Tooth Extraction Protocol

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JC F
JC F Member Posts: 74
in Head and Neck Cancer #1

I have read many posts here and elsewhere regarding the fact that many people have had to have teeth removed before radiation treatment. Some people not losing any, and some losing all, and others varying numbers, "before" rads. Is this the norm in American oncology treatment pre-rad? The protocol here in Canada, as I found out today, is that they don't remove any teeth at all before rads unless they are so far gone that they would have been extracted even without cancer involvement. They check the teeth and make necessary repairs but you keep them all through the rads and then they check them afterwards for six months to see if there is any deterioration. If any signs crop up they try everything to save them before extraction as a last resort. After six months you of course keep checking them with your own dentist. This was a big concern for me reading some of the horror stories I've read about tooth loss pre-rad. Just throwing this out there...

...anyway, my full seven week chemo-rad commences on July 2...nervous apprehension and trepidation is now my constant norm...

Comments

  • corleone
    corleone Member Posts: 312 Member
    #2
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    I didn’t have any extraction prior to radiation.

    I had the treatment done at PMH in Toronto. I was told that I might need some teeth pulled off prior to radiation, but the dentists at PMH (who are highly specialized in this type of pathology) didn’t consider that I needed any dental work. A wisdom tooth was concerning, but getting rid of it would have pushed the treatment for another month, and it was already delayed. So far no issues. You’ll have to keep your teeth very clean though, there’s a quite a bit of routine you’ll have to stick with during and after the treatment, for the rest of your life.

    The point is they would pull teeth only if necessary.

    Good luck with your treatment; you’ll get through this.

     

  • JC F
    JC F Member Posts: 74
    #3
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    Okay...

    ...thanks Corleone. She talked as if it were a consensus national protocol in Canada, perhaps a local one. Don't really care as long as I can save my teeth, or the majority of them anyway. Was just worried by several of the stories I've seen out there by many that seem to need a certain number ot teeth removed before the rads even start. I know I'll have to follow a routine rather religiously to save what I have...worried about a hundred damn things regarding this entire affair...

  • CivilMatt
    CivilMatt Member Posts: 4,722 Member
    #4
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    good luck

    JC F,

    I don’t believe it is protocol in the states to extract healthy teeth.  If it were, I must have dodged the “teeth pulling” appointment.

    Truthfully, my rad onc did require a call from my dentist to confirm the status of my teeth and 2y and 3m post I still have them all.

    The concern over teeth is directed at the ability to heal safely and properly from serious dental work once you have gone through rads.

    Keep smiling,

    Matt

  • debbiejeanne
    debbiejeanne Member Posts: 3,102 Member
    #5
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    I had 35 rad tx and pulling

    I had 35 rad tx and pulling my teeth was never discussed and i still have all my teeth today.  hope this helps.

    dj

  • donfoo
    donfoo Member Posts: 1,771 Member
    #6
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    avoiding long term complications

    Hi,

    The reason teeth are extracted before treatment is to minimize complications with extractions or any below the gum line post tx. Radiation is harmful to the jaw bone and degrades the ability to heal when injured. Often a treatment called HBOT is done before extractions post tx. The expensive and extensive treatment increases oxygen flow to the area around the jawbone and improves the healing of the damaged areas.

    Any teeth that are not healthy are considered for extraction. Generally, if the dentist feels the tooth will likely fail down the road then the recommendation is likely to pull it.

    In my case. I had one with sufficient root damage to be pulled. A second was ok but had a chance to fail later. I decided to have it taken in order to minimize need for HBOT later. Some dental treatment could have been done to improve the tooth but I wanted no delay to get rads going, a tooth was a small price to me when facing the totality of the cancer experience.

    From all the posts here over time, my impression is the US and UK are on the same page on this topic.

  • Hondo
    Hondo Member Posts: 6,636 Member
    #7
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    Hi JC

    Not sure why it is like that, but before my Rad I had all my teeth checked and did not pull any of them. My problem now is I can’t open my jaw enough to have them checked anymore. I do all I can to clean them myself so far so good but I know in time this is going to be one big problems for me and I wish I had pulled them all out knowing this.

