I asked my dental hygienist today if I still should be using flouride trays every day. She said she used to think that it should be for the rest of your life, but know she is hearing different things. So she said it was up to me. What were you told about flouride treatments post-TX, and do you still use it and how often?
Also---anyone hear of, or use, MI paste? It's a calcium phosphate paste that you leave on teeth for 3 min. then swallow.
My hygienist suggested it as an alternative to flouride.

I would like to add that for the first time ever, my dental cleaning included an oral cancer screening. Making progress!

I like you were told by my dentist to use the trays forever. I will ask him the next visit if he still is on that plan. I wouldn't care one way or the other because it's pretty much part of my nighttime routine and I take them out right before I go to sleep. I also keep them on for 30 mins.

I wish I had some teeth to try it on. LOL and then try the teeth on some good food.

Yep.. here too... lifetime

Now when I go to the dentists office they do not even offer to do a fluoride treatment, cause she already knows....

Kevin

Sorry Jim!!
Wow, David--30 mins? they told me 5. It has also become routine for me, not that big of a deal. I was just concerned about the amount of flouride I would be getting over a lifetime, and if it was dangerous in any way.

I can no longer use the stuff I got with the trays in part because the trays don't fit anymore (I had some teeth pulled right before rad and they caused other teeth in my mouth to move around quite a bit--long, frustrating story) but also because that flouride gel really feels like it burns my sensitive gums, tongue aand inner cheeks. So for a while I stopped using anything--which was bad--and then I've been looking for somehting I can use.

Right now I am using an over-the-counter moutwash that my senstive mouth can tolerate--ACT Restoring Mouthwash--twice a day instead of the recommended once a day. I think it helps do what the trays should be doing but is probably not enough. I am very careful to not swallow the mouthwash, and never swallowed the gel either, so I don't think the flouride you get should be an issue.

I'm planning on talking to my dentist more about this next time I see him. It's looking more and more like I will have this surgery this summer to release the trismus in my jaw which should help my dentist get in and see what's happening with my back teeth and maybe make me some new trays. I'm mainly having the surgery because of the need for better dental care than I can get with the limited range of motion I have in my jaw right now. But the whole thing seems neverending.

Anyway, I am curious to learn what other people may be using as flouride treatments since that would help in my conversation with the dentist.

Nelie

I was told to keep them on for a minimum of 3 mins but not to drink for 30 so I figured I would just keep them on for the whole 30. I used to do it first thing in the am but my dentist said switch to bedtime which I guess makes more since. Anyway he knows I keep them on for 30 and he hasn't said anything and I have never had any issues so I hope I'm not creating a later problem.

I was told I would need to use my flouride trays for 10 minutes a day (before bed recommended). Almost every day for a year I used them. The occasional time I did not use them, I brushed my teeth with the gel before going to bed (it was quicker). My teeth are in great shape and I lost only 1/3 of my saliva. I bet it's even less now. The oral surgeon who made the recommendation recently told me that 3 times a week was fine for the trays. He said they really are not sure how often they should be used, and I would do no harm by using them more. He tells people every night and hopes for three. Now I use them 3 times and generally brush with flouride on the other nights. I'm guessing if my mouth was dryer or my teeth in worse shape, his recommendation might have been different.

hi i hope you dont mind me jumping in but what trays????? no one has said anything to me about trays, i havent been using anything other than biotene tooth paste and mouth wash, i have an appointment with my hygenist in april should i ask?

thanks Debz

I have to admit that I have become lazier about the trays. I use a .09 foam and the dentist uses a 1.8 strength foam so I wouldn't stop in office flouride treatments - remember to bring your trays - it's much more comfortable than the "one size fits all type". I do go every 3 months for cleaning. I have to pay out of pocket for 2 of them but it is cheap insurance. My gums are healthy, I floss nightly and religiously use Biotene toothpaste.

And, yes, there is a lifetime risk of ORN and radiation is very hard on the gums.

