Hope you are checking the board Brian, as I always value your advice. Kelly went to the dentist yesterday for his regular three month checkup. Prior to radiation we had seen the dentist at MD Anderson, Kelly has two baby teeth that are still there since there were no permanent teeth to push them out. They said the teeth were ok and should not give him any trouble. So, he had radiation. This time, xrays showed that one of the baby teeth has lost its roots and there is a black spot on xray under it. Dentist said it could be an infection. Wants to send him to an oral surgeon (here in our little town) to have it removed and then drill something into bone and then put on a new tooth. I am kinda scared of them doing this as I remember them saying it was not good to mess with the bone after it has been through radiation. Have you ever heard of anything like this? Thinking about calling our research nurse or the dentist at MD Anderson. What do you think? thanks!!
Julie

Well, I need a little more information to give you really sound comments, but I will speak in generalities for now. Extractions after radiation treatments can be dangerous because the bone around the tooth extraction site doesn't always heal properly. Radiation causes hypovascularization, and with this diminished blood and oxygen supply, it just doesn't behave the same any longer. The condition that becomes a problem is called osteoradionecrosis. It involves an area that just will not heal properly, and this can become a major problem. How much risk this involves is usually dependent on the total amount of radiation exposure, and the amount of time out from the actual treatments. The longer the better, but after a certain point it really doesn't improve any more. The healing process can be augmented by saturating a person with oxygen prior to the surgery and during the healing in a pressure chamber like those used to treat SCUBA divers for the bends, except they increase the amount of O2 in the breathing mixture. It can take from 20 to 40 "dives" in a chamber to get the desired effect.

Most likely what the doctor is referring to is a titanium dental implant. These are a proven treatment in normal people with success rates in the high 90% range. Success in radiated patients is not as good. The titanium post becomes osteointegrated right into the bone permanently, and a false tooth made from porcelain over a metal understructure can be cemented or screwed to the top of it.

Re: the area of darkened radiolucency on the x-ray. This indicates an area where the bone has died back, or where an abscess might exist at the tip of a root. If it is an abscess (I cannot tell you this from what you have told me) the safest treatment plan would be to not do an extraction and implant, but to do a conventional root canal treatment, combined with antibiotic treatment for the associated infection. This eliminates messing with bone that is already compromised, and may not heal properly. If it is an area of dead bone, then it is likely that the tooth would have to be taken out. Your reference to the root itself being gone, is confusing, since there are few things that would cause the destruction of the root itself, especially after it had been there for so long.

Before the surgeon decides to extract the tooth, be sure that he is completely aware of the radiation treatments, understands the consequenses possible, has a contingency plan if healing becomes and issue, and that the possibility that this is not just an abscess which could be treated with antibiotics and a root canal has been eliminated from the differential diagnosis.

Lastly, you know that I think the people at MD Anderson walk on water, and calling them for an opinion before you leap wouldn't hurt anything. I can give you the name of someone there, who I trust implicitly, but I prefer not to post Dr's names in the forum. Let me know if you want it by email.

Thanks for the info. I think I will call our research nurse (for the clinical trial of chemo-prevention he is in) and talk to her. Then I might call the dental oncologist we had at MD Anderson. Kelly really liked him and they should still have his xrays and all to look at the tooth I am talking about. Since it was a baby tooth it had very small roots going down anyway, but they said from one xray to the next, the roots it did have are almost completely gone and there is a black spot under it. What they were talking about doing sounds like what you said. Putting something down into the bone and waiting for about 2 months till it healing and then attaching a fake tooth.
Thank you again for your help. You are a life light that I feel is always burning bright when I think I am getting lost on this journey of ours. I really appreciate all the hard work you do with this forum and everything else.
Julie