7000Rads on the main side and 60Gr/6000Rads on the other.

I always forget the designations between Grays and Rads, but I'm sure you get the idea.

Anyways, I'm sure there's always a fine point between killing the cancer and quality of life or after effects.

Presumptions go toward killing the cancer and survival for the short term, and dealing with after effects later.

Best,
John

hwt's picture
hwt
Posts: 1848
Joined: Jun 2012

I was instructed to have all my old metal fillings removed and replaced before radiation ever began. My original cancer was of the lower jaw so I started my journey with removal of the lower jaw on left with fibula flap and majority of lower teeth pulled. I am now seeing the reconstructive dentist. He told me about the risks of OCN and his words were "if you get it, you will wish you had cancer back" so I know how serious it can be. Battled pain in a "good" upper tooth all weekend, have appt. this afternoon and am worried. Long & short of it, following surgery my bite was off and few lower teeth left were in front of top teeth. Thankfully, my dentist but braces on them for 10 days and was able to pull them close enough to the top teeth so I could chew. They would have been on longer but had to start rads. My surgeon was firm that I not start dental reconstruction til 6 mos. post tx. Now my new oral maxillofacial surgeon says if I had the work done before 6 mos. I would not have needed the HBOT. He said I never should have left the hospital without a dental prothesis. So who do you believe or trust? Oh yes, the doctor at the HBO cntr was alarmed that I had my surgery 1st then rads and chemo and not the reverse? I'm very sorry for the position you are in right now and think you will find the majority of us were told to have metal fillings removed before tx

rickmail9's picture
rickmail9
Posts: 6
Joined: May 2012

I'm 100% in agreement about "who do you believe?" I went to see a new surgeon about having the fibula flap procedure and he told me that the surgery I had at another teaching hospital in September was the wrong procedure, riddled with inexperience. I too have a serious problem now with my bite. My lower molars come up on the inside of my uppers. It makes chewing almost impossible. It did however spur me to find a great recipe for scrambled eggs! I'm going in on the 24th (this Monday) to let the new surgeon take out the titanium bar that the other surgeon put in back in September. Hopefully this will help. He's telling me that my bite should have never been this bad and that I essentially spent 12 weeks trying to recover from a procedure that should have never been performed. Now I'm missing about 3 inches of my lower left jaw as a result. So what do you do, sue? It's crazy. Thanks very much for your reply and I hope you continue to get better. Best wishes for a happy Christmas!

Rick

longtermsurvivor's picture
longtermsurvivor
Posts: 1768
Joined: Mar 2010

that so many clinicians practice this particular kind of one-upsmanship. There is lots of literature on ORN. None of that literature supports scatter from metal amalgam fillings as being a cause of ORN. It probably does cause surface burns, particularly on buccal mucosa. I have been radiated twice, for a total of 13800 rads. Hey John, to get grey you just divide by 10:) I haven't had ORN yet, and I am hoping not to. I have had significant mucosal burns, however, with this latest treatment. I wish you the best in treatment. ORN is a tough customer.

Pat

wolfen's picture
wolfen
Posts: 1176
Joined: Apr 2009

That is one of the most confusing issues I find when dealing with the many aspects of cancer. Who do you believe or trust?

Although my hubby has yet to start treatment due to waiting for MDA consults and further labs and CT, the teeth issue is one of the major concerns to him. He had already been told by an ENT, med onc, radiation onc, & oral surgeon to have many teeth pulled prior to radiation. Now the last dr., a surgical onc at MDA, says to hold off on getting the teeth pulled. Also, the first set of doctors say chemo & rad first(after teeth), followed by surgery, while the MDA doc says surgery first and we "may" pull all the teeth along with surgery. Evidently MDA uses a dental college as their consult. Is this a "training facility"? I declined their offer of a dental student or professor in favor of an established oral surgeon/jaw surgeon, hoping that it's the right way to go. But who knows?

As Rick says, there are NO second chances.

My best to each of you.

Luv,

Wolfen

lts's picture
lts
Posts: 75
Joined: Nov 2012

One metal filling left in mouth. My Onc did ask whether I had them or not. I will be wearing what felt like styrofoam mouth gaurds. They put them in my mouth on Friday when I had mask made.
He did mention, because of my age(43), there is a chance of getting cancer from rad treatment. Said it wouldn't be good. He also said he was on the fence wheather to adminster 30 or 33 treatments. What is the risk\benifit of 30 vs 33. Can 3 more treatments make that much difference either way?

Rick, I wish you the best.

