Nutrition after tooth extraction, several years post radiation for BOT Cancer.

Larry449

I need to have a tooth pulled and a root canal on another tooth (RC shouldn’t matter). Since my radiation, which was four years ago, my main nutrition comes from 2 large smoothies, 4 total servings daily. Now I’m reading that after extraction I should avoid using straws, and avoid seeds. One of my smoothies has blueberries (a gazillion tiny seeds) and pumpkin seeds. Other smoothie calls for oats, also to be avoided. I’m looking for substitutes if anyone has any. Then, reading other posts on this forum about the possible need for HBOT. It’s been 4 years and two months since my last radiation treatment, is this going to be something to consider? I do have a follow up appointment with my ENT five days before my scheduled extraction so I’ll be running it by him, too.

wbcgaruss

Hi, Larry, sorry you need an extraction and a root canal.

Getting extractions and toothwork is something we H&N people do not look forward to because of previous radiation.

Depending on how close to the jawbone and the level of exposure, radiation can eliminate blood vessels in the bone and diminish the blood flow needed for healing after an extraction.

Hopefully, your dentist and your radiation doc are working together on this, and your dentist understands the risk of Osteoradionecrosis.

https://oralcancerfoundation.org/complications/osteoradionecrosis/

Larry, take this seriously, and if you can get the HBOT, do not pass it up. I took the HBOT because I wanted every advantage I could get to avoid any post-extraction Issues.

I had 30 dives pre-extraction and 10 follow-up after the extraction, of which I only took 6 or 7 because the HBOT treatment was starting to affect my vision.

There is also another method being used now, and it involves taking pills, but you must be able to swallow the pills because they are time-released, so if you have difficulty swallowing pills that won't work.

But just so you know about it and you can run it by your oral surgeon and radiation doc, it is called…

The use of pentoxifylline, tocopherol and clodronate in the management of osteoradionecrosis of the jaws

https://www.thegreenjournal.com/article/S0167-8140(20)31253-6/abstract

New approach for the treatment of osteoradionecrosis with pentoxifylline and tocopherol

https://biomaterialsres.biomedcentral.com/articles/10.1186/2055-7124-18-13

Pentoxifylline – a review of its use in osteoradionecrosis

https://www.sciencedirect.com/science/article/abs/pii/S026643561630715X

Taking these medications before extraction is supposed to increase blood flow to improve healing and eliminate problems.

If you can do these medications or HBOT it is good insurance against problems.

My oral surgeon had me get HBOT but said I would not get it again pre-extraction because I think if you get it once it will repair and sometimes create new areas of blood flow in the bone but apparently the repair and blood flow that happens is not enhanced with more HBOT later on, a sort of you get what you get in that one time run of HBOT.

The last extraction I had, I did not get anything beforehand, but certainly prayed on it a lot. I was going to get the pentoxifylline and tocopherol, but found out I could not grind the pills up, and no one was sure if they would be effective at all, ground up, because they are then not time-released anymore. I grind my meds I take and mix with applesauce. The only pill I can swallow is the small thyroid pill I take; all others are too risky of getting stuck.

I am not trying to alarm you with this, but just be as careful as you can and take every advantage you can.

As far as recipes, I have some for you. I will post below, and I hope all this helps you through this situation.

First off is a reminder of Boost VHC ( Very High Calorie ), it is 530 calories per 8-ounce container. I always had top buy this online because the only VHC I could find in the local stores was regular and less calories.

I recently bought a case and Hey Med Supply has the best price but it is still rather expensive but your health has to be taken care of…

https://heymedsupply.com/oral-supplement-boost-very-high-calorie-very-vanilla-flavor-ready-to-use-8-oz-carton-00043900894348-case-24/

Below are recipes, etc. of what people came up with, and most of these are off the forum…

ByeByeCancersays:

Benecalorie

I wanted to comment on what I used for my husband when he was going through all of this (6 years ago). He had a tough time swallowing food, but he, like your husband, wanted to try and keep eating on his own. So, I found a product called Benecalorie on Amazon. It is a 1.5-oz container of liquid that has 330 calories and 7 grams of protein.I would buy the 24-pack and add them to his smoothies, Boost drinks, and there was a time or two when he just drank the benecalorie by itself in one swallow. "Easy" calories in one gulp.

