I'm not sure that the General Board is the right place to post this message but I will for lack of any better idea.

I want to stress something for folks who may not yet have started treatment that I was not aware of and am now finding out about the hard way. My cancer was BOT right side and necessitated 33 rounds of radiation. I am now in the midst of a delimma as I am needing to have tooth #32 (lower right wisdom tooth) extracted. I am learning that it would have been much better to have done this prior to my treatment for obvious reasons. Perhaps I would have been aware of such had I known about and had been familiar with this forum at that time. The tooth that I am about to lose acts as the rear anchor (as I call it) for a four-tooth bridge, all of which I am now going to lose. The real "kicker" is that I went through all sorts of procedures on this same tooth in preparation for this bridge only weeks prior to my cancer Dx. That's neither here nor there as there was no way to know at the time that I was about to be declared a cancer patient. It also seems that there is no way to really determine if the radiation caused the problem I now have with this tooth or not. It may even be that the tooth would not have held up regardless. The point is that most likely this tooth, along with the 5K bridge work, should have been removed prior to my treatment.

I am not trying to assess blame in my situation but only want to make everyone aware who might be getting ready to begin treatment. I think it would be most important that you have a dental eval ahead of time even if your planned treatment team does not mention it. Over the months I have monitored the postings here it seems as though many people do have such an evaluation. It was never mentioned to me prior to treatment even though there is such an Oral facility at the same facility where I received all of my care and Tx. Perhaps the duty was on me regarding this issue but such never occurred to me as having never experienced anything regarding cancer personally or within my family. It may now be much more complicated and involved for me now to deal with this issue when it would have been much simpler beforehand.

Bill D.

Bill, I may be all wet, and not knowing anything about your case, it's only a guess. I worked in the dental field 30 years and know that not all Dr's are equal. It's hard for them to think outside the box at times. Has your Dr. suggested cutting the bridge and saving at least one pontic with the front anchor crown/s?(Even if temporarily).
I only once saw it, but there exists a type of implant that is a framework over the bone, rather than into the bone. I wonder if that might be an option for post-cancer patients. I must say, the one case I saw was remarkable. she had no lower teeth,little bone and dentures she couldn't use and was very skinny. a few weeks after treatment, she was eating even corn nuts (not recommended) and gained 50 pounds in a few months. It certainly doesn't help the loss to date, but if it would work, might be a way to replace the bridge. Wish you good luck whatever comes and thanks. Your sharing may help a LOT of people.

Bill, I am surprised to hear that you were not informed about the importance of getting the ok from a dentist prior to treatment.Ihad 6 weeks between diagnosis and treatment, and in that time saw many doctors. The most asked question was have you been to the dentist? No? Then get there ASAP. I do not believe it was your duty to figure that one out. I would never have thought to get a dental eval. on my own. The dentist scares me!

Hightower,

Welcome to the OCF.

A couple of comments from a dentist that does think out of the box (most of the time). You've made some very interesting suggestions and your 30 year relationship has certainly helped you to know a lot about dentistry.

The type of implant that you described is called a subperiosteal implant. They actually were the first types of dental implants to be used and I don't think that there are many, if any, being placed today. There was a high degree of failure with them. In any case, you would be right that these would be less invasive and the only thing going into the bone would be the screws holding the framework to the bone. However, the technique requires at least two appointments, the first one being a surgical exposure of the site with an impression of the bone. After healing and fabrication of the framework, a second surgical procedure is needed and if the framework fits (often not from what I've heard) then it is screwed into place. Osseous implants, as done today, are all done in one visit.

I have discussed with Bill via email the idea of saving the the anterior abutmant crown and he said that this was already discussed with him by the dentist. I think keeping one pontic hanging off of a bicuspid crown, would put too much stress on the tooth and the bone around it. What I have suggested is that he check into the possibility of having the implants at the same time as the extraction and therefore avoid the possible need for additional HBO dives for the implants if done at a later date.

What was your realationship to dentistry?

Jerry

Girl,

With the passage of time I have learned a lot more than I knew going into it and I too am surprised on the dental issue. I have my next checkup round in late October and I plan to voice my concern to my ENT, Med. Oncologist and Rad. Oncologist. It would seem that at least one of the 3 areas, if not all, would have stressed a pretreatment dental evaluation. Also, I might have signed papers to acknowledge the potential threat but I do not recall even a nurse along the way telling of possible oral/dental issues from radiation. This, even over and above the fact that Emory Hospital here in Atlanta has an Oral/Dental department that works closely with their Winship Cancer Center.

Bill D.

Bill - I totally agree with you that you should discuss this with your medical team. It should NOT have been your responsibililty to think about it!! I was treated at MD Anderson and they would not even do my initial surgery without having the consult completed with their dental oncology department. At the time, they did not know if I would have R/T but they were VERY thorough in their dental examination, full set of x-rays, etc... It should be part of the protocol...

Ginny,

You are correct. I went into Tx never once thinking about dental/issues. I had no reason to think of it having had absolutely no experience with cancer, personally or via relatives. Emory has an oral/maxifacial dept. facility pretty much in-house right there on the main Clifton Rd. campus.

Needless to say, there is nothing that can be done to reverse the potential problem I might now be facing. If nothing else, maybe at least one other person with Tx still to come will be made aware.

Bill D.