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Teeth Removal

Time Bandit's picture
Time Bandit
Posts: 19
Joined: Dec 2013

My radiation and cemo treatment for neck cancer ended about a year ago and I’m now faced with another issue. I broke a tooth in December last year and was going to have it removed along with some other dental work this past January. I was going to start capping some teeth. Well my dentist did not want to pull the tooth and sent me to an oral surgeon. The surgeon became aware of the radiation and prescribed hyperbaric oxygen treatment before the removal. Well as the story goes, my dentist did a follow up tooth exam, as requested by the oral surgeon, and provided the report to the oral surgeon. I’m now told that because of the large filling in some of my teeth they want to remove all my teeth except for two in the bottom front to act as anchors for dentures. This seems a bit excessive. What do you think? Any advice?

debbiejeanne's picture
debbiejeanne
Posts: 2433
Joined: Jan 2010

i haven't reached that point yet so cannot comment on that but many others here have gone down that road and i'm sure they will chime in.  wishing you the best.

dj

HAWVET's picture
HAWVET
Posts: 318
Joined: Apr 2006

I have partials. I had a choice on some molars and chose to pull them out and replaced them with partials. If I had that choice now, I would not. I notified my dentist that my choice now is to keep on patching until it is necessary to pull them out.

I have capped some teeth and had fillings on some on more than one occasion.

There may be other opinions so hopefully you can make the right decision. There may be a difference in recommendation on partials vs complete replacement.

D Lewis's picture
D Lewis
Posts: 1533
Joined: Jan 2010

Every oral surgeon is going to have their own approach and their own interpretations.  I'm almost four years out from treatment now, and really got blasted with radiation in my jaw area while it was happening. The teeth are starting to have issues.

I saw a maxillofacial surgeon just a few weeks ago, to discuss a lost crown/shattered tooth, and whether that tooth should be removed.  I asked if I went ahead with hyperbaric treatments, whether I should just go ahead and have all the teeth removed at once, to save myself ongoing issues.  The answer was an emphatic NO. No removal of all teeth, and no removal of the shattered tooth.  The goal is to avoid extractions at all costs.

We are all at serious risk of getting Osteoradionecrosis, and apparently that is so nasty that very little can be done to help us after that happens. They will grind my shattered tooth down to the jawline and leave it there, as a last resort, but they say there are a few other options they can try first.  Right now, I've got a temporary crown on an artificially built-up base, and we're waiting to see if a permanent crown can be installed and if it will stay there.  eeek.

Good luck with your teeth, and keep us informed.

Deb

Mikemetz's picture
Mikemetz
Posts: 346
Joined: Nov 2011

Osteoradionecrosis (ORN) is not apparently nasty--it IS very nasty, and if it develops to be chronic, it's only a matter of time before you'll be looking at a jaw resection procedure.  Mine is May 1.

I am not up to date with all of the options for fixing dental problems, but I am not a fan of hyperbaric oxygen treatments, either.  Flip a coin on that one about what doctors will tell you and how well it might work.

As for ORN, I would urge everyone who's had rads on or near a jaw bone to be on constant watch for symptoms and be on top of any problems that might be ORN-related. 

mike

 

jim and i's picture
jim and i
Posts: 1627
Joined: May 2011

Well as in everything else with this disease, everyone is different. Jim was told before treatment that it depends on the health of the teeth. They pulled Joim's molars, more bridge than teeth. Now almost three years after treatment all his real teethe have crumbled away. We could not find a local dental surgeon to remove them and were told by insurance there were two in Orlando that took the medicare health. Jim hates going to Orlando so opted to do nothing. He is in hospice now so doesn't matter. Maybe you should get another opinion from an oral surgeon since like they said, everyone is different. Not much help but thats all I know.

