Tooth decay post tx

My rad onc said teeth do not care about radiation but they do care about saliva. Problems I ran into post tx (I had supraglottic SCC into a few lymph nodes) which I finished June 12th of last year, are my teeth shifted around by a few mm here and there. I've had 4 crowns replaced because they no longer sealed properly and I had 2 root canals from decay

Plauque builds up much quicker even with a water pick . Imperative to keep the gums clean. I get my teeth cleaned every 3 - 4 mo instead of the usually 6.

My saliva has gotten much better over the last 6 months. Eating is fairly normal now though I never leave home without a water bottle. May 60% of normal?

Skiffin16 said:

Don ~ Correct...

Don, I'm surprised this is the first you have heard of this...

It's actually two separate problems, both caused by radiation...dry mouth due to radiation zapping salivary glands, and deminished blood flow through the lower jaw also due to radiation damage. 

The dry mouth can cause tooth decay, which in turn can cause teeth to prematurely having to be extracted. Once extracted, there's a real possibility of infection and lack of the ability of healing due to low blood flow through the lower jaw, which was also caused from radiaion.

Not everyone has it, or enough that it has caused damage... But more than likely over the long haul, you'll be affected to some degree..

Myself I haven't had issues with any excessive damage or decay to date and I'm nearly five years out.

Several others much further out post Tx are also doing well. A few have even had extractions and they healed up fine..., a few have also had HBO to aid in healing.

Best,

John

Just finished getting a ton of cavities filled, Most affected teeth had 2 each. As I understand it, they are called root cavities and not the same as your everyday enamel cavity. they are up at the gum line. I noticed a dark spot and thought the gum was receding so I went to the dentist even though my 6 mo. check-up was still a month away. I also have trays. Lack of saliva was my culprit. Was told sugar ok to eat but never in any type of drop or candy that sits in your mouth to dissolve. Make sure those are all sugar free. Treating these root cavities was not as extreme as regular cavities. I think I had 9 in 5 top teeth and it took a little less than 2 hours to do those, then I had the lower ones done the following week. Bye, bye to another $1000+   

jtl said:

pH

Not only does the amount of saliva decrease the pH also decreases from the normal of about 7 to 5 which you remember from chemistry class means it has gone from neutral to acidic.  I actually checked my saliva shortly after the end of rads and it was less than 5.  I had a pH meter but an easy test is to purchase some litmus paper if anyone really is interested.  We must all be deligent about oral care.  I use Sensodyne with Novamin toothpaste because it has some fluoride and the Novamin is a remineralization agent that repairs the damage from acidic saliva.  You can purchase Sensodyne just about anywhere but unfortunately the product with Novamin is not sold in the U.S.  However you can purchase it online and it ships from the UK.  My wife just returned from a trip to Canada so she brought some back.

Good point on mentioning fluoride...

Again, taht's one of the main reasoning for added fluoride treating during and after rads... To hopefully lessen the chances of decay caused by lack of saliva...

They all interact, radiation damage, lack of saliva, tooth decay, compromised healing, etc...

John

donfoo said:

various kinds available

Hi,

I tried to remember the brand but it eludes me. I googled around and this one seems quite similar: Essentia. The main things were "high pH and electrolyte bottled water". I found it at a couple typical places - local health store and even my local Safeway had it. The pH is 9.5 so much higher than most.

What happened to me was even plain water was somewhat unpleasant and slightly burned during radiation. I was mixing up lots of the soda/salt solution and that was pretty soothing. Acidic foods were really burning so I wondered if alkaline solids and liquid would be easier to ingest. 

I experimented with adding baking soda to water to get the pH up but it just tasted really bad so the search was on for bottled water with 9+ pH alkaline and there it was.

It seems marketed more for the electrolytic properties and I did zero investigation into whether it had any valid benefits other than it was more soothing to drink, so any other claims would need to be researched. Good luck, don 

I found the Essensia water at my corner Food Lion.  Besides being 9.5 ph, it has added electrolytes.  His blood tests showed that he was very low on his electrolytes, so this should work good.  Thanks for the info on this.

Cindy

fisrpotpe said:

causes

causes can be many for tooth decay

- radiation, breaks down the enamal

- drymouth

- poor cleaning

- lack of flossing

- most of all i believe it is lack of focus of cleaning the gum line

i have had problems since approx. 6 months post treatement back in 1996, the dentist where not as knowledgeable then as they are now, so not enough focus was on cleaning back then. 

- another problem that i have learned over the years is that flouride trays can be a problem. they tend to make people feel if they use them they will be fine. the problem i have experienced over time is they do not focus on the gum line. when i stopped trays about 10 years ago i began to have less problems. they told me to use my sonicare tooth brush with flouride and focus on gum line at about a 45 degree angle. i wish i had done this from day one

another i have picked up and dentist have even shared, there comes a point no matter what you do they break down. 

my thoughts are, there is no real cause.... just the best thing to do is keep them clean and when you think your are doing well keeping them clean, clean them more. 

john 

Yes you are all correct about the saliva (or lack thereof) and meticulous cleaning necessary post radiation treatment.  However there are those of us who despite all of the treatments who will still have problems.  I was one of those.  6 years post radiation I finally had to have all remaining teeth extracted..had been having fillings, root canals, crowns, etc.  Repeatedly!  I was fine for 5 more years until we discovered that osteoradionecrosis set in.  Hyperbaric treatments, oral heavy duty antibiotics and I've antibiotics for months couldn't delay the inevitable...I had mandible reconstruction in September by fibula free flap.  The pain during recovery us NOTHING  compared to what I felt for the 10 months prior to surgery.  Just throwing the idea out there.  By the way...there are many more of us SURVIVORS nowadays...we are living longer thanks to earlier detection and treatment so there are more of us having post treatment issues...just know that when the radiation doc says "such and such MAYhappen" it probably will....but at least we are ALIVE!