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Tooth decay post tx

donfoo's picture
Posts: 1649
Joined: Dec 2012

I saw an oral surgeon this week who mentioned info new to me. Thought I would share and also other input.

Dental decay post treatment is mentioned here so it is real and important we do what we can to minimize these issues. My impression to date is tooth decay, not jawbone issues, are caused by radiation treatment. He stated that tooth decay issues are caused by dry mouth, not radiation. Not enough saliva to kill the bacteria that causes cavities. He also mentioned the critical thing to watch is for any decay along the gum line as this is the clear symptom of this kind of tooth decay.

Here on the forums, I can not recollect much mention tying post tx dental issues to dry mouth nor reading the decay is found at the gumline. Sure would love to hear from those who have had dental issues. Don

Posts: 4
Joined: Nov 2013

My dentist was very informative and confirmed the dry mouth dagers to tooth decay.  He recommended trays for me to use for daily floride treatments.  Tooth enamel loss is an ongoing battle accererated by dry mouth, floride helps to rebuild the enamel.  I use my trays every day and can say so far that they have helped.  I am post 5 weeks from 35 rad treatments so my saliva glads are not working at all rith now.  Went to the dentist yesturday for my bi-annual cleaning and had the doctor inspect my teeth as a comparison from when I went in for the trays (3 months).  He was happy with the results and wrote me another perscription for 6 more months of floride.

Posts: 57
Joined: Oct 2012

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's picture
Posts: 8286
Joined: Sep 2009

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.



hwt's picture
Posts: 2330
Joined: Jun 2012

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's picture
Posts: 455
Joined: Sep 2011

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.

Skiffin16's picture
Posts: 8286
Joined: Sep 2009

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...


Posts: 90
Joined: Jul 2011

I was told from the beginning that teeth would be an issue due to lack of saliva. Very surprised that you were not aware of this. I had last 2 wisdom teeth pulled before treatment. I then went on a strict hygiene routine and still follow it to this day. I am 7 years post treatment. My dentist specializes in patients with head/neck radiation. I saw him 4 times yearly after treatment an now see him 3 times yearly.

I cut out in-between meal snacks.

After every meal I brush with electric tooth brush.

Brush my tounge with tongue brush.

Rinse mouth with non-alcohol mouthwash.

Floss with Plackers.

Each night I use Colgate Prevident in flouride trays.

I have been following this routine sinse pre treatment and have had no dental issues. I breese through my 3 yearly cleanings with no issues and my hygeinist always compliments me on the condition of my teeth and gums.

I have posted this routine before and someone said that flossing after every meal was not necessary, once daily is enough to remove placke. BS!!. I was told to floss after every meal. I floss to remove food particles that cause placke. My saliva is back to what is considered normal, but I still continue this routine.

I have said this before, but dental hygiene is one of the most important issues before treatment, during treatment, and after treatment.

donfoo's picture
Posts: 1649
Joined: Dec 2012

I wonder if pH being higher or lower affects the production of these root cavities. During treatment I got onto high alkaline water with pH over 9+. If higher pH is helps keep cavaties away, maybe drinking alkaline water all time might be good for us all.

cid817's picture
Posts: 56
Joined: Oct 2013


What kind of water is the higher pH and where can you purchase it?  Is it Kangen?

donfoo's picture
Posts: 1649
Joined: Dec 2012


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 

cid817's picture
Posts: 56
Joined: Oct 2013

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.


donfoo's picture
Posts: 1649
Joined: Dec 2012

I guess this issue passed me by as my saliva production was not compromised very much. During treatment and a couple months post, I just had low saliva when eating dry bread and such. Now I occassionaly get dry mouth at night after eating something salty for dinner but generally saliva is good. 

Still, all the suggestions on taking extra care is very important. Thanks, don


edit - geez - horrible typing and grammer - my bad

CivilMatt's picture
Posts: 4321
Joined: May 2012



Dental issues and dental care were some of the first items to come-up on my flight to treatments.  My rad once required a call from my dentist before the rad sequence was scheduled.

I have had very good check-ups, (3) post treatments and they send me home with a bottle of gel fluoride which can be brushed on or put in trays.

They told me the Xylimelts I use for dry mouth are beneficial because they help produce saliva (my pillowcase is evidence) and xylitol is ok for teeth.

I brush and floss regularly and drink lots of water.  Some foods stick to my teeth like glue (I guess to remind me on how I got here).   I also, have floss picks at the ready to aid in food removal between teeth.

Even though I use an occasional antacid for my stomach I might research playing with my body’s ph before doing that.

I wish you, your gums and your teeth many years happy uneventful chomping.



Duggie88's picture
Posts: 703
Joined: Feb 2010

I had 4 in the lower front go bad from the inside out. As I stated in another posting my wife claims I have selective hearing and I only did the floride thing during treatment and went back to regular toothpaste afterwards. So maybe the wife is correct in her observation in getting me to listen is like pulling teeth, four of them like I mentioned. I now use prescription flouride everyday in hpes my dry mouth has less effect on my summer teeth. (Sum are here and sum are there)


fisrpotpe's picture
Posts: 1349
Joined: Aug 2010

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. 


antoinette510's picture
Posts: 3
Joined: Nov 2013

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!

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