Early gum disease pre-chemo/rad: best to extract some or all teeth?
This is my first post. Thank you in advance for taking the time to read this. My 54-year-old SO has base of tongue HPV+ cancer and an affected lymph node on the right side of the neck. Need to decide how many teeth to extract. Yesterday was his oral surgery consult. He has early gum disease and a mouth full of fillings. A minimum of 10 molars need to go, mostly from the right side. The question is, is it worth keeping the rest so he can not only eat (sort of) but also retain some sense of who he is? We realize this will be a lifelong commitment to cleanings and fluoride treatments every 4 months with the increased risk of those teeth needing to go at some point later. Or is it best to just remove them all now and pave the way for a brand new set of full dentures? The thought of having no teeth for a year or so is quite difficult for him to imagine. It should also be noted that he has no health or dental insurance. He has been denied medicaid in the past but that was before his diagnosis so maybe he can qualify now? I don’t know. Anyway, he is being treated at Cook County hospital in Chicago. All of this is happening so fast. Is it possible for them to smooth everything down at the time of the extractions so that when chemo-radiation treatments are done and he is healed, he’ll be ready for dentures? Or will there still be more oral surgeries and procedures (and pain and risk of complications) anyway to be done before he can be fitted? The goal is to minimize the number of procedures, his risk for complications, and either keep teeth, or get dentures in his mouth ASAP. He has a call in to the oral surgeon to ask all these questions, but he needs to decide what to do by Monday. Today is Friday. Any input would be much appreciated. If I left an important detail out, let me know. Thank you all again.
Cristina
Comments
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Everyone is different
Hi Cristiina,
Sorry to hear about you SO's diagnosis and gum disease. There are several members on here that have had dental issues. Hopefully they will chime in soon. I get what you're asking, but do you know for a fact that he'll need dentures eventually? And how long is it until eventually arrives? Everyone is different, and just like everything in medicine, dentistry has greatly improved, so maybe the gum disease can be haulted. I have no idea, but I think dentists these days are far more interested in keeping original equipent. By the way, it may just be the way you wrote it but fluoride treatments will be lifelong, but every single day.
If I had a smile like your SO's I think I'd want to keep it as long as possible.
Best of luck to you both!
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Thank you ERomanO for your
Thank you ERomanO for your response. We don't know for a fact he'll need dentures eventually, but both of his parents have them, he's had soft teeth and dental issues his whole life, and we just figure 7 weeks of radiation treatments might be the thing that seals the deal. From what I've read on the forum (and heard from the docs), it just seems that dental problems become much worse after radiation. The message we have received from the docs is that it's best to avoid any tooth extractions post-radiation, so if leaving "problem" teeth in place is asking for trouble, then maybe going for full dentures now is the most practical move. I don't know....I don't know. This is such an awful decision to make, as I'm sure you all know too well. Thanks again.
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Tough decision
I have no particular words of wisdom. When I was first diagnosed with cancer of my salivary gland and was told chemo and radiation were necessary, the rad oncologist did not give me an option - he told me my teeth had to come out. Had 33 rad treatments initially and can understand why he did this. Fortunately, I had a great prosthodontist and after I healed up, she was able to make a great set of dentures. Two years later I had to have part of my jaw removed and had another 30 rads. She then made the necessary changes to the dentures. The teeth look good and I was able to eat whatever I wanted.
I hope you don't have to lose them (original issue is always best) but if you do, search out a good prosthodontist and let him/her work their magic. As to payment, you might want to check with your local ACS office or dental society. They may be able to point you in the right direction to get some help. Good luck.
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Risk Factors
Christina...I'm glad you found this site...there may not be time for much input to your original question, but site will be a help going forward. There are folks here who were fitted with some sort of dental guard to wear as protection during radiation. This option was not mentioned to my husband, and he developed bad sores from radiation bouncing off filling onto his tongue. If SO decides to keep teeth, inquire about the dental guard. After radiation, an extraction is serious, and folks talk about hyperbaric treatments which I'm sure are expensive. Your goal, as you say, is to minimize procedures and risk of complications, so eventual need for extraction may be the biggest risk factor to take into account. The decision your SO has to make in short time is incredibly difficult, and my heart goes out to you - you can stay strong and get through this. (My husband is a handsome bald biker, with same diagnosis as your SO).