Debz, most of us had dental trays made prior to Tx. They are basically the same type trays that many use for whitening their teeth. It's around $200.00 but worth it.

I prefer a prescription foam type flouride that I get from the dentist. It is pH neutral (i.e. no burning sensation) and can even be used during treatment with relatively little discomfort. Oral B and Butler make similar fouride foam.

I have very good salivary function now. When I had dry mouth issues I used the trays several times a week. It is essential if you want to protect your teeth from decay.

Hi all,
Gary makes a great point when talking about dry mouth and the use of fluoride. He has posted in great detail about his dental journey in the past and what he has experienced, and he has experienced it all, unfortunatly for him. As usual he is accurate and timely in his advice. I offer the following information to provide assistance to any who may require it.
When chemo/radiation impair the function of salivary glands the bodies natural protective mechanism for our teeth becomes impaired. The best way to protect your teeth when this hapens is with the regular use of topical fluoride. Fluoride application will also reduce tooth sensitivity caused by gum recession and dry mouth as well as strengthen the interface between fillings and enamel. Some fluoride releasing dental filling materials will as well be recharged with fluoride upon topical application these are commonly known as Glass Ionomers.
There are many choices when choosing a topical fluoride. Rinses, gels and foams. All are proven to have no significant differences when used properly. As Gary states, you should choose a pH neutral fluoride. It won't give you the burn feeling and as well, it will not affect adversly any porcelain or composite (bonding) that is present in your mouth.
Custom fabricated trays are a great idea. They fit well, hold the fluoride against the teeth and will cause you to use less fluoride. Fluoride can be toxic if ingested in some individuals if enough is consumed (mind you it takes a lot). It can also cause stomach and GI problems. Make sure you are using the appropriate concentration. It is recommended, and most manufacturers of topical fluoride products follow these guidlines, that for daily use a concentration of 0.05 neutral sodium fluoride be used. There are many different brands Oral B, Butler, NuFoam to name a few and most pharmacies in North America carry them or can order them for you. If not, your dentist can order it for you.
Weekly application should be a concentration of 0.25 neutral sodium fluoride. Your dentist should be your partner in this endeavor so that you have someone to guide you and answer any questions or address any problems that may occur.
Gary, the foam is a great product. Foam fluoride bottels should be stored at room temperature with the top of the cannister on the counter top or upside down. This will ensure that you will not waste the fluoride and that the "gas" that propels it out of the cannister is always pushing the fluoride out.
Fluoride foams basically have the same appearance of hair mousse. When utilizing foam products less is more. Fluoride is diffusive and will spread through your mouth or tray with the help of saliva even if you don't have a lot. A note of caution that should be mentioned when foams are being considered is that some manufactures use egg white protein to produce the foam. Anyone who is allergic to eggs should read the label carefully or choose a gel or rinse.
Discuss the protocols with your dentist and be sure to maintain your regular cleanings and exams and you may also want to increase the frequency of these visits even if there is an out of pocket expense.
Cheers,
Mike

Dr. Mike,
thank's for the tip about storage. I had to throw out an almost full can of Butler foam because of that. The Oral B seems to have a better shelf life (and it comes in more flavors ;-)

Dedz,

I'm surprised your dentist didn't at least mention possible tooth problems years post Tx from the rad? Anyway you should ask now. When we say trays they are actually molds of your upper and lower teeth that you apply a thin strip of fluoride, either paste or foam, and let it sit on your teeth for sometime, which is the topic of this thread. It is supposed to make the teeth less susceptible to the potential damage. I started using mine before my rad started and still use them every day.

Debz,
These are plastic trays that fit over your teeth that you put a floride gel in. Your dentist will make them. I was told to wear mine 20-30 minutes a day, every day for the rest of my life. I put them in the morning when I shower. You are not supposed to drink anything for at least 30 minutes after using them. For that reason, using them just before going to bed is probably a better idea.

Nelie,
I use GelKam fruit and berry flavor. It does not irritate my mouth at all and actually gets the saliva going in the morning. I cannot use anything that is mint flavored even now 10+ years later. They all burn. You might give it a try.

