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Dental restoration post tx

donfoo's picture
donfoo
Posts: 1329
Joined: Dec 2012

You read often about the dental clearances pre treatment and suspect teeth being yanked. Ohter than daily dental hygene, you don't see much written about teeth post treatment.

How long do you wait?

What options are generally offered - bridges, implants?

Is it necessary to go to a dentist that specializes in working on oral cancer patients?

How many of you found new dentist that works with oral cancer patients?

 

Feel free to throw your own related questions in.Thanks

fishmanpa's picture
fishmanpa
Posts: 1134
Joined: Jan 2013

Foo,

I just went to my dentist last week for a cleaning and examination, 4 months post Tx. I don't really know his experience with OC patients but he seems to know what he's doing. He examined me and certified me radiation ready prior to treatment and was in communication with my team. He examined my mouth, felt around my neck etc. and did the cleaning. 

As of now, other than sensitivity in my teeth and gums to extreme hot and cold, I have no dental issues to be converned with. However, based on some of the horror stories I've read, I would seek an experienced dental professional experienced with H&N patients should I need serious work. There is one at Johns Hopkins. For now however, I'm confident in my dentists abilities.

"T"

hwt's picture
hwt
Posts: 2008
Joined: Jun 2012

I saw a specialist and was getting ready for implants when my recurrance hit. I did undergo 30 hyperbaric pressure chamber tx. They were expensive and time consuming (2 hours a day) but otherwise, uneventful. They are recommended with any serious dental work following the rads.

meaganb's picture
meaganb
Posts: 237
Joined: May 2012

I have wondered the same thing. I am only 28 & my teeth were in good shape before treatment so no need to pull any. I was scheduled to have an implant prior to treatment because of an adult tooth that never came in. I also have a crown on a front tooth because of an accident when I was younger. My dentist wants to replace the crown & do a crown lengthening because the crown was originally placed too close to bone & therefore causes inflammation in my gum. I had a cleaning last week & my dentist said that the biggest concern is non healing of bone. He said it happens in 1-2 percent of cases & usually on the bottom jaw. However, they won't do any work until my ENT signs off & my ENT said he doesn't know enough about it to give consent. So...I guess I'll talk to my RO next time I go. I have looked for  a dentist that is experienced in treating pts with radiation but have had no luck. Don, if you find out any more info, pass it my way!

denistd's picture
denistd
Posts: 517
Joined: Apr 2009

I am a little over 4 years post treatment, 35 rads. In late 2011 my teeth strated to break off at the gum line, in spite of extra heavy duty care. Rad onc said it is very common and nearly all H & N radiation patients patients will, at some time or another require serious dental work. I now have no teeth, had to eventually have all pulled. have been through HBO twice now. All now seems well, bottom jaw is fine and the dentures do their job, even if I do hate them. Not everybody will have problems but radiation can cause problems years after the fact. Denis

donfoo's picture
donfoo
Posts: 1329
Joined: Dec 2012

With cancer, going to the dentist takes a different path. I have read about hyperbaric oxygen treatments and also significant issues when considering implants. Also, as Denis remarks many of us are going to have more serious dental issues and more complicated fixes due to our cancer history.

Cancer barely slowed down my eating but the missing teeth cause most issues of all as it becomes harder to chew and find places where I don't jam food into my gum. That is the reason for getting some dental fix in place. 

But options may be more limited, especially this early into recovery and added costs to get those fixes in place. Then there is the consideration of spending big bucks only to have it all fall apart if the jawbone starts failing and other teeth start cracking off. Just another new twist cancer throws in the road ahead. Still glad to have that to worry about and not far less appealing alternatives.

Dentures comes up as an option, maybe partial dentures for those not losing teeth wholesale. Has anyone ventured to get implants post tx or other solutions to patch missing or failing teeth?

I'm assumming as long as the root is strong and solid, procedures such as root canals and crowns would likely not create any unusual concerns.

traceyd1
Posts: 36
Joined: Nov 2012

My husband is currently in the process of starting implants.  He had jaw cancer and had his right jaw removed on the right side in Feb. 2012.  He had radiation prior to his surgery, and all the implants are being done in bone and tissue that was never radiated, as this tissue and bone is from his leg and fibula.  His oral surgeon and head and neck surgeon are optimistic that he won't have any problems.  They also said that they wouldn't have recommended the implants if the bone and tissue implanted had ever been radiated.

As far as regular dental care, he gets 4 cleanings per year at our dentist's office.  We are lucky that our insurance pays for three cleanings per year.  We are beginning the fight to get insurance to pay for implants and keeping our fingers crossed.

Skiffin16's picture
Skiffin16
Posts: 8103
Joined: Sep 2009

It's always a hard sell for me to accept comments from an MD that says nearly all of patients will anything at one time or another, or eventually.