Luke

AJW1966
Posts: 69
Joined: Nov 2012

just reading your post and thought i would toss my 2cents in.....yes i believe there is a difference between 30 and 33. Every single time your hit with rads it's an increase in damage which just takes longer to recover from. The longer the rads, the possibility of damage becoming more permanent is there.
I was also told that rads can cause secondary cancers. Not something i'm looking forward to.

longtermsurvivor's picture
longtermsurvivor
Posts: 1768
Joined: Mar 2010

are primarily sarcomas. This is not common enough to be of any real concern. To counter the concern about 33 treatments causing an increase in damage over 30 treatments, please remember that 33 treatments also gives a higher cure rate. That is the trade-off.

best

Pat

Skiffin16's picture
Skiffin16
Posts: 8058
Joined: Sep 2009

Like Pat mentioned, secondary cancers are always a possibility from rads..., But you have to survive the initial cancer treatment to be concerned.

Also, like mentioned, 35 is the protocul for a reason.., it's been proven and tested to be the most effective.

That doesn't mean you won't get similar results with less..., but at a higher risk of not getting the best possible outcome.

Now I don't know how update those proven results and tests are with HPV in the picture and slightly better cure rates.

There has been talk of less aggressive treatment for HPV derivied cancers, but I haven't really heard much, possibly too understudied to date.

For me if it's a matter of health and not being physically able to take the prescribed, that's one thing... If it's a guessing game on how much can I receive with the least long term effects, and still survive.

That's not a game I'm willing to play.

JG

CivilMatt's picture
CivilMatt
Posts: 2866
Joined: May 2012

Rick,

I was BOT and 1 lymph node left side of neck.

I had good teeth when I started and I have teeth now.

My rad onc actually asked for a call from my dentist before she would give me the green light for rads.

I have caps and fillings top and bottom, I did not have any pulled or recommended to be pulled. I used fluoride gel prior to rads and sometimes (not enough) now.

They had me put 4 dental rolls (2 top 2 bottom) in each time before rads.

I brush my teeth regularly, use Xylemelts throughout the day and night for moisture and worry about my teeth more than I use to. So far, so good.

I am sorry for your situation; the side effects of rads on the teeth seem to be all over the place. I wish you luck in figuring out what will work best for you.

Best,

Matt

Skiffin16's picture
Skiffin16
Posts: 8058
Joined: Sep 2009

I did have a check up before rads started, but never any mention of having my teeth pulled, or having any fillings drilled out and new ones put back in.

So far so good....

I'm going on four years post Tx and rads...

I have had a few cavities filled, and one crown. Other than that I haven't noticed or had anything else going on...

I do use flouride a few times a week...

But didn't have any additional aids or protection during the IMRT..

JG

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

I was told by both of my cancer docs plus an oral surgeon to have my 16 remaining teeth pulled (they were not in great condition) before radiation so that I would not have necrosis of the mandible. I had 120 HBO treatments to see if it would help my raspy throat. Then, a year or two later, I developed ORN. So, you tell me, do doctors know what they're talking about when it comes to cancer. I think not.

ErthWlkr
Posts: 23
Joined: Oct 2012

Hi Rick -
Sorry to hear about the issues you're having. I've often remarked to people that the disease was easy - the cure was incredibly difficult!

Prior to treatment, I was fitted for mouth guards that I had to use at every treatment. I was told it would prevent radiation from bouncing around in my mouth. I also was to use them for fluoride gel treatments - although the gel itself was unavailable to me. During treatment, the oncologist examined my mouth and felt there was some irritation developing from the treatment on the left side of my mouth. So he had me wet squares of gauze before every treatment and clamp down on them to avoid further irritation. This was in addition to the guards.

I did develop necrosis of my basal skull at the location of the tumor. This was nearly 4 years out. Hyperbaric oxygen (HBO)treatments were recommended - went thru 40 treatments over 6 weeks. The necrosis was halted and seems that there may be new tissue regeneration. Have these treatments been recommended to you?

Like others, haven't completely escaped dental issues. Half dozen cavities, two broken teeth repaired, two crowns. Ongoing observation by a dentist and hygienist...

- Jeff

hwt's picture
hwt
Posts: 1848
Joined: Jun 2012

Just returned from the dentist with a fresh root canal. Seems the radiation destroyed the nerve as there was no decay or cavity on the tooth itself. I finished tx almost 7 months ago. I guess it is unlikely to think this is going to be an isolated incident bit I am hoping.

SIRENAF42's picture
SIRENAF42
Posts: 204
Joined: Oct 2008

I had to have 4 teeth pulled that had the metal fillings in them I also wore a mouth piece to protect the gums and remaining teeth. They did not want to wait for me to have the silver fillings removed and the newer white fillings put in.. I am 4 years past treatment and have had no issues with any of my remaining teeth or gums (knock on wood).

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