Dental restoration post tx

donfoo
donfoo Member Posts: 1,771 Member

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

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Comments

  • fishmanpa
    fishmanpa Member Posts: 1,227 Member
    So Far

    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
    hwt Member Posts: 2,328 Member
    fishmanpa said:

    So Far

    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"

    Don

    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
    meaganb Member Posts: 244 Member
    I have wondered the same

    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
    denistd Member Posts: 597
    meaganb said:

    I have wondered the same

    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!

    Teeth

    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
    donfoo Member Posts: 1,771 Member
    New criteria for certain

    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.

  • Skiffin16
    Skiffin16 Member Posts: 8,305 Member
    Nearly All... ~ Hard Sell

    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
    TracyLynn72 Member Posts: 839
    Currently I need...

    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
    lorig01 Member Posts: 83
    Teeth

    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
    lorig01 Member Posts: 83
    lorig01 said:

    Teeth

    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.

    By the way

    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
    donfoo Member Posts: 1,771 Member
    lorig01 said:

    Teeth

    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.

    that was radical

    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
    Skiffin16 Member Posts: 8,305 Member
    donfoo said:

    that was radical

    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

    Yanked...

    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

  • Duggie88
    Duggie88 Member Posts: 760 Member
    Don

    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

  • traceyd1
    traceyd1 Member Posts: 79 Member
    donfoo said:

    New criteria for certain

    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.

    Dental Implants

    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.

  • donfoo
    donfoo Member Posts: 1,771 Member
    Duggie88 said:

    Don

    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

    common story

    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
    janetluvsron Member Posts: 116
    did anyone have dental advice

    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

  • jim and i
    jim and i Member Posts: 1,788 Member
    hyperbaric treatment

    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
    debbiejeanne Member Posts: 3,102 Member
    jim and i said:

    hyperbaric treatment

    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

    deb, unfortunately from posts

    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

  • Skiffin16
    Skiffin16 Member Posts: 8,305 Member

    did anyone have dental advice

    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

    Flouride

    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
    TracyLynn72 Member Posts: 839
    Skiffin16 said:

    Flouride

    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

    Flouride

    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 :(

  • lorig01
    lorig01 Member Posts: 83
    donfoo said:

    that was radical

    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

    Not that bad

    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... :)