     

    Take care

    Tim Hondo  

  • Guzzle
    Guzzle Member Posts: 710
    #8
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    Hondo said:

    Hi JC

    Not sure why it is like that, but before my Rad I had all my teeth checked and did not pull any of them. My problem now is I can’t open my jaw enough to have them checked anymore. I do all I can to clean them myself so far so good but I know in time this is going to be one big problems for me and I wish I had pulled them all out knowing this.

     

    Take care

    Tim Hondo  

    Teeth

    Jc, dons right. Same in UK. Any suspect teeth go prior to treatment. Hope it gos OK , G

  • phrannie51
    phrannie51 Member Posts: 4,716
    #9
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    I don't think saving good teeth

    is a local thing.  Only teeth that are already deteriorated get the yank.  I had dentures when I started treatment.....I have been grateful for that, as my teeth were never good, even as a kid.....I'm sure I would have had to go toothless all through treatment and beyond if I'd had to have them pulled before treatment started. 

    They just really don't like having to do much work on bad teeth after treatment.....rads mess up bone and tissue......so everything is much more difficult after radiation is over.

    p

  • SASH
    SASH Member Posts: 421 Member
    #10
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    teeth

    My Rad Onc, wanted 4 wisdon and 8 molars pulled prior to radiation.  These were all healthy teeth with the exception of one of the wisdom that was impacted and had a small amount of decay.  This was preventative so the radiation wouldn't cause damage to them.

    I believe this is based upon where they will be radiating the patient, the dosage given, and the potential for compromising the teeth with radiation. 

  • donfoo
    donfoo Member Posts: 1,771 Member
    #11
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    SASH said:

    teeth

    My Rad Onc, wanted 4 wisdon and 8 molars pulled prior to radiation.  These were all healthy teeth with the exception of one of the wisdom that was impacted and had a small amount of decay.  This was preventative so the radiation wouldn't cause damage to them.

    I believe this is based upon where they will be radiating the patient, the dosage given, and the potential for compromising the teeth with radiation. 

    interesting point

    Sash brings up a medical reason why good teeth may be extracted before rads. Like all things cancer, so much depends on the unique characteristics of your cancer. In the extreme, when the jawbone is resected then everything is lost. In a case where the cancer is very near the jawbone and there is no way to avoid beaming rads at the tooth and bone, then a good tooth is likely going to get pulled.

    Guards are used to help reduce rads on the jawbone. Rads may bounce of metal crowns and that might cause long term issues. So many factors - it all depends as they say.

  • Jeff2159
    Jeff2159 Member Posts: 108
    #12
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    donfoo said:

    avoiding long term complications

    Hi,

    The reason teeth are extracted before treatment is to minimize complications with extractions or any below the gum line post tx. Radiation is harmful to the jaw bone and degrades the ability to heal when injured. Often a treatment called HBOT is done before extractions post tx. The expensive and extensive treatment increases oxygen flow to the area around the jawbone and improves the healing of the damaged areas.

    Any teeth that are not healthy are considered for extraction. Generally, if the dentist feels the tooth will likely fail down the road then the recommendation is likely to pull it.

    In my case. I had one with sufficient root damage to be pulled. A second was ok but had a chance to fail later. I decided to have it taken in order to minimize need for HBOT later. Some dental treatment could have been done to improve the tooth but I wanted no delay to get rads going, a tooth was a small price to me when facing the totality of the cancer experience.

    From all the posts here over time, my impression is the US and UK are on the same page on this topic.

    Teeth pulled

    I just had 3 lower right jaw teeth removed after radiation in Dec 2012-Jan 2013. Prior to extraction I had 20 treatments of the hyperbaric oxygen treatment and then 10 after extraction. The commitment to HBOT everyday M-F for 2 hours was the only pain. Luckily it was only 20 min away and I could do it at 7am so I could avoid traffic and still have time to do some work at the office. My teeth were in perfect condition but cancer had invaded some of the soft tissue around the teeth. Luckily not the jaw

  • JC F
    JC F Member Posts: 74
    #13
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    donfoo said:

    interesting point

    Sash brings up a medical reason why good teeth may be extracted before rads. Like all things cancer, so much depends on the unique characteristics of your cancer. In the extreme, when the jawbone is resected then everything is lost. In a case where the cancer is very near the jawbone and there is no way to avoid beaming rads at the tooth and bone, then a good tooth is likely going to get pulled.

