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Tooth or Consequences

ejourneys's picture

A recent thread on the WhatNext.com forums asked if any of us had experienced problems with our teeth during or after cancer treatment. The answers give a tour of dental "collateral damage."

After my cancer diagnosis in early 2014 and before beginning chemo, I'd had dental work done. That including extraction of an abscessed tooth that had split down the middle and couldn't be saved. The work concluded with my getting a crown at upper left (I think that's tooth #15, since I've had all of my wisdom teeth removed).

During chemo I had kept myself very well hydrated. Even so, I would wake up from thirst in the middle of the night and kept a water bottle by my side at all times. I used prescription toothpaste and an extra-soft toothbrush. Cancer treatment is notorious for doing a job on teeth. Chemo dries the mouth out like nobody's business and that dry mouth provides a foothold for bacteria in a body whose immune system has been compromised. It's a double-whammy. And that's not including the effects of radiation, if one receives radiation to or near the head.

Post-active treatment, my dental cleanings looked good. So did my X-rays, once we had waited a sufficient amount of time after I had finished radiation. I thought I was in the clear.

Then word came down that my upper right molar (#2) needed a crown. I gave my partner a heads-up that if I seemed a bit out of sorts, it was because I felt some mild discomfort and had to concentrate on chewing on the other side of my mouth for a while. My partner wanted a reminder in case she forgot, which led to this extra art doodle "quickie" in May:

I had noticed extra sensitivity once my permanent crown had been placed, in a way that felt much different from my earlier crown (and much different from my other two crowns, dating back to the 1970s and 1980s). My dentist gave me a gel, which made no difference, and my tooth sensitivity worsened.

On Saturday, July 23 -- about 1-1/2 months after placement of my permanent crown at #2 -- I emailed my dentist that the throbbing pain I felt seemed to originate around the crown and radiate from there to my lower jaw. The pain could last for hours after eating and it also awakened me during the night. Interestingly, I did not feel pain while brushing with a regular soft toothbrush.

Obviously this was no ordinary "sensitivity." The pain I felt reminded me of the pain of the abscessed tooth that had split (#31). I also noticed that my right cheek had started to swell. Initially I had suspected the crown, but biting down suggested otherwise. With the extraction of #31, my crowned #2 had nothing to press against. My pain seemed to come from #3, the tooth next to the crown.

I called my dentist's office first thing Monday morning (7/25). My dentist was off for the day, but she had spoken to her assistant on Sunday and given the go-ahead to put me on the antibiotic Clindamycin. (I am allergic to the penicillin family.) Her assistant X-rayed me again -- I learned that ordinary dental X-rays don't extend to the ends of the roots. Sure enough, there was a suspicious shadow at the end of a root on #3.

(These days I make sure to ask for the neck guard in addition to the regular X-ray protection apron. The risk of thyroid cancer increases after a breast cancer diagnosis and vice-versa. That was news to my dentist's assistant.)

The assistant told me that the Clindamycin should eliminate my pain in a couple of days. By the time I saw my dentist on Thursday (7/28), my pain had decreased a little but still required regular applications of Anbesol -- and my swelling had increased, plus I was running a low-grade fever in the evening. I'm a person who usually runs cool.

My dentist added Flagyl to the mix, and we made an appointment with an endodontist for a root canal. The good news is that despite the pain and swelling, tooth #3 is in good shape structurally.

Each antibiotic must be taken four times a day, six hours apart, and they can't be taken together. My pharmacist told me that the Clindamycin and Flagyl should be spaced at least two hours apart from each other. I was already spacing out the vitamins I was taking to fight against bone loss from anastrazole, and taking anastrazole to fight against cancer recurrence.

That added up to one heckuva pill-taking schedule:

My cheek swelling is shown in the top shots. The schedule at the bottom comes courtesy of Free Alarm Clock, a terrific program that lives on my laptop.

I wondered how in the world I was going to get any sleep. I felt beyond grateful that I live and work on flex time.

Pretty soon I was also thankful for my tablet, because I now have my ten pill-taking alarms set on that, too, and have been taking it to bed with me:

Not having to keep resetting my manual bedside alarm clock makes a big difference. These days I subsist on what naps I can. My tablet wakes me up, I take my pill (and need to remain upright for at least ten minutes afterward when taking the Clindamycin), and usually I can get back to sleep for something between one and three hours before the next alarm goes off. In addition to notes on my laptop and tablet alarms, I've printed out a cheat sheet of what I take when. I've already had an anxiety dream that my alarm woke me and I took the wrong pill. But hey, I achieved REM sleep! *fist pump*

After 22 doses of Clindamycin and 8 doses of Flagyl, I think my swelling has decreased slightly. My pain has decreased significantly. It's not entirely gone, but I haven't been tempted to use Anbesol. I say "tempted" because anything containing alcohol -- including Anbesol -- is contraindicated with Flagyl.

As someone without a smartphone, I have high praise for my tablet. My main reason for purchasing one was to give me online access in case I was hospitalized again, since my hospital has WiFi. ArtRage for Android has gotten me through time spent in waiting rooms, especially those whose TVs interfere with my reading. Other features are icing on the cake. Now another medical use has endeared me to the technology.

My dentist had given me clearance to meet my friend Kathy for lunch on Friday, plus I had gotten to the point where I no longer had to do things like pulverize my salads into gazpacho. Eating out with a friend was a treat in more ways than one. The photo for my July 30 quickie was taken on the road:


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Original shot:

I have no idea what this building (adjacent to Towne Square Mall in Spring Hill, FL) is used for, or the significance of the gigantic Adirondack chair.

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