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I understannd your dilamma,Cristina347 said:Thank you ERomanO for your
Thank you ERomanO for your response. We don't know for a fact he'll need dentures eventually, but both of his parents have them, he's had soft teeth and dental issues his whole life, and we just figure 7 weeks of radiation treatments might be the thing that seals the deal. From what I've read on the forum (and heard from the docs), it just seems that dental problems become much worse after radiation. The message we have received from the docs is that it's best to avoid any tooth extractions post-radiation, so if leaving "problem" teeth in place is asking for trouble, then maybe going for full dentures now is the most practical move. I don't know....I don't know. This is such an awful decision to make, as I'm sure you all know too well. Thanks again.
I understannd your dilemma, and that is a diffiult decision for sure. Even if you don't know for a fact that dentures are inevitable, you are forced to play the odds.
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Check With Your Radiation Docs
If you are getting radiation close to or on the jawbone it damages the blood flow in the bone. This creates problems healing because of less blood flow. If you have radiation and it affects your jawbone enough you should probably have HBOT (Hyperbaric Oxygen Therapy) before and some follow up after your procedure.
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hyperbaric-oxygen-therapy
If your blood flow is affected enough and you don't you may end up dealing with osteoradionecrosis (ORN) which a fellow in our local support group had and needed to have part of his jawbone replaced because it wouldn't heal. I have read others on here have had it I believe Mike Metz that posts on here had it and they had to have a fibula used to replace a bad part of their jawbone that was affected by it.
https://oralcancerfoundation.org/complications/osteoradionecrosis/
This is not to scare you but to let you know to ask enough questions.
If you are going to need HBOT I had recently had to have a tooth pulled that was infected and my face all swelled up so it was an emergency and I could not have had the HBOT even if I would have needed it, the tooth needed pulled right away and luckily the dental surgeon said I had good blood flow that he could see when he pulled it so I wouldn't need HBOT. But I called the local cancer center where I had my treatments and checked with my radiologist and the HBOT center there and they told me recently medicare had changed rulings on it and in my situation it would not be covered. I believe she said it would cost me $10,000 a week but they don't do out of pocket customers at the campus and she would refer me to a private business that does it and does it and does it much cheaper. That is why some people are buying their own chambers and using them at home.
https://www.google.com/search?client=firefox-b-1-d&q=hyperbaric+chamber+cost
I hope all this info and the internet links provide some help and you will probably have to copy and paste them in your browser.
So check with your docs as to your radiation fields because if you are going to have radiation heavily around and very close to your jawbone area it can affect your future dental situation down the road and may affect your dental decisions now.
God Bless-take Care
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Made me smileProustLover said:Risk Factors
Christina...I'm glad you found this site...there may not be time for much input to your original question, but site will be a help going forward. There are folks here who were fitted with some sort of dental guard to wear as protection during radiation. This option was not mentioned to my husband, and he developed bad sores from radiation bouncing off filling onto his tongue. If SO decides to keep teeth, inquire about the dental guard. After radiation, an extraction is serious, and folks talk about hyperbaric treatments which I'm sure are expensive. Your goal, as you say, is to minimize procedures and risk of complications, so eventual need for extraction may be the biggest risk factor to take into account. The decision your SO has to make in short time is incredibly difficult, and my heart goes out to you - you can stay strong and get through this. (My husband is a handsome bald biker, with same diagnosis as your SO).
Yes, I'm glad I found this site, too! And reading that you also have a handsome bald biker made me smile.
Btw - We took your advice and asked about a dental guard to wear during radiation treatment. They looked as if they had no idea what we were talking about and said no, we don't do that. So frustrating!!!0 -
Extraction update
Sorry for taking a while to get back on here. It's been a tough week. Thank you all SO VERY MUCH for sharing your kind words, advice, information, and experiences. It was all very helpful! To make a very long story short, on Monday my SO ended up having 12 teeth extracted, including 3 wisdom teeth. It was horrific. He was in the chair 2 hours and it took 4 people. Blood and teeth everywhere. All but 2 teeth broke off and had to be drilled and dug out. The 2 that did not break off came out with bone attached to them. Apparently, his teeth were fused. On the right side due to the cancer (does this sound right?), and on the left side because he used to box and do MMA. This happens to fighters with repeated hits to the jaw, we learned. He wimpered almost in tears trying to hold his face still over all the potholes and bumps the whole 50-min drive home.
