Anyone have any experience with needing to cover or shield metal dental work from rads?

I rec'd a call yesterday from a surviving patient of RO#1. He let me know some about his experience (stellar - probably the "best patient" the dr. had).

He mentioned having metal in his mouth (fillings, crowns), and the need to cover the metal for tx(in his case, by buying and wearing a mouth guard from Dick's Sporting Goods and using wax during treatments). He said this was much cheaper than having a guard made by a dentist.

I had read here that teeth need to be in good condition prior to tx, but hadn't seen any notes on metal. I just had build-up work done on two teeth in preparation for upcoming crowns (metal overlaid with porcelain) and a loose filling replacement.

I had asked my dentist about flouride trays (saw lots of comments on the need), and he let his assistant know to add bleaching trays to my estimate for a later appointment, closer to tx time. These are about $200 for the set. He also said he'd order flouride for me when the time came. The dentist did not mention a need to cover my metal during treatment. I also have a metal retainer cemented in - will it need to be covered or removed?

I had 2 old metal fillings prior to rad and my dentist replaced those with the non metallic ones.

Hi Pam,

I had a number of ceramic crowns during treatment (I don't recall if I had metal fillings, since I was at that time on a program with my regular dentist to change out all of my old metal fillings). I did not have any issues or need anything during treatment.

The flouride trays, I was told, should be used during treatment - my normal dentist was not a good or knowledgable source of information on any of this; I saw a dentist who had a specialty in H&N radiation patients regularly during treatment.

Outside of having a knowledgable dentist, your RO should be able to provide some guidance.

Best wishes,

Chris

My understanding is that metal fillings are a problem for imaging (and so are also a problem for planning radiation treatment). I do not know whether metal fillings are a problem for the radiation treatment itself.

For imaging, metal fillings can cause distracting "artifacts" which make the image difficult to interpret. With enough "artifacts", the image may become useless. There are alternative imaging strategies that can avoid the artifacts if the equipment is capable enough (I don't recall exactly, its something like using higher frequencies, or high energies, than usual. I think its pretty common these days in CT imaging.)

I have quite a number of metal fillings, as well as several crowns. Everyone who reviewed my full mouth X-rays agreed that my teeth were sufficiently healthy that no dental work was needed before my radiation treatment. I think the primary concern was whether I had any dental infections... fortunately, I didn't (and still don't). Such an infection might normally require a root canal procedure; however, if one is discovered prior to radiation treatment, I think they usually recommend that the tooth be pulled (as there usually isn't time for a root canal). I've heard of some people getting many teeth pulled.

Rob

Metal fillings cause artifacts with low energy X rays (i.e. a CT scan with kV energy). In the MV range this is not a problem.
I too have several metal fillings and the focus of the irradiation was the anterior mobile tongue, i.e. the portion between your teeth. No teeth were removed prior to IMRT, with enough irradiation positions they could get around the metal. However, if there are extensive metal parts obstructing the radiation path then this may be a problem.
I am a bit perplexed about shielding dental work form x rays. This is not going to work x rays are not deterred by wax.
What you can do is use wax or cotton to move lips a bit out of the radiation field.... but only if the RO is on board with this.

M

I had the classic silver/mercury amalgam fillings throughout my mouth throughout the entire first 72GY of radiation. My oconological dentist did recommend that I wear the flouride trays during treatment. Why: he was concerned about potential heating or redirected radiation from the fillings. It gave me a sense of comfort but perhaps that was just because it did keep my tongue off the extensive fillings and the teeth themselves. I know when I posted this earlier that the "science" behind that was questioned. The issue was moot to me by then.
I do know there was extensive artifact splatters on my original CT that discovered the cancer which was attributed to my metal fillings in the radiologist's report.
Months after TX was over, I did get four crowns and three root canals (including a cracked wisdom tooth) and the new fillings are plastic and didn't need HBO or anything special.
So bottom line: my metal fillings didn't negatively impact my TX and I did wear my flouride trays during radiation TX with certainly no ill effects or discomfort.

I had all my metal fillings replaced years ago save one. The dentist at the time said that one was fairly small and in great shape and did not need any work.

I went into treatment with that one small filling. It did not interfere with the radiation field as I was getting some shots to the back of the throat (from the side) and the rest to the nodes. That radiation field hit the nodes first and then hit the tooth.

I also had a tongue block during treatment, which is a tongue depressor with a big chunk of foam on the end that I had to bite down on. This is meant to move my tongue out of some of the radiation field or something (I never understood that part). I did not have a tray because of the tongue block (too much)

The point here is that the worst of the Ulcers I got was right next to the filling. My RO said that the filling had lensed a small concentration of radiation into the tongue.

Kelly