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Teeth extractions after radiation

fredrailling
Posts: 8
Joined: Feb 2013

My wife completed radiation and chemo 2 yrs ago for throat cancer. The cancer is gone but now her teeth are breaking off at the gum line. She has 2 front teeth on the bottom broke off and another tooth is about ready to break off. Her radiation Dr. said if the has her teeth extracted she should have Hyperbaric Oxygen Therapy.  We were advised that our ins. would not cover this and the therapy would require daily treatments and a long drive everyday. She is considering just getting the 3 teeth extracted without the HBOT. Any help out there???

 

longtermsurvivor's picture
longtermsurvivor
Posts: 1830
Joined: Mar 2010

The reason HBO is recommended is to prevent osteoradionecrosis, a complication you absolutely DO NOT WANT.  Several on the board can tell you of their first hand experiences with this.  I would push poke and prod away at the insurance coverage for HBO.  You are not in a hurry; you need to have all your ducks in a row before tackling this.  Generally the noncoverage happens because of factors that can be handled, with appropriate modifications of submitted diagnoses, and/or appeals within the insurance process.  Start with the people who would do the HBO for you; typically they have a lot of experience with tweeking the diagnostic codes to help you out.  Failing insurance qualification, consider applying for Medicare.  Mine covered the expected portion of HBO (which is very expensive), leaving  me with something under $1000 of bills.

 

best to you.

 

Pat

fredrailling
Posts: 8
Joined: Feb 2013

Thanks Pat. We signed up last year to go on a cruise, and wouldn't you know it, her teeth started breaking off. She needs to maybe able to get something done cosmetically until she can arrange to have the HBOT. She is very headstrong though. She had one pulled last year not knowing the consequences, and it healed ok. She is like. I had one pulled and it was ok without the HBOT. and it was ok. But I tell you when she told her radiation Dr. He about fell out of his chair.

ljoy's picture
ljoy
Posts: 88
Joined: Dec 2007

My insurance paid for my HBO treatments because it was medical and a result of my tosil cancer treatment.  I would advise not having the teeth pulled without HBO first. The radiation has damaged circulation in the bone and it may not heal. I had 30 treatments before surgery and 10 after to remove to lower jaw teeth. It all healed fine. I had to drive an hour and a half each way every day. You should try and find an oral surgeon that is familiar with radition treatment side effects.

Hope this helps.

 

fredrailling
Posts: 8
Joined: Feb 2013

Thanks ljoy, This supports what Pat said. She is very disappointed with the prospects of this. But I don't believe she has any real options.

Billie67's picture
Billie67
Posts: 834
Joined: Jul 2012

I would have to say your wife got unusually lucky in not having any problems with her last extraction. I have to assume that the dentist who did the extraction must not have known about your wife's medical history because it is not recommended that that type of procedure is done without HBOT. I worked in the dental field for many years and we would have never done an extraction or other bone related surgery on anyone with history of H&N cancer if they hadn't had HBOT. That being said, she should try and find an oral surgeon who works closely with oncologists.

She really should NOT go ahead with these other extractions without the HBOT because her chances of getting lucky again are not great.

If you appeal the insurance companies decision and have your onc write an explanation you may get the procedure covered. It is medically necessary! Maybe they are not aware of your history without being reminded of it. As
mentioned earlier in another post, it is very expensive and insurance
companies certainly are not going to approve it for just anyone.

Have your wife be patient and get all of her ducks in a row before making a decision that might not be the best thing.

Billie67's picture
Billie67
Posts: 834
Joined: Jul 2012

None of what I am saying is intended to scare you, just info for you to consider.
Good luck with everything.
What treatment centers are you near?

Billie

fredrailling
Posts: 8
Joined: Feb 2013

Thanks for your comments Billie you have been very helpful. Probably Baptist treatment center in Brentwood Tn. about 55mins. from here. not a bad drive. south nashville. I would not have to drive through Nashville or go downtown. Nashvilles traffic conjestion is terrible.