Prior to the extractions, we asked many questions in an effort to decide what to do....take out just the 10-12 they were recommending, or remove them all. The doctor commented that taking them all out would be an aggressive move. He also said that even if that's what he chooses to do, there's no way they could take them all out in one sitting. So for now, he opted to just have the 12 removed. He is in so much pain. He moans a lot in his sleep and the meds wear off too quickly before it's time for the next dose. He's alternating hydrocodone/acetaminophen with 800mg of ibuprofen. He has almost no appetite. He takes meal replacement shakes to work and I liquify foods for dinner. This is already awful and he hasn't even started chemoradiation yet. He has an appointment to see my dentist May 7 so he can get his professional oppinion as to what to do with the rest of his teeth. Right now, I can't imagine him going through all this again.
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Thank you so much!!!!wbcgaruss said:Check With Your Radiation Docs
If you are getting radiation close to or on the jawbone it damages the blood flow in the bone. This creates problems healing because of less blood flow. If you have radiation and it affects your jawbone enough you should probably have HBOT (Hyperbaric Oxygen Therapy) before and some follow up after your procedure.
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/hyperbaric-oxygen-therapy
If your blood flow is affected enough and you don't you may end up dealing with osteoradionecrosis (ORN) which a fellow in our local support group had and needed to have part of his jawbone replaced because it wouldn't heal. I have read others on here have had it I believe Mike Metz that posts on here had it and they had to have a fibula used to replace a bad part of their jawbone that was affected by it.
https://oralcancerfoundation.org/complications/osteoradionecrosis/
This is not to scare you but to let you know to ask enough questions.
If you are going to need HBOT I had recently had to have a tooth pulled that was infected and my face all swelled up so it was an emergency and I could not have had the HBOT even if I would have needed it, the tooth needed pulled right away and luckily the dental surgeon said I had good blood flow that he could see when he pulled it so I wouldn't need HBOT. But I called the local cancer center where I had my treatments and checked with my radiologist and the HBOT center there and they told me recently medicare had changed rulings on it and in my situation it would not be covered. I believe she said it would cost me $10,000 a week but they don't do out of pocket customers at the campus and she would refer me to a private business that does it and does it and does it much cheaper. That is why some people are buying their own chambers and using them at home.
https://www.google.com/search?client=firefox-b-1-d&q=hyperbaric+chamber+cost
I hope all this info and the internet links provide some help and you will probably have to copy and paste them in your browser.
So check with your docs as to your radiation fields because if you are going to have radiation heavily around and very close to your jawbone area it can affect your future dental situation down the road and may affect your dental decisions now.
God Bless-take Care
Thank you so much!!!!
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Sorry to hear that your SOCristina347 said:Extraction update
Sorry for taking a while to get back on here. It's been a tough week. Thank you all SO VERY MUCH for sharing your kind words, advice, information, and experiences. It was all very helpful! To make a very long story short, on Monday my SO ended up having 12 teeth extracted, including 3 wisdom teeth. It was horrific. He was in the chair 2 hours and it took 4 people. Blood and teeth everywhere. All but 2 teeth broke off and had to be drilled and dug out. The 2 that did not break off came out with bone attached to them. Apparently, his teeth were fused. On the right side due to the cancer (does this sound right?), and on the left side because he used to box and do MMA. This happens to fighters with repeated hits to the jaw, we learned. He wimpered almost in tears trying to hold his face still over all the potholes and bumps the whole 50-min drive home.
Prior to the extractions, we asked many questions in an effort to decide what to do....take out just the 10-12 they were recommending, or remove them all. The doctor commented that taking them all out would be an aggressive move. He also said that even if that's what he chooses to do, there's no way they could take them all out in one sitting. So for now, he opted to just have the 12 removed. He is in so much pain. He moans a lot in his sleep and the meds wear off too quickly before it's time for the next dose. He's alternating hydrocodone/acetaminophen with 800mg of ibuprofen. He has almost no appetite. He takes meal replacement shakes to work and I liquify foods for dinner. This is already awful and he hasn't even started chemoradiation yet. He has an appointment to see my dentist May 7 so he can get his professional oppinion as to what to do with the rest of his teeth. Right now, I can't imagine him going through all this again.
Sorry to hear that your SO has to endure this agony prior to getting cancer treatments, which, at ths point, might seem like a picnic in comparison. Hopefully the rest of his teeth can stay, but if not then better extract them now than later.
Best of luck to you both!
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So sorry for all you've goneMickeyD said:Tough decision
I have no particular words of wisdom. When I was first diagnosed with cancer of my salivary gland and was told chemo and radiation were necessary, the rad oncologist did not give me an option - he told me my teeth had to come out. Had 33 rad treatments initially and can understand why he did this. Fortunately, I had a great prosthodontist and after I healed up, she was able to make a great set of dentures. Two years later I had to have part of my jaw removed and had another 30 rads. She then made the necessary changes to the dentures. The teeth look good and I was able to eat whatever I wanted.