Debbie

phrannie51's picture
phrannie51
Posts: 3728
Joined: Mar 2012

because you just finished the hyperbaric treatments, and they're thinking "might as well get them while his jaw is good"???  I mean, in order for you never to have to do the HBO treatments again?  And if that's the case, what's the point of holding on to two teeth, especially the two front ones which would be the weakest teeth in your mouth for anchoring??  Why not a full set of dentures?  I would think that within two years, those teeth will have loosened, and you'd be looking at full dentures.

Before I jumped into that big of "cure", I'd want the oral surgeon explain how he's thinking....and explain why have the two front teeth for anchors??

p

D Lewis's picture
D Lewis
Posts: 1533
Joined: Jan 2010

In our case, the two front teeth are not the weakest.  The two front teeth are pretty much completely out of the radiation field, and would be the ones most likely to survive over the long term.

Deb

ljoy's picture
ljoy
Posts: 85
Joined: Dec 2007

I had two lower mollars come loose four years after treatment for tonsil cancer. X-rays revealed osteoradionucrosis from radiation. Looking at the x-ray even I could see the damage. I had 30 HBOT treatments, then surgery to remove the teeth and debridment of the bone. then 10 additional HBOT's. It all healed very well and I have had no trouble since. I have several caps and large fillings as well. Two or three of them have been replaced since my cancer treatment.

My oral surgeon stated the secret is to make sure the debridment surgery gets down to bleeding bone. Leaving damaged bone will continue to cause problems.

My doctors have always said they prefer to save my teeth as long as possible. Annual x-rays show  my bone structure and teeth are in good condition. They should be able to evaluate your condition in the same manner. If nothing else, seek a second opinion. Be sure the doctor knows and has experience with ORN. My regular dentist did not recognize it when he referred me to an oral surgeon. I have since switched dentist's.

hwt's picture
hwt
Posts: 1935
Joined: Jun 2012

I would try to save what I had as long as I could. I'm w/Phrannie, why save just 2 as anchors? If those 2 hold up, why wouldn't the others? I did HBOT 30 days, just time consuming and expensive, not painful.

tommyodavey's picture
tommyodavey
Posts: 358
Joined: Nov 2011

I would see several Oral Surgeons before making a decision.  Does your OS specialize in Oral Cancer?  Mine does.  When I first got my cancer, the Head and Neck surgeon introduced me to his team of specialists.  My Rad Onc, ENT, and Oral Surgeon who gave me the go ahead w/o pulling any teeth.

 

That is a lot of work to your mouth.  Make sure you have all the facts and opinions of several surgeons.  Once you are convinced, acceptance will be easier.

 

I hope you can keep most of your teeth.

 

Tom

KB56's picture
KB56
Posts: 250
Joined: Apr 2013

time bandit, one of my biggest concerns was my teeth after all the radiation.  So far so good but I go to the dentist every quarter and use the fluoride tray nightly.  I would exhaust a evety  option before getting them pulled.   As others have advised, I would go to someone who is knowledgable about the radiation impacts to see if there are any other options.   I'm about 3 months behind you (June is a year for me) and last week I had to have a crown replaced.  i've had a lot of work done over the years and would really like to hold on to that "investment" as long as I possibly can.  

after reading the post on teeth after radiation, I may need to find a dentist that has experience as well.    Keep us posted on what you learn as this is key for several of us.  

 

Keith

Guzzle
Posts: 558
Joined: Mar 2014

From what I gather post treatment dentist can clean and do simple stuff but anything else must go to oral surgeon. Each NHS oncology hospital has staff of specialist dentists. I have my day with one of them and mask people next wed. I really want to keep my teeth!

Guzzle
Posts: 558
Joined: Mar 2014

Sorry should have said UK perspective.

fisrpotpe's picture
fisrpotpe
Posts: 1338
Joined: Aug 2010

i would not do it, i had two teeth pulled 3-4 years ago and now have ORN of the mandible. they tell me it is caused by radiation damage and by pulling them it gave to big an area to heal fast enough. 

now i have root canals when they start to get bad. down the road when the break off, they cut them off at gum line and mound them over. 

sometime soon i will be have the big jaw surgery and probably will be replaced with titainium. 

that being said you have to do what your comfortable doing. 

john 

Kelly_Scott's picture
Kelly_Scott
Posts: 6
Joined: Apr 2014

I had stg 4 tonsil cancer, spread into my lymph system. Neck dissection, rads, chemo. You know the drill. I'm 1.5 years out now.