Here is a link to the Benecalorie on Amazon.https://amzn.to/3PC75Y6

~Sandra

Also, here is a weight gain recipe that 2 ladies shared that I found a long time ago related to cancer and gaining weight afterward--

Deb,

So sorry I’ve taken so long to get that recipe for your dad! I checked with our nurses and here it is:

1 box (3.4oz) of instant pudding
3/4 cup half & halfcream
1/2 cup of water
1 cup of Carnation evaporated milk(use canned, not powdered, etc.)

Mix together in a bowl, then mix with a mixer for one minute until it begins to thicken. This recipe makes 4 servings. We use it to help individuals we serve who are underweight to assist in gaining weight. As you can see…it is very rich and full of calories. Let us know how your dad is doing!

• These Recipes and Tips are from Debbiel0 on CSN H&N Section

And here is another communication shared recently with me by a lady on this forum concerning weight gain after cancer treatment, and I am sure she would be glad if I would share it--

• Coffee cream ( 18%) 1 cup 480 calories
• Coconut milk 1/3 cup 150 calories
• Greek-style yogurt 1 cup 270 cal
• 2 tbsp Ground Flaxseed 100 cal
• 3 tbsp Hemp Hearts 170 cal
• 1 tsp nut butter 100 cal
• 1 tsp honey 100 cal
• banana 80 cal.

I would mix all of the above into a shake for my husband. It makes about 3 - 3 1/2 cups and 1300 calories. He would sip on it all day. Then we would make him soft eggs or oatmeal to top off the calories for the day. Jello or pudding and ice cream are also other foods to slide down.

Using coffee cream when making soups or sauces, cooking oatmeal in it, and using it for puddings. It is an easy way to boost calorie intake. The Hemp Hearts and ground Flax can be expensive. If you have access to Costco, they are reasonably priced there. ( at least in Canada is the way it is)

Use honey as much as you can in tea or coffee, or just in warm water.

I think the best advice I got from our nutritionist was to think outside the box and add cream or Greek yogurt to whatever you can think of. Throw in a couple of tbsps of flax or hemp seeds to soups, your boost, or hot cereal cooked in heavy cream. Mashed potatoes with heavy cream and lots of gooey gravy are always good,well-balanced too.

Hope some of these ideas help. Another well-balanced change from Boost is Soylent. I can't remember the calorie count, but it is a very good meal replacement.

I know I am kind of rambling... but I hope some of these ideas help,or at least give you a variety. It is hard to get excited for a meal that is the same as the last one!

Split pea soup and baked beans with honey are great for calories..

The flaxseed and hemo hearts don't change the taste all that much, just a way to sneak another 100 calories in. I had never ventured into that type of food either. My daughter-in-law is super healthy, and introduced me ( young ones, ya know!)

Almond butter or cashew butter is just another alternative to peanut butter. Change up the taste a bit.

I have a long list of food allergies: no dairy, no cheese, no chocolate, so finding calories was really tough for me. For example, Geekyogurt can be up to 270 calories, whereas my non-dairy yogurt is 60 calories. So, when my husband was going through his treatment, it was actually fun for me to keep finding new things to make for him. Cheese is another good source of calories; melt it and add it to soup or potatoes.

Flyinhigh says:

Highcalorie

I use a powdered mix from GNC called 1340.  If you followed their mixing instructions and used 4 large scoops with water, and supposedly get 1340 calories.  I mix it half or third strength with 12 oz. of milk and figure I get 500-600 calories, plus a lot of protein.  You can try this, and if you don't like it or can't tolerate it, GNC will take it back and refund your money. It comes in vanilla, chocolate, or strawberry(my favorite).

Grandmax4says:

calorie

I used a drink called Scandishake, bought through Amazon. It's really good, I can't remember the calorie and protein. I made it with crushed ice and milk in a blender, delicious

Drivingdaisysays:

Drinks

Only drank Orgain, organic, and a small amount of natural sugar. Decided no more chemicals in my body. I just poured it into my feeding tube. I still drink it, but the plant is plant-based. Became lactose-intolerant.  Good stuff. I'm more of a naturalist, but to each their own. Going on 4 yrs NED, so I did something right.

