Long-term impacts of head and neck radiation

Gazebo78

In January 2013, I was diagnosed with Stage 4b base tongue cancer.  I had an inoperable tumor and involvement of lymph nodes on both sides of my neck.  Tests proved my cancer was not HPV related.  So I underwent 7 weeks of Cisplatin along with 35 radiation treatments.  In July of that year I was declared cancer-free and just celebrated my 4th anniversary as such.  Yay!!  Having said that, I continue to struggle with all of the standard side effects - reduced saliva, loss of taste, trismus (I can open about 2 fingers wide), lymphodema (I never touch my face with a razor), restricted range of motion, muscle spasms, hypothyroidism (treated with meds), disfigurement of my carotid arteries (the vascular surgeon refers to them as "twisty"), anemia and declining dental health.  The last item is the reason for my current post.  Over the past 12 months, I have experienced a marked decline in my oral health.  Teeth are beginning to break (the top half of a lower molar broke off just above the gum line) or crack (multiple upper teeth with cracks and related cavities).  Fillings are falling out.  My gums are receding.  I have consistent low-level pain in my lower jaw.  I recently had to have 2 upper molars pulled due to severe deterioration.  The oral surgeon told me due to the risk of uncontrollable infection, he would not consider pulling any lower teeth if that became a problem unless I was approved for hyperbaric oxygen treatments.  Following the extractions, the lower jaw pain continued and my regular dentist subsequently refused to touch my mouth, even to fill cracks and treat minor cavities until cleared by my oncologist.  I returned to the radiation oncologist and he has scheduled me for an immediate PET scan.  If that rules out recurrence (here's hoping), he is thinking I may be suffering from osteoradionecrosis and will recommend starting hyperbaric oxygen therapy.  Can anyone share their experience with similar dental deterioration problems and actions taken to address the problems?  The oral surgeon spoke to me as if this could be a very challenging problem to get under control.  I have been more than blessed to have these years and while uncomfortable, all the symptoms I referenced above are a small price to pay for life.  Just looking for any helpful insights to be sure I am doing all I can to combat these new developments.

Thanks for your help!

Jim

 

SASH

HBO

Prior to treatment, Rad Onc wanted all molars and wisdom teeth pulled as they would be in direct line of radiation.  12 teeth pulled prior, and all were perfectly good with the exception of a single wisdom tooth that was slightly impacted and had minor decay.  Over the years since treatment, the balance of lower teeth would become loose or crack.  I went from zero cavities at time of treatment, to a multitued.  These were mainly on the lower teeth.  About 15 post radiation treatment I was down to 4 lower front teeth.  As you can imagine it was hard to chew food with just these teeth.  

I went to a referred Maxillary Facial Specialist that actually specializes in high risk oral surgeries after high dosages of radiation.  I went through 28 sessions on HBO prior to the remaining 4 teeth were surgiacally removed.  He also did some lower mandible work to flatten this out and remove any remaining pieces of roots that had broken off.  He at that time implated 4 posts to hold a pemanent denture.  Then 10 more HBO treatments for improved healing, meds to help with the healing, etc. 

5 months later another surgery to uncover the posts and do a skin graft from my thigh to help cover the exposed bone.  Then more heading until they started making the lower permanent denture.  Several months later this was installed and I am now approaching 1 year with this appliance which is helping with the chewing.

Mikemetz

The Gift That Keeps on Giving

My own battle with ORN started about 9 months after my radiation treatments, and sad to say, continues today--8 years later.  Mine was not about teeth, it was about the jaw bone on the treated side.  If you start to be told that your jaw bone is involved, let me know and I can fill you in on my experience.  I'll have to let others tell you about their problems with teeth and gums from radiation.

From my expereience with them, hyperbaric oxygen treatments are ineffective, expensive, and really time consuming.  The research on HBO for head/neck rads is very inconclusive, so be as informed as you can before making that decision.

mike

 

Gazebo78

HBO

Thanks for your insights.  The PET scan came back clear in the head/neck, although identified a potential remote trouble spot.  I will see what the oncoklogist says about next steps.  Thanks again for your input.