Brian;
First, let me apologize for the time it has taken to reply to your very informative posts on my upcoming dental decision. In fact, today is the first time I have been back to the OCF website since mid-July due to the sudden hospitalization of my Father-in-Law in July and the on-going caregiving my wife and I have provided him since. His funderal was on Oct 21/08, and with that closes a 93 year long history book. During the last few months we have been focused on health issues other than my own although I did manage to stall off the hyperbaric chamber start date three times already, which was not favorably received.

I found your dental background fascinating particularly in view of my own approximate 20+ years serving the dental community as a financial consultant. I founded a business consulting group that specialized in dental practice valuation and brokerage, transition management, and strategic planning. I got my start working for a division of Citibank Canada that provided a boutique funding service for the health professions, and this introduced me to the dental community as a whole and put me in touch with its many movers and shakers.

Along the way we grew by delivering an excellent product to our clients, but also by merging with a father & son run competitor that doubled our corporate presence. The father, a new business partner back then, was also a well known dentist/entrepreneur on the international dental speaking circuit by the name of Dr. Wayne Halstrom. Halstrom invented the Halstrom Hinge, the patented component in the "Silencer", a dental appliance that helps those who snore and suffer from sleep apnea. One of my current dentists who has provided me much support and guideance is Dr. William Liebenberg, another well known and respected international speaker on dental efficiency who you may know. Another former client & long term friend is an oral surgeon by the name of Dr. Harold Bergman who developed and marketed the first simplified titanium implant system that could be installed by a general dental practitioner. I used to attend all the regional and national dental conventions in Canada as an exhibitor (but not as a speaker...), so it wouldn't surprise me if our paths had crossed or came close to crossing at some point in the past. It's a small world, but as Stephen Wright once opined, I wouldn't want to paint it!

I really appreciate your common sense advice about seeking a second formal opinion. I met with my primary dentist, Dr. Terry McKay (he referred me to the OCF website in 2006), a week or so ago on this matter and he suggested he would contact the oral surgeon again to relay some of my concerns which I hadn't shared during our short in-the-chair consultation. To be honest, I haven't built a lot of confidence in my appointed dental oncology team, preferring to rely on my discussions with McKay and Liebenberg who I have known and sought treatment from for 30 and 15 years respectively. While they both operate very progressive, cancer-savvy dental practices in North Vancouver, BC, they are not members of my official oncology team at the Fraser Valley Cancer Centre, much to my chagrin.

A month or so ago I felt an unusual item in my mouth which turned out to be one of my lower molars that had broken loose at the gum level. I experienced no pain, but suspect that what remains in my lower mandible could become a problem in the future.

In addition to the loss of my teeth and the resultant cosmetic consequences, my primary fear is the lack of access the surgeon will have to perform any extraction or fulfill any subsequent restorative preparation, ie implants or partial dentures. McKay is confident he can maintain my upper and lower front teeth well into the future, but his concern has been basic access to the posterior area as well.

Like yourself, I maintain a constant vigil on routine preventive maintenance including power brushing and the use of various anti-bacterial and flouride rinses.

I find it interesting that there hasn't been a consistent approach to dealing with the exposed bone that has suffered the osteoradionecrosis. My dental oncologist at the FVCC suggested we monitor it over time and deal with it at the time any pain arises. After a couple of years of monitoring the site without any pain, all of a sudden it becomes an issue that requires a signidicant amount of attention. Sure there is evidence of dental caries and on-going deterioration in those areas that are unable to receive a more complete oral hygiene program. This is nothing new however, and why now?

I believe the point you have raised requires an answer. The fact that it hasn't been discussed with me other than almost two years ago when I had the 40 hyperbaric dives is somewhat unnerving. It makes no sense to me whatsoever that post-operative healing is no longer the major concern, particularly in view of the exposed bone that has not healed despite a couple of surgical attempts to remove it by an ENT specialist (a strenuous ninety minute hospital procedure under general anaestetic), as well as by my dental oncologist with a planer, and my primary dentist using various instruments, all with little or no measureable gain.

So far, it has all been about a lack of sufficient access due to trismus (a maximum non-stretched opening of 18mm between my upper and lower front teeth...), whereas healing should be of equal if not greater importance.

I shall pursue that well recommended second opinion, and if I may, will report the findings to this forum upon receipt, and hopefully obtain further insight.

Thanks again for your input to this distressing situation of mine, especially in view of the amount of time your committment and involvement with the OCF website demands of you. It is surely appreciated...

Sincerely,
JT2