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Pulling Teeth

Posts: 50
Joined: Sep 2007

I need some advice for a friend - he was just diagnosed with stage IV throat cancer from smoking/drinking. I guess the treatment will be lots of radiation and some chemotherapy. As you all know, he and his family are in shock and, quite frankly, terrified. I've read a lot of your posts and am grateful for the advice I've already read and sent the tips on to my friend. He will have a feeding tube put in. My question is this: the doc has decided that all (I think all) of his teeth need to be pulled and pulled before radiation begins. Why would they not try to save his teeth? Does anyone have any idea why they want all of his teeth pulled? That sounds extreme to me. I know a lot of you have recommended flouride trays - I passed that along and have encouraged them to press the doc for a solid explanation. I don't really know if the doc actually gave them a good reason and maybe they were just unable to hear and absorb everything all at once or not. I just really haven't seen any references to teeth being pulled on this discussion board. Thanks so much for any help you can offer.


Posts: 1849
Joined: Aug 2010

Jim's teeth were all removed before any treatments began. He was on his way to dentures and while there were teeth that could have been saved, he opted to have them all removed to avoid any complications. It was the right thing for Jim.

Jim did have a feeding tube put in but never used it for anything other than irrigation of the tube itself. During treatment, he rarely missed a meal and most days he consumed around 3000 calories of regular food, sometimes finely chopped for his comfort and ease.

Jim had negligible mouth sores or swallowing issues throughout. He is two months post-treatment, has done very well so far with continuing ear pain being a difficult-to-manage remaining issue.

Throat cancer is kind of a misnomer: it is usually restricted to one part of the neck, in Jim's case, hypopharyngeal and base of tongue cancer was the diagnosis. It is an aggressive cancer with a brutal treatment protocol.

Removing Jim's teeth was difficult to think about but we still feel it was the right thing to do for him.

sweetblood22's picture
Posts: 3228
Joined: Jan 2010

The reasons that they reccomended teeth pulling is:

1. Lack of saliva can cause severe tooth decay. I would only let them pull my 3 wisdom teeth and the four next to them. Even tho I brush 5-6 times a day and use trays my teeth are disinenagrating.

2. Mouth may not be able to open wide enough to brush back there after rads. I think it's called trismus. Whateven it's called my mouth doesn't open very far anymore. They want you to be able to open far enough for at least get three fingers in there. I can't even get in two. I have to brush with a baby tooth brush cause I can't get normal size ones in there and in the back teeth.

3. Radiation can cause less blood flow to the tissue in the neck and the jaw. The blood flow can sort of kill off the jaw bone. Also cause nerotic tissue. So I you would need to. Have a tooth pulled, the jaw bone and gum and hole will not heal.

There are some that have been in need of hyperbaric treatments with dental work and that is extremely costly. I am facing over $3000 in dental work right now. I have to have about every tooth filled. It's really upsetting, I don't know what else to do. Can't brush anymore than I already do.

I'm sure someone else may cover something I forgot, but that's the major reasons why I can think of right now.

ratface's picture
Posts: 1319
Joined: Aug 2009

It was recommended I have several teeth pulled in possible need of root canals. They worry is that if the tooth needs fixing during treatment it will literally be impossible and this is hard enough to do without tooth complications. My guess is his teeth weren't too good to start. I opted out as fear gripped me and wanted to start treatment. In retrospect it would not have made any difference to the outcome of treatment and I regret not having the teeth pulled. The teeth in question did need work after the treatment and hence I'm into financial bills of about the same as sweetblood without dental insurance. Once through treatment you cannot just get an extraction like a normal person without first going through hyperbaric chamber treatment. Sweetblood is right on, on all counts. Although this is an aggressive cancer there generally is enough time to deal with the teeth first. Tough call but he will be dealing with dental issues for the rest of his long remainning life. Your a good friend. How long will the delay be in starting treatment, a couple of weeks won't matter.

fisrpotpe's picture
Posts: 1349
Joined: Aug 2010

As posted earlier I had to have two teeth pulled because of the problems ratface and sweetblood have shared due to radiation. I will add that I did not do HBO again. I had it done almost 3 years ago do to a necrosis problem near the larynx. When I did the tooth extractions HBO told me that the help from HBO after having been previous treatments does not help. So they put me on an very strong antibiotic for 5 weeks, it did very well. So far no infection but as of today the pot hole is still not filled over the bone. The oral surgeon was trilled and told me to come back in 6 months rather than every couple weeks. Yea me until the next time.