Suzj says:

if you want tomix it up..

If you get the urge to mix it up, go with a high Protein Boost, mixed with a Carnation Instant Breakfast, and a few scoops of ice cream - that'll up your calories

Here's my radiologist's recipe. You can change the flavors by finding a substitute for peanut butter, using a different fruit, or a flavored yogurt. These are mixed by my better half in a Vitamix machine.

1 cup ice cream

1 cup Greek (or any full-fat) yogurt

Pack of Carnation instant breakfast

1/3 cup peanut butter

1 banana

Milk to thin to the right consistency

Larry, wishing you the very best here and will pray for a great outcome and smooth recovery from the extraction with quick positive healing.

Wishing You The Best

Take Care, God Bless
Russ

Take Care, God Bless

Russ

Larry449

https://csn.cancer.org/discussion/comment/1725037#Comment_1725037

Well Russ, you definitely gave me some suggestions. I’ll need to go thru them again to find what I can use. Basically, the very thing causes the problem tries to prevent you from treating it! I thought I was doing ok maintaining things, but ?? As for my smoothies, I could leave seeds, etc. out and supplement them with Boost, although from past experience if I drink them daily for more than a few days they tend to give me bad indigestion. HBOT: never heard of it. I’ll be investigating that. Do you know if it’s covered by Medicare? I’ve already been overloading my credit cards for lack of dental insurance. I will see my ENT next Wednesday, an already scheduled follow up appointment. (And I’m getting real close to the end of visits. He normally releases patients after 5 years.) The Radiation Onc. on the other hand has been out of the picture for three years since her practice lost its lease and got evicted. She moved to, I don’t really know but I still wouldn’t go back to her if she was still here - long story but basically I felt like she didn’t seem to know about anything beyond the doors of her office and a big argument about COVID vaccines. Like I said, long story. Almost forgot, the pills you mentioned: How big are they? Depending on how big they are I may or my not (if they’re too big) be able to swallow them. I regularly take time release Tylenol (arthritis strength) and right now the dentist has me taking amoxicillin tabs that are roughly 1/4” wide by 7/8” long! I really worried about them but so far they’ve gone down ok - with a large enough gulp of water!
(Edit: I’ve looked up the three pills in question. They shouldn’t be a problem as they’re smaller than some pills I’m already taking. I also check into my Drugs.com app to check interactions, two are ok but Clondrenate doesn’t register on drugs.com. )
Thanx once again.

wbcgaruss

Hello, John, I know I gave you quite a bit but I will go over your response and try to simplify everything I can.

You are right, the very thing that causes the problem tries to prevent you from treating it and that is why if you can get any edge on the situation to help avoid problems.

Hence, why I mentioned the HBOT and the pill regimen to increase blood flow.

To my knowledge, they either do one or the other, not both together.

Probably the best thing would be to have the HBOT for this time and the pentoxifylline, tocopherol, and clodronate at another time if needed.

Since you never heard of HBOT, I will post and paste some links and such so you can read about it, and there are plenty of videos out there to watch also.

Whatever you do be sure to get your ears cleaned before you start a run of HBOT because it can cause issues and possibly pain as the chamber you are in is operated.

It is not difficult; I slept through many of them.

I am on Medicare, and it was covered for me, but I also have an additional Medicare Advantage Plan that we pay for, so I am not sure if it was covered by Medicare or both plans.

You are going to have to research it because Medicare covers non-healing after the fact, many times, but you will be getting this pre-extraction before the tooth is pulled and follow-up treatments thereafter.

All my HBOT appointments were set up with my oral surgeon and were given at the health campus where I had my cancer treatment.

Please keep in mind that there are many small independent HBOT centers that many times do not charge as much and are sort of a family atmosphere.