Just finished having all my teeth removed two weeks ago. I'm young (45) but I'm a no-nonsense type of person. If there is a problem then I deal with it head on (so to speak). I couldn't stand the thought of continually having dental appointments with no real guarantee of anything except pain and misery to go along with it. My dental surgeon felt that hyperbaric TX was just not necessary because I'm very healthy otherwise and motivated to improve. We broke up the removals into several chunks (7-10 teeth at a time) to minimize the strain on me. It went quite well, though it did hurt.

I'm glad it's over and I can move on. Yeah, I miss my teeth but it's H&N cancer and that ***** isn't satisfied until you bleed for her.

BTW my surgeon also wanted me to consider anchor teeth but my concern was that I just wanted to get this done and move on. Full dentures can "float" without anchor teeth but for me it's worth the risk just knowing that I won't have to sit in another doctor's (dentist) chair. It's not a judgement call on anyone but sometimes I think people try to hold on too much to what their past lives were. I'm not the same person now as I was pre-cancer and my life has to be dealt with differently, choices are less 'gray' and it's just something I elect to deal directly with.

thennies61's picture
thennies61
Posts: 188
Joined: Jan 2014

During surgery they removed what was left of my teeth.Over the yrs was either losing them or had them pulled.Figured why I was out anyway to go ahead.When I seen my doctor yesterday he said after radiation he will send me to a denist that specializes in this.Have dentures made for my uppers with a thicker plate at the top which he said will help my thounge push the food down throat.

debbiejeanne's picture
debbiejeanne
Posts: 2433
Joined: Jan 2010

kelly, u definitely sound like a "no nonsense" kinda guy.  i haven't seen you here before so i just wanted to say welcome and we're glad to have you.  1.5 years out is a great milestone.  so gald to hear you are doing so well.    live on!!

dj

Time Bandit's picture
Time Bandit
Posts: 19
Joined: Dec 2013

Going for a second opnion but I have to wait for a time slot.

cardfreak
Posts: 2
Joined: Apr 2014

 I had head and neck cancer a very long time ago and due to the treatment had to have all of my teeth removed.. all 30 of them.  It required 20 weeks of hyberabric oxygen treatments(HOT), 5 days a week.  I then had the teeth removed waited 3 weeks and had to go back for another 20 weeks of HOT.  I walked around and went to work toothless during the last treatment session to ensure healing before I was able to get fitted for my new teeth.  All in all, I have to say that it was probably the best thing that happened to me and I miss my real teeth a lot less than the other things I lost due to treatment!  Now if my teeth hurt, which they never do, I just take them out!!  

I will be 20 years out from Stage IV - Grade IV in August of this year.

Everyone's experience will be unique but I am so glad I had my teeth removed!

Good Luck with what ever you chose!

thennies61's picture
thennies61
Posts: 188
Joined: Jan 2014

Had all mine removed during surgery.When talking to my surgen a couple of weeks ago he said as soon I'm done with radition he will set it up for me to have the new ones made. He what he will have the do is make partle thicker and that way it will help the tounge get the food down easier...

joannaw81
Posts: 110
Joined: Sep 2011

My mom finished radiation in February of 2011. She never removed her teeth prior to radiation as all of them were stable. Today she is going to remove all her bottom teeth as all of them are bad and not fixible due to radiation treatment. She is terrfied but teeth removal is far better than cancer.

Time Bandit's picture
Time Bandit
Posts: 19
Joined: Dec 2013

Much time has passed, Got a second opinion and it is down to three that were removed last Tuesday after 19 HBOT. All seems to be doing well except for eating and trying to keep my teeth clean of what food I can now chew. 

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