fisrpotpe's picture
Posts: 1349
Joined: Aug 2010

I am a 14 plus year survivor. I have spent thousands of dollars and hours in the chair having my teeth worked on, reworked and reworked many times. Besides that the amount of pain from those teeth is beyond words. I have used trays without success, after changing dentists because he could not help anymore I went to a University where they have alot of experience with post radiation treatment of the head and neck area. One of the first statements he made was part of the problems were the trays. He changed me to brushing the fluoride so it can be bushed into the gums, trays do not. This has helped for the last 7 plus years but no matter what they do the teeth continue to break down. In fact in late April I had to have my first to teeth pulled. Having your teeth pulled after radiation is a huge risk, if the jaw bone gets infected the only option is to have the bone removed. Today I drove over to see my oral surgeon as a follow up. He told me still after all these months the tooth pot holes are not completely healed over. This example show how much the damage of radiation does to the blood flow to the gum and jaw, and how slow the healing is post treatment. In our local head and neck cancer support group many have said that they feel down the road that there is nothing they can do, the teeth will just break down no matter. My dentist's get very frustrated the last year when they continue to see break down. I brush three times a day, floss each time, use a water pic each time, and apply fluoride 2-3 times. If my mouth gets dryer than the extreme dry it normally is, the water pick seems to help some.

I have certainly wanted all my lower teeth out for at least 10-12 years. I am not sure I would take out the top teeth as I have very minor problems in that area. My suggestion is to have the lower back teeth(the back four teeth on each side). These are the ones I have had the most problems with, the ones that get the most radiation, the hardest to keep clean, the area of the most dryness, Out of the 8 locations I mentioned I now have only three available, two were pulled, 5 are cut off around the gum area.

I suggest you (any one) find a dentist that have lots of experience and knowledge with radiation treatments. I know I am probably the odd person here that would suggest to have those teeth removed before treatment.

Good luck with your decision.


miccmill's picture
Posts: 248
Joined: May 2010

Glenn had all his teeth removed before treatment. He also was on his way to dentures anyway. He had gingivitis and the doctors felt that his teeth would not survive radiation treatment and would put him at risk for osteonecrosis. That risk has been removed.

He does have significant trouble getting enough nutrition in via mouth but will be cleared for dentures at the end of this month and that should help.

We're really glad it went this way so he could be spared the pain and expense of restorative work, periodontal work and root canals further down the road.

Army_Guy's picture
Posts: 53
Joined: Oct 2010

The biggest danger from radiation to the head and neck is osteoradionecrosis; a fancy term for bacteria killing the jaw bone. My dentist was concerned before I started treatments because I have had periodontal problems in the past (pyorrhea, better known as gum recession) and sent me to some specialists. At first, they all discussed pulling some of my teeth but decided on a good cleaning, perio exam, deep cleaning and root scaling. That was early June. They prescribed fluoride gel and trays and I began using them 2 weeks prior to radiation treatments. I also brushed and flossed after every meal (and will for the rest of my life). I have had no additional gum recession and stuck with this plan throughout treatment (even when my mouth and gums were sore from treatment I used a very soft toothbrush and made it softer by running it under hot water). Had a checkup in October and dentist said things look good. Seeing periodontist on Nov 19th. Just follow their orders as they usually know what they're doing. There is always the option of a second opinion.

I feel blessed and fortunate to be alive.

Stay strong and always use your best judgment when dealing with this problems. My MO is to weigh benefits against risks.