I hope you don't have to lose them (original issue is always best) but if you do, search out a good prosthodontist and let him/her work their magic. As to payment, you might want to check with your local ACS office or dental society. They may be able to point you in the right direction to get some help. Good luck.
So sorry for all you've gone through. Thank you for sharing and I'm glad you found such a great Prosthodontist! Hopefully, we will too.
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Sorry You Folks Are GoingCristina347 said:Extraction update
Sorry for taking a while to get back on here. It's been a tough week. Thank you all SO VERY MUCH for sharing your kind words, advice, information, and experiences. It was all very helpful! To make a very long story short, on Monday my SO ended up having 12 teeth extracted, including 3 wisdom teeth. It was horrific. He was in the chair 2 hours and it took 4 people. Blood and teeth everywhere. All but 2 teeth broke off and had to be drilled and dug out. The 2 that did not break off came out with bone attached to them. Apparently, his teeth were fused. On the right side due to the cancer (does this sound right?), and on the left side because he used to box and do MMA. This happens to fighters with repeated hits to the jaw, we learned. He wimpered almost in tears trying to hold his face still over all the potholes and bumps the whole 50-min drive home.
Prior to the extractions, we asked many questions in an effort to decide what to do....take out just the 10-12 they were recommending, or remove them all. The doctor commented that taking them all out would be an aggressive move. He also said that even if that's what he chooses to do, there's no way they could take them all out in one sitting. So for now, he opted to just have the 12 removed. He is in so much pain. He moans a lot in his sleep and the meds wear off too quickly before it's time for the next dose. He's alternating hydrocodone/acetaminophen with 800mg of ibuprofen. He has almost no appetite. He takes meal replacement shakes to work and I liquify foods for dinner. This is already awful and he hasn't even started chemoradiation yet. He has an appointment to see my dentist May 7 so he can get his professional oppinion as to what to do with the rest of his teeth. Right now, I can't imagine him going through all this again.
Through such a difficult time. Sounds like quite a time at the dentists, very involved and the teeth breaking didn't help matters. Get the dentist to give you prescriptions for stronger pain meds no need to suffer. If you need more teeth out have the pain meds ahead. Strong ones. Yes your cancer treatment did not start yet and this is beating him up but it is best to have things taken care of ahead of time that could cause serious problems later if ignored. This cancer stuff is not easy but take one day at a time and there will be better days ahead. God Bless
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I feel your pain
Hi. I waas diagnosed with tonsil P16 positive with 1 lymph node in 2012. Doing great now. I was given the same choice. In the end I decided to have all teeth removed so that I wouldn't have to deal with issues going forward. I had 7 implants put in and have "snap In"dentures in place. I love them. They look great and I can eat almost anything. I don't regret my choice. I was about 5 months with temporary dentures untilt hey could "expose" my implants. So I went back to work with temps. They were hard to get used to but the snap in dentures feel very natural.
Early on when I went out in publiv before I could wear the temp dentures, i wore a surgical mask so I was not self conscious about not having teeth. That worked well. Please let me know if you have any questions.
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Another thoughtlorig01 said:I feel your pain
Hi. I waas diagnosed with tonsil P16 positive with 1 lymph node in 2012. Doing great now. I was given the same choice. In the end I decided to have all teeth removed so that I wouldn't have to deal with issues going forward. I had 7 implants put in and have "snap In"dentures in place. I love them. They look great and I can eat almost anything. I don't regret my choice. I was about 5 months with temporary dentures untilt hey could "expose" my implants. So I went back to work with temps. They were hard to get used to but the snap in dentures feel very natural.
Early on when I went out in publiv before I could wear the temp dentures, i wore a surgical mask so I was not self conscious about not having teeth. That worked well. Please let me know if you have any questions.
If you decide to remove all, I had mine removed during my surgery, (lymph node removal), so I slept through it all. Good luck and I hope you feel better soon!
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Another Consideration
When I first discussed cancer treatment with my oncologist's they mentioned that I might want to consider a PEG tube (feeding tube). I declined, but by the end of the second week of rads, I had no appetite at all and had lost almost ten pounds. Your SO looks to be in good physical shape and he will need to maiintain his weight and overall health during rad and chemo treatment. If he is having difficulty eating now you may want to consider discussing a PEG with your doctor. I used mine throughout the rad treatment and a few months thereafter, and them had it removed. It is somewhat inconvenient, but in my case at least, was necessary. Best of luck to both of you.
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