Hi,
I'm now 5 months post radiation and went to see my periodontist for a cleaning and to assess the impact that radiation had on my gums. It seems the combination of gingival and periodontic disease plus radiation had caused some of my gums to recede significantly. My periodontist suggested a gum graft to build them back up again, the target area is a location that was part of the radiation field.

During my 6 week check up with my ENT doctor, I asked about doing a gum graft on radiated tissue and he said it was a bad idea, that radiation reduces the blood flow to tissue and that increases the chances that a graft would fail. I then asked my oncologist the same question and got the opposite response, that blood flow to radiated tissue is at its greates in the 3-6 months post radiation and decreases from there.
My question is whether any of you have had a gum graft or other graft procedure performed on radiated tissue and if so, what your experience has been. Thanks, Sheldon

Sheldon,

I've had gum grafts post-radiation, but not so soon after (as I recall, I had at least a few years between radiation and the first graft). It was done by the same oral surgeon who diagnosed my cancer and who assisted in my glossectomy and neck dissection, and I know he took a lot of precautions in doing the graft because of my history. I had no problems with it, and it was relatively successful.

As it happens, I just had a visit with the periodontist today, because the area around my upper wisdom tooth (on the side that had most of the radiation) has been showing significant degradation of the bone. Right now they're using antibiotic therapy in that region in the hope that it won't become necessary to pull the tooth.

Cathy

Sheldon,

I wasn't sure from your post if your periodontist has significant experience with post-radiation dental issues. If not, get a referral to one and get another opinion. I have heard you have to wait from my ENT and my dental surgeon that specializes in cancer patients.

Ed

Sheldon-

Ditto on what Ed said about discussing further with a dentist/maxillofacial surgeon regarding latent effects of radiation on such tender tissue. You want to do everything you can to avoid infection and/or decay/caries. I work for a dentist and we have - only recently - seen alarming increases in osteomyalitis and one case of soft tissue radionecrosis.

Super important thing to do for the rest of your life no matter what - even if it means going to a dental college for a "cheap" cleaning. Be diligent about cleanings/prophies. Three months is the absolute longest you should go.

Change the way you brush or what you brush with. A SoniCare toothbrush vibrates and their heads are very soft but effective. The vibration actually helps increase - sort of like massaging - your gums. DO NOT saw back and forth with a regular toothbrush as that pushes the gum further back. The SoniCare can be gently moved without the standard brushing motion.

Depending on the doctor/dentist they may or may not based on the nuances of your situation, recommend use of a water pic (on the lowest setting available) to rinse debris out of the gingival pocket that might be missed when flossing (which should be done diligently, too).

Hopefully you use Prevident or fluoride trays nightly. Little things that make a huge difference! Do I sound like your mom? Now go pick up the towel off the bathroom floor, young man!

Hugs and kisses!

Susan

Hi Susan,
Thanks for the advice. I've done pretty much what you've suggested. I switched periodontists after my surgery to one who is more experienced with patients post-radiation. Problem is that in a small rural area, that may not be much experience. I've asked the ENT in Boston and the periodontist in Burlington, VT to talk among themselves and come to some conclusion. I'm scheduled for a cleaning every 3 months.

I use an Oral-B electric brush, have one at work for after lunch and have gotten very religious about flossing, brushing and using a rubber tipped thingy to massage my gums after every meal. I'm using Biotene toothpaste rather than Prevident since Prevident is a little too abrasive for me just yet.

Since I've done everything you've asked, can I have dessert now? can I? (if only I could taste it!) Best to you and Ed - Sheldon