Even without radiation, nearly all of us will eventually have dental problems, that's a sure bet... Will some of us have either more issues or more severe issues, probably. But will all or nearly all of us have more issues, or more sever issues than eveyone not radiated, I'm not so sure or convinced as of yet.

I am also over four years post rads..., so far I haven't had any more issues than I ever have had.. That consists of one or two fillings a year (mainly old fillings needing re-filled), which I have had well before Tx.

I've also had a crown added, also not uncommon as I had two crowns and a root canal pre-Tx.

I guess time will tell...

JG

TracyLynn72's picture
TracyLynn72
Posts: 747
Joined: May 2013

two small cavities filled, a broken tooth pulled and a root canal/crown.  Yay me.  The dentist has to call my rads onc because he doesn't think that is all needed right now...It's too soon he says. 

lorig01
Posts: 69
Joined: Jul 2012

Hi.  My dentist did her internship at MD Anderson and understands the effects of radiation on teeth.  For me, she recommended all teeth out. My oral surgeon agreed. I have implanted dentures now and had the implants put in prior to radiation. The could only do 7 posts because of the field of radiaion.  It took a while to get used to but i am able to eat almost anythign and they look great.  I was really worried about dental work done after radiation and I have always been plagued with dental problems.  I used to have my teeth cleaned 4 times a year and I still had occasional crowns or fillings needed.  I think it is hereditary.  Anyway, I figured I might as well get all my dental costs done upfront :)  I have had really good luck witht he implanted dentures.  I would recommend them to anyone who is having treatment for head and neck cancer.  I have heard of some folks getting the implants after radiation.  Not sure about that. I am 1 year out from treatment of stage III tonsil cancer.

lorig01
Posts: 69
Joined: Jul 2012

I am in the Houston area. If anyone needs a dentist familiar with the effects of radiation treatment on teeth I can highly recommend Dr. Joan Marruffo at Medical Center Dental.  In addtion to creating outstanding dentures for me, she walked me through what to expect from radiation treatment and was a compassionate cheerleader throughout my cancer treatment. I think I learned more from her on what to expect than from all of my other doctors. I cannot speak highly enough of her. She was a "life saver".

donfoo's picture
donfoo
Posts: 1329
Joined: Dec 2012

Hi,

Your case seems quite unusal, to have all your teeth pulled and implants done before radiation. It seems most of us are overloaded just dealing with the direct cancer issues much less having the time and energy to go through with such extensive dental work. As is said here many times, each of our journies on the cancer road are unique so there must have been some circumstances that necessitated so much work and causing delay in radiation treatment due to dental recovery. don

Skiffin16's picture
Skiffin16
Posts: 8103
Joined: Sep 2009

I have known a few on here that also were told to have all of their teeth pulled prior to Tx... Definitely not the norm, but unfortunately not rare... I'm sure each had other things going on that led to that decision by their MD's..., or at least I hope so.

JG

lorig01
Posts: 69
Joined: Jul 2012

Actuallly I didn't need to delay my radiation. I had the neck dissection, tonsillectomy and all teeth removed and implants put in in one operation.  That worked well because I had pain relief and then I had to wait 3 weeks to start radiation. So no delay.   that way when I was "toothless" I was at home recovering frm cancer so it may the dental work more bearable, (with the radiation effects I really didn't care about my loss :)).  The one thing that irritates me is that insurance did not cover the costs. The only cost that was covered was the removal of the teeth.  I have always wondered why they pay for breast reconstruction for breat cancer but not dentures or implants for head and neck cancer.  Teeth actually serve a function, (to eat), whereas breast do not. I know some of the guys may disagree... :)

Duggie88's picture
Duggie88
Posts: 570
Joined: Feb 2010

2 1/2 years after radiation some of my bottom front teeth started breaking off. I ended up doing the hyperbaric thing and had four pulled (three already broke off). They seemed to rot from the inside out. They told me because of the radiation. Since they went bad while I was above ground I went for the denture thing because they told me my jaw would never survive the implants.

      Jeff

donfoo's picture
donfoo
Posts: 1329
Joined: Dec 2012

Hi Jeff,

Your story seems the most common for those that encounter radiation induced dental failures. Some teeth rot and fall out or break off then your jawbone is too compromised from the radition to hold up to implants which leaves dentures or bridge type devices. 

From a cost recovery standpoint, it seems dentures are more easily fought for and paid by insurance. It seems getting dental coverage to pick up implant work is more difficult and seemingly less that a 50/50 proposition.