    Guards are used to help reduce rads on the jawbone. Rads may bounce of metal crowns and that might cause long term issues. So many factors - it all depends as they say.

    Thanks for all the replies...

    The cancer clinic dentist checked, probed, and x-rayed everything today and said I was lucky for a man in his 50's with a major sweet tooth (guilty) that I had little to no damage to any teeth or gums that will require extraction beforehand and should not lose any post treatment as long as I do all the things necessary to protect them. She will do a thorough cleaning and strengthen a couple of fillings to make sure they stand up to the rad brutality...one small mercy...baby steps...

  • donfoo
    donfoo Member Posts: 1,771 Member
    #14
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    Jeff2159 said:

    Teeth pulled

    I just had 3 lower right jaw teeth removed after radiation in Dec 2012-Jan 2013. Prior to extraction I had 20 treatments of the hyperbaric oxygen treatment and then 10 after extraction. The commitment to HBOT everyday M-F for 2 hours was the only pain. Luckily it was only 20 min away and I could do it at 7am so I could avoid traffic and still have time to do some work at the office. My teeth were in perfect condition but cancer had invaded some of the soft tissue around the teeth. Luckily not the jaw

    what happened...

    My teeth were in perfect condition but cancer had invaded some of the soft tissue around the teeth. Luckily not the jaw

    Your teeth were perfect prior to treatment, right? Even though the cancer was not in the bone, you likely received a lot of rads directed at the teeth/jaw area. Did they explain the teeth failing because of this, is it a case of ORN?

    Wishing you the best that healing is complete and you any further rad side effects are minimal. Don

  • Jeff2159
    Jeff2159 Member Posts: 108
    #15
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    donfoo said:

    what happened...

    My teeth were in perfect condition but cancer had invaded some of the soft tissue around the teeth. Luckily not the jaw

    Your teeth were perfect prior to treatment, right? Even though the cancer was not in the bone, you likely received a lot of rads directed at the teeth/jaw area. Did they explain the teeth failing because of this, is it a case of ORN?

    Wishing you the best that healing is complete and you any further rad side effects are minimal. Don

    what happened

    yes my teeth were in perfect condition and some of the lower teeth have moved as they are not as straight as I had braces as a kid. Yes i did receive rads directed at this area as my surgery site was on the right side of tongue. What is ORN?

  • donfoo
    donfoo Member Posts: 1,771 Member
    #16
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    Jeff2159 said:

    what happened

    yes my teeth were in perfect condition and some of the lower teeth have moved as they are not as straight as I had braces as a kid. Yes i did receive rads directed at this area as my surgery site was on the right side of tongue. What is ORN?

    Consider a specialist

    Hey Jeff,

    There are a few here who have ORN. Osteoradionecrosis. Here is a fast link http://emedicine.medscape.com/article/851539-overview. One of my personal long term concerns is the development of ORN for the potential for significant dental and jawbone issues.

    Who extracted your teeth? Was it a oral surgeon specializing in oral cancer patients? Since you had HBOT, the dentist was surely aware of the radiation to the jaw. It appears ORN was not mentioned. What was the reason for the rapid decline in these teeth, tissue, bone?

    The teeth moving enough to prompt extractions seems unusual for a relatively short time post. What is the view on any further degrading of the teeth, etc? Read up and get armed with plenty of knowledge and ask some hard questions. If you are not 100% solid go find someone who is more experienced. Good luck, Don

     

  • BruceGLarson
    BruceGLarson Member Posts: 22
    #17
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    I did not have any taken out

    I did not have any taken out specifically for the radiation either. However, during surgery, they had removed all the lower teeth and I am now waiting to get the go to look into dentures.

    Were you fitted for the mask for radiation?

    If you have time, check this out: http://www.hypeorlando.com/orlando-helping-orlando/2014/06/15/cancer-radiation-and-the-bell-that-never-was/

     

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