At first they wanted to extract everything. My radiation oncologist spoke with them that is was going to be IMRT so then they backed off and just want to remove the teeth most vulnerable to the radiation (basically all of the molars and teeth on the right side of my mouth). I have been very vigilent throughout my life with dental hygiene, seeing the hygienist 2 -3 times a year, flossing daily, etc. Anyone with IMRT experience out there wish to comment on their experience? I have like 2 days to decide what to do!

You should not be having healthy teeth taken out. Only those teeth which are compromised in some way, such as with periodontal disease or large caries should be removed. Removing perfectly healthy teeth just because they are in the path of the radiation beam is not right. I have a full compliment of teeth in my mouth, and I had the maximum doses of radiation in all areas except for the maxilla and mandible right in the front of my face. Post radiation 5 years now, all those teeth are still healthy. I work hard at my dental hygiene which is difficult because of the acute dry mouth and the fact that xerostomia allows plaque to build up on my teeth very rapidly. Plaque turns to calculus, which in turn will allow periodontal (gum) disease to get a foothold. What they are afraid of is that some tooth might be compromised, not by radiation but by other things after your treatments. If it does you could have a serious problem. You should not have dental extractions after your radiation treatments because of the risk of osteoradionecrosis. Some doctors go overboard and take things out that are healthy just

I found a Syllabus (DS464B) from UCLA about "Dental Management of the Irradiated Patient" It is very complex, detailed and controversial. Basically if the radiation to the teeth can be kept below 5500 cGY, osteoradionecrosis (ORN) rarely happens unless the teeth are in bad shape. In other cases ORN has been exacerabated BECAUSE of extracting all the teeth. In some cases ORN hasn't showed up for over 20 months after treatment. Sometimes the teeth killed can be saved by root canals and there are also alternative treatments to hyper baric chambers. The paper was written by J. Beumer, R. Nishimura and T. Curtis with sections on radiation therapy of head and neck tumors contributed by Kenneth T. Shimizu.

John had IMRT. His tumor was base of the tongue. He did not have any teeth removed. He was told to see his dentist before beginning radiation. He had a floride treatment. He just saw the dentist a week ago and he said that he felt that John's teeth were in good shape. The dentist did give him floride to use at home during radiation but he did not use it as faithfully as he was supposed to. He had so many things to do--ie rinse four times a day with nystatin for thrush, magic mouth wash for pain, etc. There were just not enough hours in the day because he would do a rinse and have to wait a half hour or so to even drink water.
Good luck
Meredith

Gary I am familiar with this, and you are partially mistaken in it's interpretation. ORN doesn't happen to teeth per se, although extremely high doses of radiation can kill anything. It involves any tissues which have lost their ability to heal as a result of irradiation, so when they are damaged, (such as the mandible after a tooth is extracted leaving an open socket/wound) they don't heal properly and the exposed tissues die. For most of us, ORN is mainly an issue of the irradiated tissues response to future trauma. In reference to post radiation extraction, that definitely exacerbates ORN since you are traumatizing tissues with limited healing capacities when you do the extraction. As to the death of a tooth itself, the radiation treatments most frequently cause decalcification and demineralization of them and they become easy targets for conventional caries. When caries expose the pulp chamber (in normal people too), the tooth dies. Root canals never actually save teeth. The tooth is still dead, but they remove the nerve fibers and micro vascularization within the root canal itself with reamers. This is then filled back up with an inert product like gutta percha. The tooth is dead, and even the little fibers that hold it in the bony socket are dead too. So it becomes fixated into the bone permanently or ankalosed. With no blood supply, the tooth over time becomes brittle and is subject to fracturing. If you have any teeth which are compromised significantly the prudent thing is extraction prior to radiation. Anything that they/you decide to keep better be in good condition, and more importantly the surrounding tissues and your perio health must be optimum. Even today I worry about taking a spill off of my Harley that might fracture my mandible, or knock out a tooth. ORN would be an issue to me for sure.