Tooth pain

Jsmale

My husband has developed tooth pain 8 months after radiation therapy for tonsil cancer. I have a call in to the dentist...anyone else experience this?

wbcgaruss

This Could Be

A regular tooth problem such as an abscessed tooth or cavity, etc, a regular dental problem.
If more than one tooth it still could be a regular dental problem.
Get to your dentist and make sure he is aware of the radiation and cancer treatment.
He may even want to contact your cancer team and find out the amount, strength, and the field of coverage of the radiation.
He can do an examination and see if he can find what is going on.
I would definitely recommend he get a complete set of X-rays done at this time.
I think between the exam and the X-rays your dentist will be able to figure out what is going on.
Don't forget even though we had cancer and treatments we are still subject to all the average troubles in life.

If your husband needs an extraction you may definitely want to consider HBOT (Hyperbaric Oxygen Therapy) therapy first before the extraction.
And your dentist may want to send him to an oral surgeon who is experienced with H&N cancer patients.
My dentist knows of my radiation treatment and sent me to an oral surgeon for my last extraction.
The oral surgeon highly recommended HBOT before the extraction.
I told him ahhh just pull the tooth.
He had been in touch with my rad doc and knew the radiation field I had and this concerned him greatly.
He emphasized this with me by his explanation, concerns, and demeanor letting me know this should not be taken lightly because if ORN sets in it can ruin a portion of the jawbone and would require me to go to Philadelphia for an operation where they take a bone fron another part of the body and repair the jawbone with it.
So I took his advice and got the HBOT before the extraction of 30 treatments before the extraction and 10 afterwards except I stopped at 6 afterward because it was affecting my vision too much.
My jaw was sore and swelled from the bad tooth but I took penicillin antibiotics which took the soreness, swelling, and infection away and bought me time till I got my HBOT treatments in and got the tooth extracted..
We people that had H&N radiation have to be very aware of the possibility of Ostenodenecrosis (ORN) literally bone death.
I am not trying to alarm you but just make you aware this affects us the rest of our life and we have to be very careful about our dental care and maintenance.

Essentially, the radiation destroys some of the very small blood vessels within the bone. These blood vessels carry both nutrients and oxygen to the living bone. A reduction in these vessels correlates to a reduction in the bone’s ability to heal itself.

All patients who require extraction of teeth in a previously irradiated field should be considered at risk of developing osteoradionecrosis.

Here is a link to an article from the Oral Cancer Foundation explaining it very well--
https://oralcancerfoundation.org/complications/osteoradionecrosis/

Here is a link about HBOT  https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hyperbaric-oxygen-therapy

So let me say your husband may just need a tooth repair or something minor but I just want you to be aware and cautious that you handle his dental care with extreme caution and confer with your radiation doctor about his fields of radiation and his ideas on your husband's dental care.
His radiation fields may not be in an area where there is any concern and he can always go ahead and get any regular care without concern but you will have to check because each person's treatment plan is and was different.
This is another example of radiation the gift that keeps on giving.
Believe me, I didn't want to get HBOT but the risk of not getting it outweighed my balking at it.

I hope this info helps.

Wishing You The Best-Take Care-God Bless-Russ

 

 

 

 

 

 

 

Jsmale

wbcgaruss said:

This Could Be

A regular tooth problem such as an abscessed tooth or cavity, etc, a regular dental problem.
If more than one tooth it still could be a regular dental problem.
Get to your dentist and make sure he is aware of the radiation and cancer treatment.
He may even want to contact your cancer team and find out the amount, strength, and the field of coverage of the radiation.
He can do an examination and see if he can find what is going on.
I would definitely recommend he get a complete set of X-rays done at this time.
I think between the exam and the X-rays your dentist will be able to figure out what is going on.
Don't forget even though we had cancer and treatments we are still subject to all the average troubles in life.

If your husband needs an extraction you may definitely want to consider HBOT (Hyperbaric Oxygen Therapy) therapy first before the extraction.
And your dentist may want to send him to an oral surgeon who is experienced with H&N cancer patients.
My dentist knows of my radiation treatment and sent me to an oral surgeon for my last extraction.
The oral surgeon highly recommended HBOT before the extraction.
I told him ahhh just pull the tooth.
He had been in touch with my rad doc and knew the radiation field I had and this concerned him greatly.
He emphasized this with me by his explanation, concerns, and demeanor letting me know this should not be taken lightly because if ORN sets in it can ruin a portion of the jawbone and would require me to go to Philadelphia for an operation where they take a bone fron another part of the body and repair the jawbone with it.
So I took his advice and got the HBOT before the extraction of 30 treatments before the extraction and 10 afterwards except I stopped at 6 afterward because it was affecting my vision too much.
My jaw was sore and swelled from the bad tooth but I took penicillin antibiotics which took the soreness, swelling, and infection away and bought me time till I got my HBOT treatments in and got the tooth extracted..
We people that had H&N radiation have to be very aware of the possibility of Ostenodenecrosis (ORN) literally bone death.
I am not trying to alarm you but just make you aware this affects us the rest of our life and we have to be very careful about our dental care and maintenance.

Essentially, the radiation destroys some of the very small blood vessels within the bone. These blood vessels carry both nutrients and oxygen to the living bone. A reduction in these vessels correlates to a reduction in the bone’s ability to heal itself.

