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Save the teeth!

D Lewis's picture
D Lewis
Posts: 1576
Joined: Jan 2010

Three and a half years out from treatment, I had a dental crown fail catastrophically.  Turns out it was completely decayed through from beneath, and the tooth itself was shattered.  After numerous discussions with my oncology team, dentist, endodontist, and maxillofacial surgeon with special expertise in osteoradionecrosis... I have a better understanding of the situation.  The Osteoradionecrosis specialist is appalled that anyone is allowed to go through the head/neck radiation treatment regime WITHOUT mandatory removal of the back two molars from each side of the lower jaw.  The blood flow to the bone in these areas is severely damaged by the rads, the teeth themselves are damaged by the rads, saliva is compromised, etc.  I was warned that I was much more prone to decay but I wasn't told that crowns were much more susceptible to bacterial attack up through the bottom and that they could fail from the inside.

I have four crowns, on these back four teeth.  The dentist and endodontist were focused on the one tooth that failed.  I took myself to the ORN specialist, and he was the only one to recommend a panorex dental x-ray to see what else was brewing.  Turns out one of the back teeth on the opposite site is also nursing decay under the crown and has an abscessed root.  These things aren't even causing me any pain - in part, I suspect, owing to radiation damage.

So, ORN guy says NO WAY should I have even a single tooth extracted if there is any way to save even just the root. Hyperbaric Oxygen would help, but there is no guarantee that this will prevent ORN from happening.  He said to forget any idea I might have had about extracting multiple teeth now.  The time for that is long past. ORN is so nasty that he won't let me.


So the Endodontist did a root canal today on the shattered tooth. Yeouch.  Face is now swelled up like a chipmunk.  I'm waiting for a call back from my dentist, to schedule the crown... or button... or seal... or whatever she can come up with to cover what is left of the tooth.  And, looking forward to having a second root canal on the other side.

Take-away lesson from this.  If you haven't started treatment yet, you might want to get those back bottom teeth removed, even if they are covered with pretty crowns and look perfect.


Deb - the chipmunk face

thennies61's picture
Posts: 285
Joined: Jan 2014

During surgery they went ahead a removed my teeth as he told me before that during radiation most would be destored so might as well remove while your out.

Debi16043's picture
Posts: 52
Joined: Aug 2011

My doctors also removed all my teeth and I'm so glad because I don't have the worry of having to have teeth worked on after radiation.

Ruben and Jude's picture
Ruben and Jude
Posts: 155
Joined: Apr 2013

Hi Deb,

Ruben had his two bottom molars extracted prior to radiation, and is experiencing ORN in his right lower bone, where the tooth was extracted. He will be starting HBO treatment on Monday. He has been meticulous about caring for his teeth during and since radiation by flossing at least twice a day, using Biotene products (tooth paste, gum, gel), and professional strength floride treatments on a regular basis. We are optimistic the HBO will be beneficial.

Hope your treatments go well. God Bless. Take Care.


ratface's picture
Posts: 1319
Joined: Aug 2009

Coming up on five years I'm astounded by the amount of money I spend at the dentist as tax season has borought it to the forefront. I've had two root canals since treatment, two crowns, an extraction with a weird springy device that went for months on end and 3 cleanings per year. I've avoided HBO so far and dread the idea. I currently use flouride trays, a sonic brush and a water pik and it appears I'm just staying even with the rate of decay. In hindsight I agree that the rear molars should just come out prior to radiation as it will save you headache down the road.

CivilMatt's picture
Posts: 4317
Joined: May 2012


Dear chipmunk face,

What is your take-sway lessons for those who have are already post treatment and have crowns on three of their four first molars?

If I hear you right and I think I do I may have 3 little decay fests going on.

Oh, do the surprise side effects ever have a plus side?

So far my dental appointments have been fine and I hope that continues.  I will be a little more proactive and at my next appt. mention the crowns.

Deb, you are coming up on 4 years post rads, did you have any clues to what was happening?  Also, how would you rate your teeth care (1=none, 5=normal, 10=stellar)?

Molars on alert in Oregon,



D Lewis's picture
D Lewis
Posts: 1576
Joined: Jan 2010

Matt, I've been the poster child for dental care.  Even my dentist mocks me.  Flossing, rinsing and brushing after every meal and snack... I must floss eight times a day. Seeing the dentist for a cleaning three times a year, using fluoride dental trays, prevident toothpaste, biotene rinse and biotene gum... On a scale of 1 to 10 I'm somewhere around 11.5.  

No clue what was happening.  Eeeek. 

Endodontist was able to perform a successful root canal through the temporary crown on the broken tooth and the temporary is hanging in there for now.  Now I must wait a week till my dentist can try to do her magic and get a new crown to stay on.  If not, we grind what is left down to the gum line and put a little cap on it. Endodontist told me to chew on the other side.  There may not be an other side.


KB56's picture
Posts: 312
Joined: Apr 2013

Deb, i've really tried to stay ahead of the dental issues as well and is still one of my biggest worries going forward.  I had a lot of work years ago, several crowns, etc and know that radiation/lack of saliva will be an issue.  I use the flouride tray nightly, brush multiple times a day, floss, etc AND also avoid all carbonated drinks and most sweets based on my dentist recommendation.  Still, my teeth seem more sensitive now (even on the side that wasn't radiated) and I go to the dentist quarterly for cleaning/check up.   I need to check into that panorex dental xray to see if I can get that done.

Thanks for the note and your experience.  It gave me some info I didn't have but something that concerns me greatly and I really try and stay on top of.

Good Luck!


donfoo's picture
Posts: 1648
Joined: Dec 2012

Still, my teeth seem more sensitive now (even on the side that wasn't radiated)

Maybe with all the activity to the gums all the time, things are a bit sensitive. Sort of sounds logical that too much flossing for example can make your gums sore. 

Don't know where the phrase "too much of good thing" starts to apply in our world but I suspect a keen dentist can offer some insights.

Crazymom's picture
Posts: 339
Joined: Nov 2011




i have spent 20,000 on crowns on my back molars from this cancer...I hate to hear that I may have wated my money....ugh...I clean and use flouride trays and all is ok now, but I am now worried.   Ann

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