I'm hoping to get some sort of improvement as the current situation is just in the tolerable zone for a "normal" person, maybe it is par for the course for the "abi-normal". 

janetluvsron's picture
janetluvsron
Posts: 108
Joined: May 2013

did anyone have dental advice as to what to do during rads?  before rads?

ron had to get flouride trays made and do daily flouride treatments to help protect the teeth.

they also got him a hydeo flosser, (kind of like a power water pic, pressure washer for the mouth)

just wondering if anyone did the flouride treatments daily , and have they had any problems.

janet

Skiffin16's picture
Skiffin16
Posts: 8103
Joined: Sep 2009

Janet, I think most on here were advised, or underwent some discussions concerning flouride. 

A lot of us did/do or are using flouride daily... I did for about a year, then tapered off to about once or twice a week as my saliva improved. Now maybe once a week or so... I have about 95% of my saliva back. Saliva (or lack of) I believe being one of the more important factor as for tooth decay.

But as for radiation damage, I'm pretty sure that flouride doesn't do much.

Just my thoughts anyways...

John

TracyLynn72's picture
TracyLynn72
Posts: 747
Joined: May 2013

Not one word about flouride was ever mentioned to me.  I ended up with 2 or 3 cavities after rads that were not there before :(

jim and i's picture
jim and i
Posts: 1685
Joined: May 2011

Does everyone have to have hyperbaric treatment before dental treatment? Does insurance cover this? Jim's teeth are crumbling but we do not have funds to go to dentist let alone hyperbaric. Does medicare cover these teeth problems because they are result of tx? I have many questions.

Debbie

debbiejeanne's picture
debbiejeanne
Posts: 2590
Joined: Jan 2010

deb, unfortunately from posts on here i think u will have 2 fight w/medicare to pay for that.  several people here have been thru it already.  i'm sure they'll give you more info.  good luck.

dj

hrowe
Posts: 51
Joined: Oct 2012

I'm 14 mo post tx. My teeth have shifted around by a few millimeters.

Had 4 crowns redone (some less than 5 years old) and had 2 root canals. Total cost $7K. All done by my general dentist. No issue with healing. He uses a laser on the gums where the crowns would sit.

My saliva is ~50% of normal.

I was going to get an extraction - tooth near front lower right. My rad onc recommended getting hyperbaric treatments if that was going to happen. He ordered some HBO and I saw the hyperbaric specialist who is an MD/DDS. She recommended 20 before extraction, do the extraction within one week of finishing those 20, and then 10 more after. Each treatment is 90 min which allows for pressurizing, saturation and depressurizing. My regular dentist said leave sleeping dogs lie. The tooth was an old crown that broke off (post tx) at the gum line and has had a root canal years ago. No abcess. So, he smoothed it out and filled the top. Not very noticable. Could I get by without the HBO? Yes, but the HBO reduces the risk factor of improper healing.

Implants are NOT recommended per the specialist. 50% chance of failure, that is the bone won't take and they could end up spinning. Problem is reduced blood flow into the bones due to the rads and if you need cadaver bone it, of course brings no blood flow to help heal everything.

donfoo's picture
donfoo
Posts: 1329
Joined: Dec 2012

Seems like a number of survivors have dental issues that require abi-normal and costly fixes. It does seem implants post tx for those who were radiated in the mouth area is a high risk ill-advised way to get teeth back in the mouth. That pretty much leaves dentures or bridge type devices. For those with a fair number of extracted teeth, dentures seem to be more common. What about those who have a tooth missing here and there but most still intact?

The whole hyperbaric chamber treatment seems pretty extreme and really costly if insurance does not pay which seems pretty iffy. For that matter seems many survivors shoulder the brunt of dental costs. Ironically, it seems getting the needed dental work done post tx can exceed the cost of the insurged cancer treatments.

Guess I need get a consult with a dentist who is experienced working on oral cancer survivors. 

Crazymom's picture
Crazymom
Posts: 318
Joined: Nov 2011

MD Anderson gave me a name of someone who would help with my dentistry.  He worked at MD Anderson for several years then mmoved out on his own.    I have spent over $20,000 on my teeth.  You need to get a name from your cancer center and go talk to someone.

