Problems with teeth after radiation

Dental/Oral hygiene during and after treatments
For comparison, my cancer was HPV 16 positive Squamous Cell Carcinoma originally found in lymph nodes left neck with the primary site found in the left tonsil. I had 35 IMRT treatments and 7 concurrent weekly Cisplatin Chemo treatments.

For oral care/dental care, I was lucky in that my regular Dentist had 13 years working at the VA Hospital with Head and Neck Cancer Patients. So, he already knew what I would go through and how to minimize the impact. He gave me a very strict regimen which I followed religously and thankfully now almost one year post-treatments, I have not had any dental problems.

Some of mine was luck and the fantastic technology of my Oncology team, but the majority of it I owe to my Dentist who had seen hundreds of patients before me and knew what to look for and how to avoid as much damage as possible.

Be Well..................JK

Teeth
I had problem with my teeth after radiation treatment in head/neck area. I was lucky to have a dentist with lots of experience treating patients who had cancer. He also does not like people to lose teeth and will do what he can to save teeth.

I use a fluoride tray every night. It seems to work since I have not lost any teeth. I also have my teeth cleaned every four months. I used the Biotene toothpaste for a while; nothing wrong with it except that it is for people with dry mouth due to cancer treatments, that's me. I just thought that with a Crest toothpaste with extra fluoride plus the fluoride tray I was fine. I am back to using Biotene in the morning.

I think soccerfreaks mentioned that he feels his teeth sort of crumbled. That happened to me, I would find tiny pieces of tooth in my mouth. Some of my teeth were actually falling apart in little pieces. That's when we decided it was better to take them out. An oral surgeon took care of that and my teeth didn't come out in one piece. They would break in pieces every time he tried using those plier things dentist use to pull teeth. I am glad he put me to sleep before the procedure.

Since many times there is not only damage to teeth but also to bone (mandibule bone?), I went to the hyperbaric chamber before and after surgery. It also worked very well for me because it strengthen the bone and I was able to have implants.

Radiation usually causes dry mouth and with a dry mouth you do not have enough saliva to help clean the bacteria that accummulates in your mouth. So I think great dental hygiene is important plus visits to your dentist.

I didn't have problems with infections in my gums. Like I said, I have a great dentist and he took care of everything, prevention and treatment.

TereB

I am anti Tooth Fairy
I had to have all the metal fillings removed and replaced with non metal (not sure what it is) before I started rads. I also had four teeth removed as they could not fill them with anything but metal. Since then I have had issues with hot/cold but no other problems. I use a prescription floride mouth wash weekly and have become a listerine junky.


BILL

soccerfreaks said:

teeth
I had 33 rads following surgery for tongue and neck cancer (squamous). Beforehand, I had extensive dental work done, including a cleaning that took three trips, as they worked on a quarter at a time before finishing up the upper half, along with some guy basically using pliers (or so it seemeed) to yank a molar with a problem.

All of this helped a great deal, and your post provides the opportunity to let others know that they absolutely MUST get their dental work done well prior to treatment.

To answer your question, I got a false positive for additional head/neck cancer when a PET scan showed a spot in my mouth. Fortunately, my doc had me go to dentist (and subsequently to oral surgeon) and they discovered an infection beneath a filling. No cancer there!

Otherwise, I note that from time to time I feel as though my teeth are sort of disintegrating, even though I have no evidence of that. It just seems on occasion that I can FEEL pieces, small pieces, of tooth coming away.

I do not do the fluoride treatments, but have heard greats thing about them. Instead, I still use the toothpaste and mouthwash I was provided when leaving the scene of the crime (:)), the Oasis mouthwash and the Biotene toothpaste.

I still get my teeth cleaned as well, because, like you, I would like to keep my teeth.

From everything I've heard, the fluoride trays are great stuff. I may look into it myself now that you have brought it up again.

Take care,

Joe

tooth care
After I was diagnosed and before treatment started I was sent to the dentist. He evaluated my teeth and concluded both left and right molars where tipped into each other. While they did not currently have any cavities, they were considered high risk for post treatment decay. I had all 4 teeth removed as a precaution. I was never compulsive about brushing my teeth, now I am. Due to the thickened saliva and dry mouth I was brushing upwards of 5 timesa day. I can't make it through the day without my waterpick. I use floride trays very speratically. I am 2yrs 6mon. post treatment, I did regain limited salivary function. When I do use the floride trays it does have the side effect of making my mouth water. My last dental visit was 1 month ago I had 1 small cavity which was filled.

