Dental issues post tx

donfoo
donfoo Member Posts: 1,771 Member
in Head and Neck Cancer #1
Hi Jude,

 

I did not realize I was replying to post in the roll call thread. Repy to this post of yours.

 


ORN.... sounds like an acronym for oral radiation necrosis, or possibly oseos radiation necrosis??? He had a level 7 radiation. Ruben had two lower molars extracted, one on each side, prior to radiation. The right lower area never really healed all the way, and he has had some bone tissue coming through all during radiation as well as now. At first, it was thought to be pieces of broken tooth coming through the gum, but they did xrays and found it was dead bone all along. The oral surgeion sez it was caught early, and they are watching it closely. It was debrided two weeks ago, and seems to be doing a little better. They are hopeful it will stop in it's tracks with the help of hyperbaric treatments. They said the radiation definately caused it, as the gum didn't really have time to heal before starting rads. He was a stage 4 and they didn't want to delay treatment any longer.  What was surprizing to the oral surgeion was that the focus of the radiation was on his left lymph node, but the dead bone is on the right. Eyebrows were raising all over the dental department. What's done is done. We are focusing on the positive, that it WILL STOP in it's tracks.

Hope all is well with you. Weren't you having some dental issues as well??

Take care, God Bless.

Jude

Ruben's circumstances certainly indicate the lack of healing from the extraction pre rad was a factor in the bone issues he is currently experiencing. ORN, from my understanding, starts once there is disruption to the jawbone like a tooth issue (extraction).  Usually it happens post tx when a tooth gets pulled or damaged. In your case, the extraction set it off early. Has the bone condition been diagnosed or described as  ORN? 

I did have a dental concern post tx. There was bone that was exposed where a tooth was extracted prior to rads. The oral surgeon said it was not unusal for bone fragments to push through for some time but I was concerned it was more serious and related to the rads. I went to a second oral surgeon for a consult and he advised the same thing and then within a couple weeks after that visit it did disappear for good.

Dental issues are fairly common so it is important for folks to stay tuned to the care and condition of their teeth. I've not had much luck finding a primary dentist who has much experience with oral cancer survivors with rad treatments. Between him and the oral surgeon and myself  being vigilant I hope to jump on any dental issue that may arise. Who or what specialization is caring for Ruben's dental issues?

So far, the only real words of wisdom is basic dental hygiene, some flouride assist via trays or prescription paste, and doing everything except getting a tooth pulled as that is the trigger for HBO, a big pain in the butt and costly too.

Don

Comments

  • Ruben and Jude
    Ruben and Jude Member Posts: 155
    #2
    bone issue

    I agree, dental hygiene is SO important. Ruben has been vigilant during and post treatment. He flosses no less than twice a day, uses biotene products, prescription and professional floride treatments, oral peroxide, rinses, etc.  The bone issue started almost immediately after the tooth was extracted, so it was thought the piece coming throught was a residual part of the tooth that may have broken off during extraction. Once the first piece came out, there was no more sign of an issue. Then suddenly after several weeks, it appeared again. We talked about it to the rad/onc who sent us to the oral surgeon. It took some time for Ruben to get in for that appt., but once he did, xrays were taken and it showed where the tissue was not healed, and an area of dead bone, which is what is now coming through. During that initial visit to OS, she was able to pull out the piece which was visiable, and file down more, just below the surface of the gum. He's been told by all who are in the know, that in general, his teeth look good and it's obvious he takes good care of them. I'm an oncology nurse by profession, so this whole ordeal has me on hightened (over) vigilance. Yell

    Since the debridement, he is in less pain, and on recheck a few days ago, did not need to have any additional debridement. The OS is optimistic and said HBO should be a huge benefit. Fortunately, he is covered by the VA and they are getting him the treatment. We live near Long Beach, CA, so he doesn't have far to travel. I am told they have veterans coming from other states as far away as Montana. His entire treatment, from tonsilectomy to rads and chemo has been through the VA in Long Beach. He is scheduled to have the 'standard' 30 dives. 

    I'm surprised this happened, and then again, nothing surprises us anymore!!! We did everything we were supposed to and more. You never know what you're gonna get from the gift that keeps on giving!  But we are so very thankful for each beautiful day of life that we have together.

    Blessings and positive thoughts coming your way.

    Take care.....   Jude (and Ruben)

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