Duggie88's picture
Duggie88
Posts: 556
Joined: Feb 2010

Fred I agree with all the above, I had the pleasure of going through radiation and then lossing my four bottom front teeth with them breaking off at the gum line just last year. I didn't take a chance, I went through the Hyperbaric treatments 20 before the extractions and 10 afterwards. Because of the radiation I wasn't a candidate for inplants so I was fitted for a plate last year at which time I told my dentist all I want for Christmas is my four front teeth. I didn't get my new teeth untill mid January but the good news is I no longer have to tell people I play ice hockey.

As for the insurance, I am a trustee for a pension and health and welfare fund and hear appeals once a month. Given the fact the hyperbaric treatments are medically neccessary I would move or vote to have them covered. Many times people want these treatments for a quicker healing process only making it the reason they are denied. I would definately appeal her demial with testimony either in person or written from her doctor(s)

 

Enjoy the day.............I do...........every one of them

      Jeff

fredrailling
Posts: 8
Joined: Feb 2013

Thanks Jeff, these comments are very helpful maybe not what she wants to hear but what she needs to. Again thanks.

fisrpotpe's picture
fisrpotpe
Posts: 1343
Joined: Aug 2010

i had my treatments 17 years ago. i have had not 5 teeth removed over the last 4-5 years. none of them have been with HBO. my oral surgeon at Indiana University does not believe in the need to have HBO if there is just a little or no infection. all we did was a big antibiotic for 2 weeks and review and kept watch approx every ten days for almost two months and then checked every three months a couple times. the healing was slow but did not have a problem. 

have you doc's used durning treatment send paper work to insurance to request HBO approval if you going to do HBO. i know several who have been approved this way. 

a close friend locally who was tossed the same as you with doing or not doing HBO. he decided to go HBO and had some problems with ears and hearing after approx 5 treatment and stopped them. it's been two months now and has had no problems. he has a very slight amount of infection at the time or removal.

good luck with your choice

john 

 

fredrailling
Posts: 8
Joined: Feb 2013

Thanks John. I suggested to her she gets further consultation with an oral surgeon referred by her radiation Dr.

Ingrid K's picture
Ingrid K
Posts: 811
Joined: Mar 2011

Please ask your doctor or HBO office to resubmit to your insurance carrier.  Sometimes things just need to re-coded in order to pass.  The HBO treatments are MANDATORY to prevent future major issues with jawbone deterioration and complete failure. 

Even if your wife did not have the HBO in the past, she was very lucky the extraction did not cause a problem....yet.

The treatments themselves are not at all painful...just time consuming.  It will be well worth the struggle now to get the treatments.  If your dentist is not insisting on them, find another dentist who is experienced in radiated patients.  Like billie says, radiated patients have special needs to address.

wishing you both the best of luck.

 

Duggie88's picture
Duggie88
Posts: 556
Joined: Feb 2010

Fred

After HBO and the extractions I can truely say I never healed so fast in my life. I had them pulled in the morning (same day huricane Sandy hit) and by night fall I had no pain at all. And I was even looking forward to the pain pills for dinner. My oral surgeon check me two weeks later and was really pleased with how fast I healed.

 

Pursue the appeal. Good luck

 

Take care

hwt's picture
hwt
Posts: 1987
Joined: Jun 2012

I am currently doing HBOT. My 1st insurance company approved the tx but before I got started my husband's retirement plan switched insurance carriers. I lost 6 weeks waiting because the 1st place I was going to get tx did not have the right billing codes in their computer to move forward. I got frustrated and called another hospital and started my tx three days later with insurance approval. I was very fortunate to have two places with chambers within 10 miles from my house. Tell your wife there is no pain in the chamber just a dull and boring 2 hours a day. Very time consuming and then if travel is involved all the more time and expense. I was told not to risk having my dental work done without it. I agree with Pat.

fredrailling
Posts: 8
Joined: Feb 2013

Thanks we will have an hour one way drive to the nearest chamber. Lots to look into.

 

fredrailling
Posts: 8
Joined: Feb 2013

Thanks Ingrid. We definitely need to get further consultation.

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

Had my teeth extracted in 2004 prior to radiation.  Had 120 HBO treatments starting in 2009 to help with throat rawness.  Developed ORN in 2011 AFTER 120 HBO's.  Had 4 more HBO's after the mandible graft and it still failed.  Thankfully, I was fully covered by insurance but, to me, alot of time was just wasted inside that chamber.

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