Take care,
Eileen

Hi all,
I would like to add that Eileen is right about nothing to drink for 30 minutes after application and you should add to that nothing to eat as well.
Also, for anyone who is or wants to bleach their teeth to whiten them, whitening products will not work after fluoride application. So, use your whitening products before you use your fluoride.
The best time of day to use fluoride, of any type, is before bedtime. Eileen also mentions this in her post for the sake of conveinience but, she as well has picked the perfect time. When we sleep our saliva production goes down considerably. Once again, for those who have a less than normal saliva function, less saliva means less natural defense against bacteria that cause cavities and gum disease. Applying fluoride before going to bed accomplishes two goals in protecting your teeth and strenghtehning them and killing bacteria when your natural defenses are lower. Fluoride is, in fact, a substance that kills bacteria.
Cheers,
Mike

Hi Dr Mike, thanks for the info on fluoride. I've recently been prescribed a 5000ppm fluroride toothpaste as opposed to 1450ppm which seems to be standard. However, I'm not sure on how often it should be used per day.

My dentist said I could use it as often as I like (?), elsewhere I've read you should use it once a day, last thing at night. At the moment I'm brushing 4 times a day, 3 times with normal 1450ppm toothpaste and once last thing at night with Duraphat 5000.

Is this enough, or should I use the 5000ppm toothpaste more often?

thanks for any advice.

John

johnd,
Hi I am trying to convert your "ppm" to conventional concentrations and having trouble. So I will revert to concentration values. In my opion, as my interpretation of fluoride concentrations that have a beneficial effect before/during/after chemo and radiation therapy according to the research I have read is that; 0.05 sodium fluoride for daily use and 0.25 per cent concentration of neutral sodium fluoride for daily use.
As far as the ppm or (parts per million) designation that went the way of the horse drawn carriage in Canada (so I have no clue of what 5000 ppm of fluoride is in todays concentrations)
Cheers,
Mike

I can't imagine that any OTC toothpaste would be as effective as prescription foam.

The instructions for the foam I use are 3-5 minutes and no water or food for at least 30 minutes. As Doctor Mike suggested, I only use the trays before bedtime.

Another tip - if you are in treatment or freshly out of it use a baby's toothbrush. Put your Sonicare away for the duration. Regular and electric toothbrushes are far too abrasive on damaged tissues.

[quote=Dr. Mike]johnd,
Hi I am trying to convert your "ppm" to conventional concentrations and having trouble. So I will revert to concentration values. In my opion, as my interpretation of fluoride concentrations that have a beneficial effect before/during/after chemo and radiation therapy according to the research I have read is that; 0.05 sodium fluoride for daily use and 0.25 per cent concentration of neutral sodium fluoride for daily use.
As far as the ppm or (parts per million) designation that went the way of the horse drawn carriage in Canada (so I have no clue of what 5000 ppm of fluoride is in todays concentrations)
Cheers,
Mike [/quote]

Hi Dr Mike, 5000/1000000 = 0.05, so 5000ppm is equivalent to your 0.05 fluoride, which is what I thought.

My question is really 'What does 'daily use' mean?' - once a day or 4 times a day? Is 'more' always better, or is there an optimum amount?

cheers
John

johnd,
0.05 % fluoride should be used once a day. I think any more use than that would have and insignificant advantage as the research already states that that is the best for protection.
Cheers,
Mike

Thanks Dr Mike.

My "radiation dentist" (recommended by Georgetown CCC) points out that his TV and movie clients with all caps etc, also need to use the flouride trays for life, so we are in good company . Plus we are all having "youth" problems,as our risk of decay and caries is closer to children and teenagers than seniors, so we need our flouride
I was also told to use the trays without any flouride for each RT since I had so many metal fillings that the "scatter" would have burned my tongue and mouth even more. I could not deal with the flouride many nights during treatment due to having to rinse the mucous before sleep (and every two hours during the night) but use it regularly now.