 

Ann

denistd's picture
denistd
Posts: 517
Joined: Apr 2009

Hi Deb. I had some dental work before rads, medicare paid. After rads when things started to go bad, my radiation Onc wrote a letter for Medicare's review. My oral surgeon also wrote that extractions and HBO were medical necessities to preserve my jaw bone. Medicare paid everything 100%, there was no wrangling. I was told before rads started that I should look after my teeth. used biofene toothpaste 3, 4 times a day and fluoride trays. It staved things off for 2 years then teeth started to break, never had any pain just breakage. had some removed  (went through HBO for that) 8 months later he decided to remove the remainder, more HBO, right thing to do, both cosmetically and jaw wise. have had no trouble since. There is, however, a major obstacle that will be standing in everybody's way from here on in, Obamacare. Cutbacks are already happening across the board in healthcare, the days of regular scans, especially pets, is over, cutting hundreds of billons out of medicare is gutting it. If you have insurance through your employer or such, shock is about to set in. Insurance companies, in trying to contain the premium increases it would have to make have opted for reducing the benefits in the plan, you will be seeing more PA's in the future and appointments will become limited. Example, I saw my gastro guy (PA) in May, had to have tests, was told follow up appontment would be in November, all tests were ok. My wife had an endoscopy done for her GERD, her co-pay was $300, it used to be $100. I suggest that if you need to get things done, do it now before it gets worse. I was an HR director for 20 years and intimately involved in health insurance and such. Denis

jim and i's picture
jim and i
Posts: 1685
Joined: May 2011

Thanks Denis. I will get with Jim's oncologist for a recommendation to his medicare/insurance company.

Debbie

donfoo's picture
donfoo
Posts: 1329
Joined: Dec 2012

Ann,

I may as well go buy lotto tickets. It is so fortunate you had resources to get your dental work completd but for many I suspect a missing tooth in the gumline is going to have to do. Mine are all in the back so cosmetics is not an issue, just being able to chomp down on stuff like the old days without having to navigate the food around to a place where my gum does not get jammed.

Denis, 


I think it is fair to say this next year will be one of the most difficult ever in navigating the business of health insurance. Personally, I m treading water trying to buy as much time as I can as I have several options to pick through. Current insurance has been great but need to reup in the fall. OCare options maybe. Wife has plans at new job to choose from. The most sobering thing of them all is the out of pocket costs for sick folks like us generally pretty high. For 5 decades plus, I never spent more than a couple hundred out of pocket. With cancer, I can blow through thousand dollar bills with hardly a sneeze. Even having treatment costs behind me, the ongoing medical needs are just so much higher than a healthy person that costs for all this is having a major impact on personal budget. Kids in college adds more strain to boot. All said, sure better to be alive and ***** about it than the alternatives. lol

denistd's picture
denistd
Posts: 517
Joined: Apr 2009

Yeah Don, looks like lots of thinking has to to start. October 1 the exchanges open, but in truth they won't be ready. The exchange will offer 3 plans bronze. silver and gold, if you are of limited income you can apply for subsidies. You will see that new people here on the forum are not getting scans after treatment, mostly scopes and x-rays, maybe one Ct or two. That will be the new protocol as insurance comapanies start to get squeezed out of business. Dental costs have become utterly ridiculous with no real dental insurance available. I know my dental costs were astronomical, lucky that Medicare paid for it, but I fear the money won't be there to cover much in the coming years, you cannot reduce funding $800,000,000,000 (that's eight hundred billon, hope there's enough 0's there) over ten years and maintain the level of care we are used to. Pretty grim looking for our kids and grandkids.

jackflash22's picture
jackflash22
Posts: 331
Joined: Aug 2013

I have read so much about teeth as thats my biggest dread to lose my teeth. I've made sure they are in good nic before rad but still its not a guarantee I wont lose them. If the onc dentist removes them then he makes good after with dentures or whatever free of charge if I decide to not to have teeth removed before rad and at a later date my teeth rot I then have to go to my dentist. He's a private dentist but as I was a patient of his before he went private he kept me on for free. (NHS). I was a carer at the time looking after my mother full time and had to give up work so I'm glad he took pity on me. I,ve been with him many years and feel at ease with him he's never hurt me doing work on my teeth. I saw him today and the first thing he did was to pull up a chair and ask me about my op, said how he feels for his patients when something like this happens he then checked my teeth filed a pointed tooth a little because it caught the scarring in my mouth where the tongue flap was taken from. He then recommended Duraphat 5000ppm floride toothpaste to be used sparingly for the time I needed it. He even let me have it for half the cost and apologised for having to charge for it. I feel sorry that your costs are so high, I believe from what my sister tells me (shes now an American citizen) that medicare costs the earth if you can afford it otherwise you have to pay for doc and dentist in full. She has a good insurance plan as her husband was military and now she has medicare or something but because she has such a good insurance everytime she goes to the docs they find something wrong with her sell her drugs via insurance then a year down the line tell her she didn't have that wrong with her but now because of that she needs more drugs and so on. They put a pacemaker in her then two years later said she didn't need it. I'm not knocking your system as I expect not all docs are like that (yes, she has changed docs)  A lot of people knock our NHS but I find its great and has been for all my family. They got on my case as soon as I was diagnosed. Reading all the posts on this site everyone has a very good team of doctors.

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