HBOT Explained Hyperbaric Oxygen Therapy

Johns Hopkins

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hyperbaric-oxygen-therapy

12 Facts About Hyperbaric Oxygen Therapy: Answers to Your Top HBOT Questions

https://thedearingclinic.com/post/hyperbaric-oxygen-therapy

Videos

How does hyperbaric oxygen therapy work?

https://www.youtube.com/watch?v=6XFx35whGns

HBOT 101: An Introduction To Hyperbaric Oxygen Therapy

https://www.youtube.com/watch?v=E-RNRF7V_Z8

As far as eating and drinking and indigestion, among other things is I found out from my experience and others of the H&N community that we just have to adapt and deal with things as they happen because it seems our bodies and situations are totally different from a non-cancer treated person. It can be a challenge. Upset stomach, take Rolaids or Alka-Seltzer.

As far as tooth maintenance on our mouths with brushing, etc., we can only do so much. We are dealing with a radiated area and decreased saliva for many people, which is a big factor in oral and tooth health.

There is a certain amount of this left to chance.

For instance, I follow my Dental Hygienist's instructions and go for regular checkups every 6 months.

I floss and brush in the morning and use Act Drymouth Mouthwash as instructed by the hygienist for 30 seconds minimum. I brush after every meal and clean between my teeth with one of those small plastic fuzzy type things like a pick to be sure no food is left in there. At night, before bed, I brush again and follow that up with a higher fluoride toothpaste just to coat my teeth overnight to help prevent cavities it is called Denta 5000 and has to be prescribed by your dentist.

I am doing all I can within reason, but the idea is to save them as long as you can while fighting treatment leftovers and the aging process.

The Amoxicillin you are taking is good for you, it will get rid of any infection before the extraction, which is good to have, no infection present if possible.

Looks like you have checked out the pills and you can probably swallow them, but my opinion would be to consider the HBOT First and the pills for any successive treatment needed, but it is your decision only to know what's best for you.

If I can help further, or I missed something please let me know.

Wishing You The Best

Take Care, God Bless

Russ

Larry449

https://csn.cancer.org/discussion/comment/1725038#Comment_1725038

https://csn.cancer.org/discussion/comment/1725051#Comment_1725051

Hey Russ, Here’s my problem right now: First, my radiation oncologist is no longer in the picture. Her entire facility was evicted from the property by the medical company(?) that owned it. That was in April 2022. I’d had a follow up appointment on 4/24/22 but they called the week before to say all future appointments were cancelled! No further details as to where to go, etc. (I’m glad I was done with my radiation, there were quite a few who weren’t) Apparently she is practicing about 45 miles away, we had some - I’ll call them disagreements, long story - so I will not go back to her. I also have no idea of the strength of the radiation, all I knew was ‘radiation’. If that’s a factor I don’t know how to find out.

Second: Both my ENT (who diagnosed me) and my dentist are closed on Friday so I can’t reach either until Monday. I have a follow up appointment with my ENT on Wednesday and my dental work is scheduled for November 10, five days later. Doesn’t leave much time to arrange HBOT. In the meantime, my teeth *hurt! Gotta do something. The only encouraging thing I could find during more digging down the rabbit hole is that surgical extractions are more likely to cause problems than simple extractions. Mine will be (should be) a simple extraction. I’m also having a root canal on tooth # 26 which is lower front center. Yup, I also see that RCs can cause similar problems but this one is so small… I don’t know, maybe that doesn’t matter. My dentist knows I had the radiation so hopefully he’s taken it into consideration although he didn’t mention it. I will call his office first thing Monday morning and see if I can talk to him and run all this by him. Again, I do have the appointment with my ENT on Wednesday. See what, if anything he has to say.
Tnx, Larry.

wbcgaruss

OK, Larry, I understand, a lot of factors are playing in here where there are no answers, and your timeline to do any HBOT or Pills is not there.

If you ever have a future event you can plan for, I would give myself every benefit and edge I could.

In the meanttime, I think you will do fine with a simple extraction and root canal.

The dentist should be able to tell you if you have good blood flow when he pulls the tooth.

You can't always plan in this head and neck game.