All patients who require extraction of teeth in a previously irradiated field should be considered at risk of developing osteoradionecrosis.

Here is a link to an article from the Oral Cancer Foundation explaining it very well--
https://oralcancerfoundation.org/complications/osteoradionecrosis/

Here is a link about HBOT  https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hyperbaric-oxygen-therapy

So let me say your husband may just need a tooth repair or something minor but I just want you to be aware and cautious that you handle his dental care with extreme caution and confer with your radiation doctor about his fields of radiation and his ideas on your husband's dental care.
His radiation fields may not be in an area where there is any concern and he can always go ahead and get any regular care without concern but you will have to check because each person's treatment plan is and was different.
This is another example of radiation the gift that keeps on giving.
Believe me, I didn't want to get HBOT but the risk of not getting it outweighed my balking at it.

I hope this info helps.

Wishing You The Best-Take Care-God Bless-Russ

 

 

 

 

 

 

 

Thank you! I am aware of the

Thank you! I am aware of the seriousness teeth problems can cause. Great to know about the hyperbaric chamber! Will see the dentist next week and go from there! Thanks for taking the time to reply

wbcgaruss

Jsmale said:

Thank you! I am aware of the

Thank you! I am aware of the seriousness teeth problems can cause. Great to know about the hyperbaric chamber! Will see the dentist next week and go from there! Thanks for taking the time to reply

You Are

Very Welcome
Wishing You The Best-Take Care-God Bless-Russ

Remington25

Dentist 4x per year

I was told to see my dentist 4x per year vs 2x per year.  I have my 3rd appointment since completing radiation tomorrow and the previous 2 are looking good.  I do the flouride treatments most evenings and have about 50% saliva but it is sticky.  Best to keep in frequent contact with your dentist IMO.

FOMC

HBOT and Medicare

JUST NOW got off the Chat Line with the Medicare folks about whether or not they would cover the treatments.  They will cover between $145-$150 of the cost per session (IF the provider is a Medicare participant) which means you most likely will be on the hook for whatever the difference is (total cost and deductible)  The Medical Code for the procedure is 99183 in the event you need to reference it

 

Jerry

Logan51

Great

information, Jerry. Being FT-dependent, I found the clause in the Medicare Coverage Book that covers the Jevity I pour down my tube and used it with my Provider to make it easier for them to get it Medicare approved.

As for the pain, sorry to hear. I was in the Dental Surgeon's chair around 8 months after tx finished to get a tooth pulled. The Oral Surgeon saw my C information, called the Rad Dr., and said I could not get the tooth extracted. That became one of 3 Root Canals I've had post-tx. Good luck.

Fireman

Tooth Pain

wbcgaruss is right on with his comments. I'm one of those unfortunate people who developed Osteoradionecrosis of the jaw after a dentist pulled a tooth on the radiated side for tonsil cancer. This was done 7 years post radiation. I was told by my ENT to see an oral surgeon but my HMO would only approve a dentist who said he had experience with cancer patients and assured me things would be fine. How wrong he was. ORN can be incapacitating and cause debillitating pain. 6 years after my diagnosis of ORN and being relatively pain free, I went to my oral surgeon because a piece of dead bone had worked it's way into my cheek on the irradiated side. After taking an Xray he discovered my jaw had developed a pathologic fracture. I am now set to have a vascularized fibular graft from my leg to my jaw. The surgery I'm being told will last from 10 to 12 hours with a lenghty rehab period after that. See an oral surgeon who has experience and expertise dealing with post radiated cancer patients and not the neighborhood dentist.

wbcgaruss

Thank You Fireman

For sharing your situation.
I am sorry you have to go through this and wish you the best of outcomes.
I thank you for sharing because this highlights that this is not something to be taken lightly by post-radiated H&N patients.
As I stated earlier I was not serious about it and told the oral surgeon to just go ahead and pull the tooth, figured I would take my chances.
He wanted me to get HBOT (Hyperbaric Oxygen Therapy) to increase healing and lessen my risk.
But he strongly urged me to reconsider and that it was a very serious matter and if I didn't want the HBOT treatment and just got the tooth pulled he had a raft of paperwork for me to sign.
I assume to show he strongly urged the HBOT treatment and I refused it.
He also said if you get Osteoradionecrosis I am then going to have to send you to Philadelphia, PA for an operation like Fireman is facing.
I am glad I have an oral surgeon who cares so much for the welfare of his patients and impressed that on me.
So I took his advice and got the HBOT.
HBOT does not guarantee that you will not have problems but decreases your risk greatly.
But This is the only treatment I am aware of to help avoid Osteoradionecrosis.
I am thankful I had a good outcome and a concerned and caring physician.
SO PEOPLE PLEASE BE AWARE OF THIS AND DON'T TAKE IT LIGHTLY.
Below is are links on HBOT and Osteoradionecrosis.

https://hyperbaricsorlando.com/hyperbaric-oxygen-therapy-and-osteoradionecrosis/

https://www.virginiamason.org/osteoradionecrosis

 

 

 

 

Mikemetz

From experience, I totally agree with Fireman--have them also check for ORN. You can check yourself for signs of in-mouth lesions and exposed bone.

mike