Posts: 50
Joined: Sep 2007

Thanks so much for all of your responses - they're really helpful. I'm pretty sure they will opt to take his teeth out - that sounds like the right thing in his case. I really hope this discussion board will help to give my friend some hope to fight a good fight. The doc gave him a 50% chance of survival. Do you know of anyone with those odds that are survivors? I'm pretty certain my friend's philosophy in life is live hard til ya die and I'm afraid he's wanting to hang on to that way of thinking. But . . . he has a ten year old son that is quite a motivating force for him - they're buddies. Also, he has a teeny tiny wife and she is quite the fighter! She will most definitely kick him in the butt every step of they way if she has to! Having said that, I gotta say that my heart goes out to him and all of you! My husband passed away last March from colon cancer and I thought that was a bad one (I know all cancer is bad but I think the challenges are harder in some more than others); but, I think that what you all have gone through is hell - I'm so sorry - I've just decided that, very ofen, life is just plain hard - I think it's important to always keep your chin up and do the best you can and truly appreciate the good things that come along but, seriously, life is just full of hard things. Good luck to you all and God bless you! I will check in from time to time and probably have more questions as things go along. I'm hoping my friend or his wife will get on here themselves but, if not, I'll continue to be a connection for them.

I hope you all have a wonderful day!

matthewcplourde's picture
Posts: 33
Joined: Sep 2010

I was so young (11 years ago), I still had all my wisdom teeth in there at time of surery/radiation. They had to get me under the knife so quickly after the biopsy, my teeth stayed in.

About 3 years ago, I needed my wisdom teeth pulled. It was a big deal and we were quite scared of osteoradionecrosis... If you can avoid "one more thing", I think it's a good play.

luv2cut1's picture
Posts: 288
Joined: Oct 2010

My husband, Pat, had all of his teeth pulled prior to treatment. It was so traumatic at the time, but we are now glad that he went ahead and did it. We were told that the risks of dental work after treatment, as well as the likelihood that he would need dental work in the future, was the reason to have them all pulled first. We were really lucky. We had a great prosthodontist who made him temporary dentures right away. After he finished treatment he got implants, which, after a fight, insurance covered! It seemed so extreme at the time, and it was very emotional, but Pat would do it again in a heartbeat. If your friend has medical insurance, encourage him to fight for them to pay.

Wishing your friend all the best,


stevenl's picture
Posts: 587
Joined: Jan 2010


Don't listen to the odds that they tell you. They are based on some stupid percentages that I don't know where they come from. I had stage 4 tonsil cancer and my odds were not good. But I beat it and am going to continue beating it. Tell your friend his odds are the same as mine, 100%. I also had 6 teeth pulled and had a deep cleaning and implants and a new bridge before rads.

Best, Steve

PattyNC's picture
Posts: 65
Joined: Oct 2006

My brother's radical head& neck surgery was done in May 2006. He had to have all teeth removed in 09 ... so far, he hasn't even considered dentures (mostly because of the high $$$). Also, he says they told him his jawbone is necroctic at the time they did the removal. With all that said, Mikey is lucky to have retained fairly good taste buds and he eats surprising well! Just cuts the steak into tiny bites and chows down. He has gained from 125 to 137 since moving in with us so things are slowly getting better it seems at this point.

Prayers & happy thoughts to all.

Posts: 50
Joined: Sep 2007

Thanks everybody for your advice! My friend gets his teeth pulled and a feeding tube put in this week and then he will begin his eight weeks of radiation and chemo. I don't know all of the details but I know he's really scared and really bummed that he will be going through this during the holidays. He lives in rural southern Ohio and my brother spent the weekend with him and his family - they had a really nice time - took a lot pictures - did some praying - cleaned his garage - took a walk through the hills - got some more firewood together in preparation for winter - fixed the skirting on his trailer - built a new set of stairs for his trailer. They had a nice cookout and really had a nice visit - good time! Hopefully, times like that will sustain him. Man cancer sucks! You just want so badly to be able to do something about it but the cancer part is just so out of our hands! Ugh!!!

MarineE5's picture
Posts: 909
Joined: Dec 2005


As Steve mentioned, please do not get wrapped up with the numbers that are given. Much of the data that is out there is outdated.

I often mention to people an old phrase I heard years ago and it seems to hold true. " It's not the size of the dog in the fight, but the size of the fight in the dog".

Tell your friend that even though it is near the Holidays, he will make it. Same thing happened to me. I started my radiation roughly 4 days before Thanksgiving in 2004. I was able to eat mashed potatoes with turkey gravey. This was after having part of my tongue removed, neck disection, Peg Tube. I had filled up on my nutrition cans earlier. Being with the family was more important then the dinner. The same for Christmas. At that time, I just wanted everybody to be happy and if I got tired, I went off to take a nap. They understood. The following years are better : )

My Best to You, Your freind and Family, and Everyone Here

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