I too, onetime had to have a tooth pulled right away and could not wait because I was sore and in pain, and the jaw on the side of my face was swollen up because of the bad tooth, so out it had to come, and thankfully it healed well with no problems.

I am Wishing You The Best

Take Care, God Bless

Russ

Larry449

https://csn.cancer.org/discussion/comment/1725056#Comment_1725056

Good morning Russ, I spoke to my dentist this morning about my concerns about Osteoradionecrosis. Before I even said the word he knew where I was headed and decided we should put the extraction on hold. He’s not worried about the root canal on the front tooth so that’ll be done next Monday and we’ll reassess the molar and if need be, he’ll refer me to an oral surgeon and also talked about HBOT. In the mean time he’s sending a prescription to my pharmacy for Clindamysin (stronger than the Amoxicillin I’m on now). He also agreed that I should run it by my ENT when I see him on Wednesday.
Thanx once more for your help,
Larry.

wbcgaruss

Well, Larry, what a turn of events.

I am so glad for you.

This sounds like you are going to a dentist who is in the know and has dedication and loving concern for his patients.

I believe this is the best possible alternative to give you every edge you can get in this.

Between your dentist, your ENT, and your oral surgeon, you are in good care.

I am so glad your dentist saw the red flag and is getting you more in depth care to be as careful as possible..

The Clindamysin will take care of any tooth infection while you and your team decide your course of treatment.

John, the reason I stress is that people use every advantage they can to eliminate healing problems. The chance of Osteoradionecrosis is because once the tooth is pulled, that is it. If you haven't done HBOT or Antibiotics, you are at where you are at; no extra help was done. If Someone has issues with healing. There are several things that can be tried, but if the process, such as debriding the jawbone, does not work to solve the healing issue, it can be a major problem.

That major problem is jawbone replacement, and that is why I stress giving yourself every advantage you can.

That does not mean it is guaranteed to have no issues or be a success. There are people who have done the HBOT or meds and still ended up with problems, but that percentage is very small, so as I say, it's not guaranteed, but you are giving yourself every advantage.

There are people on our forum who have dealt with this.

This is why I am so happy to hear your dentist is going the extra mile to help ensure your success.

As many of us you are a Blessed Man Larry

Wishing You The Best

Take Care, God Bless

Russ

Larry449

https://csn.cancer.org/discussion/comment/1725082#Comment_1725082

Russ, it’s been a few days so here’s where I’m at now. I have a my first appointment with the oral surgeon tomorrow. One of the things I will be mentioning if he doesn’t mention it first is that on another forum (actually chatGPT which my daughter says is unethical) I’ve read that while ORN is somewhat rare with odds that run from 2 to 28%, a root canal can reduce those odds to less than 1%. The tooth in question isn’t really that bad. It does have a crown that I’ve always thought was too high (if that makes sense). That’s why I went with extraction in the first place, and of course the cost difference,so I thought just get it out! But, if the oral surgeon agrees maybe I’ll go that route instead. Whatever, I’ll take his advice. Oh, by the way I contacted the medical group my RO was at and they sent whatever records they had. Unfortunately they didn’t list the strength of the radiation. I did track down the RO at her new group, gave her a call and while she couldn’t give me the exact strength said for my 31 rad treatments it would’ve been between 6000 and 7000 centigrays (60 to 70 Gy?) so at least I can let the dental docs know. I’ll know more after tomorrow.

Larry

wbcgaruss

Hi Larry, you are correct ORN is somewhat rare with odds that run from 2 to 28%. But you want to avoid it and take all possible steps to do so because it is a big deal.

I believe they can save a tooth and let it in if they can do a root canal.

The last tooth I had to have pulled, they tried a root canal on, but the root canal was so narrow that it broke off the root canal tool in it, and I had to have it pulled.

It seems you have been gathering information and making connections with previous medical groups and doctors, and are quite prepared for any situation in this instance, and are working with an oral surgeon.

I believe you are quite prepared for this as much as you can be, and I commend you for doing all you can to prepare for this.

I have a good feeling about this for a positive outcome.

Thanks for continuing to keep us updated.

Wishing You The Best

Take Care, God Bless

Russ

NEGU (Never Ever Give Up)