Hope this helps


JOE

tci said:

Flouride Trays
Just finished 7 weeks of head and neck radiation last Tuesday. Have been using Flouride trays for the whole time, with the idea I would have to use them forever (according to the dentist) mentioned this to my Oncologist, she told me not so, that I could use a high flouride toothpaste and wouldn't need the trays. Made me feel much better but I still worry about it. I have to make an appointment with my dentist now that I am done to do some work not done prior to my treatment, so I will let you know what I find out.

teeth
Tci. You didn't say how much of a loss you suffered to your saliva glands. After 25 face radiation treatments I proubly lost 1/2 of my saliva glands. So my mouth felt like it had mud in it. I continued to take many medications for pain and other problems over the last 5 years. My teeth had major problems. Many loose fillings and decay along with problems of thinning at the gum line. Fixing my teeth after cancer cost many thousands of dollars and continues to this day. In fact right now I have an ice pack on my face as I saw the dentist today ha ha. Anything you can use to help your teeth is good and I would not throw out the flouride tray. I also use biotene toothpaste and mouthwash. The mouthwash does not contain alcohol so it does not cause more drying. Best of luck Slickwilly

slickwilly said:

teeth
Tci. You didn't say how much of a loss you suffered to your saliva glands. After 25 face radiation treatments I proubly lost 1/2 of my saliva glands. So my mouth felt like it had mud in it. I continued to take many medications for pain and other problems over the last 5 years. My teeth had major problems. Many loose fillings and decay along with problems of thinning at the gum line. Fixing my teeth after cancer cost many thousands of dollars and continues to this day. In fact right now I have an ice pack on my face as I saw the dentist today ha ha. Anything you can use to help your teeth is good and I would not throw out the flouride tray. I also use biotene toothpaste and mouthwash. The mouthwash does not contain alcohol so it does not cause more drying. Best of luck Slickwilly

Teeth will be problematic
Radiation is absorbed by our jaw bones and suffer blood flow issues. Our saliva is diminished thus we cannot keep bacteria at bay. We suffer damage from both ends then.Some issues are bound to crop up.

I had a year long abcess under a filling which was just recently resolved by pulling the tooth. You have to stay on top of dental care. I'm on flouride trays also.

TereB said:

Teeth
I had problem with my teeth after radiation treatment in head/neck area. I was lucky to have a dentist with lots of experience treating patients who had cancer. He also does not like people to lose teeth and will do what he can to save teeth.

I use a fluoride tray every night. It seems to work since I have not lost any teeth. I also have my teeth cleaned every four months. I used the Biotene toothpaste for a while; nothing wrong with it except that it is for people with dry mouth due to cancer treatments, that's me. I just thought that with a Crest toothpaste with extra fluoride plus the fluoride tray I was fine. I am back to using Biotene in the morning.

I think soccerfreaks mentioned that he feels his teeth sort of crumbled. That happened to me, I would find tiny pieces of tooth in my mouth. Some of my teeth were actually falling apart in little pieces. That's when we decided it was better to take them out. An oral surgeon took care of that and my teeth didn't come out in one piece. They would break in pieces every time he tried using those plier things dentist use to pull teeth. I am glad he put me to sleep before the procedure.

Since many times there is not only damage to teeth but also to bone (mandibule bone?), I went to the hyperbaric chamber before and after surgery. It also worked very well for me because it strengthen the bone and I was able to have implants.

Radiation usually causes dry mouth and with a dry mouth you do not have enough saliva to help clean the bacteria that accummulates in your mouth. So I think great dental hygiene is important plus visits to your dentist.

I didn't have problems with infections in my gums. Like I said, I have a great dentist and he took care of everything, prevention and treatment.

TereB

Teeth and Jaw and radiation

HI TereB,

I was wondering about your process of getting treatments in the hyperberic chamber.  Did your oncologyst arrange it, or did you have an oral surgeon or dentist help set that up?  Also, are know it isn't an expensive procedure and was wondering if you had issues with insurance not covering any of it.  I am a head and neck cancer survivor.  I have not lost any teeth, but have had a few root canals and now issues that could mean a bone graft of my mandibule.

Any information would be greatly appreciated.

Thank you all,

MickDolphin

denistd said:

HBO

I have had HBO twice now, and have had all my teeth removed, I am on medicare and highmark freedom blue. They covered the HB and the teeth removal. Onco sent a letter to them explaing that removal of teeth was a medical procedure and neccesary to prevent any jaw damage. All is now well. have dentures and that was not covered.

HBO

Thank you so much Denistd!!!!

MickDolphin said:

HBO

I am also wondering about your process of getting treatments in the hyperberic chamber.  Did your oncologist arrange it, or did you have an oral surgeon or dentist help set that up?  Also, are know it isn't an expensive procedure and was wondering if you had issues with insurance not covering any of it.  I am a head and neck cancer survivor.  I have had a few root canals recently and now issues that could mean a bone graft of my mandibule.

Any information would be greatly appreciated.

Thank you again,

MickDolphin

HBO

My Onco and Oral Surgeon and dentist did all of the work. Everything was covered at 100%, the teeth removal was done as an out patient. I believe the HBO is around $400 a session but not sure as I saw no bills. Your oncologist is the main man. To prevent any further damage was his tap.

George_Baltimore said:

HBO and Medicare

I will second what Denistd said.  Starting in 2009, I've had a total of 124 HBO treatments.  Each one was covered in full by Medicare and a medi-gap from Blue Cross Blue Shield.  One other thing, PLEASE ask you doctor about bone debridement before you decide on mandible replacement!  There are some on this board who have had no problems with that surgery.  Unfortunately, I am not one of those.  My doctors never mentioned the possibility of debridement of the mandible.

HBO

I was told the HBO is $2500 a session if insurance doesn't pay for it. My insuance approved but in the meantime my husband's former employer changed insurance carriers so now starting the process again. Since surgery, rads and chemo, I have had one root canal done and it went without incident. Seems the radiation took the root because there was no decay or cavity on the tooth. Life is sometimes just not fair.