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