So my husband Michael went for a root canal on April 12 and one extraction on April 13. He had the twenty hyperbaric treatments prior to them and 10 afterwards. We had thought everything was healing up all right although he did not have many follow �up dental visits scheduled with any of the four separate dentists involved in his care,. About 2 weeks ago he had some swelling again and he went back to his regular dentist and he told him that the tooth with the root canal was infected and the tooth is loose. He put him on antibiotics, the swelling did get better, he went back to the dentist this past Monday and he told him that it looked better, but still not totally healed. Today he woke up with a mouth full of blood. He really doesn't know exactly what is bleeding. He is scared and I am scared. He goes back to the dentist today in a couple hours. Any thoughts, reassurance, whatever???

Yikes... Maybe there was puss or something inside the root area and this caused the bleeding... Gums are sensitive. There are a few people here who know lot about dentistry. Thru can probably give you better in site but I would say it's likely the infection TTY not to freak.. Radiation is unkind as you know healing is hard. Sending you blessings.

Thanks for the in-put and good wishes. Michael went to the dentist this morning and the dentist says it is infected worse than it was Monday when he saw him last time. Monday the dentist said it was getting better, but now is worse again. He put him on yet another antibiotic. He was on amoxicillin for 10 days (last day was Monday) and now he is on augementin. These local dentists here do NOT seem to know a lot about oral cancer patients and their problems. I do have a call into his oncologist who we pretty much trust. I do worry too about all the different rounds of antibiotics he has been on since the cancer for various things. Just when we are getting semi close to that five year mark more problems are coming up. Just want him to feel better and my stomach to stop hurting also. Thanks again.

Does your hospital have dental oncologists? Maybe transfer there - we have them at pmh... I get a checkup every few months. They will do any complicated care as well. And since it's a cancer hospital they are well versed in working with OC patients. Good luck!

Hi,
My husband is a general practice dentist. Part of being a competent generalist is to know when to pass on issues. He has no problems referring people on to specialists, but I do know GP dentists who try to do it all. My having gone through oral cancer treatment has given him a special knowledge of the subject, but he does not feel comfortable with treating me for major problems with my teeth. Luckily for both of us, major problems with my teeth have not ever been an issue.

Those dentists associated with cancer centers are the ones to be seeing, but I know if you are a distance away that can be a problem. Contact your ENT or if you have seen any dentist at a cancer center, you might be able to contact them first.

Hope you can get this resolved very soon, not anything to mess around with.
Best,
Anne

Thanks for your responses. So I was finally able to talk with the oncologist�s nurse yesterday about 2:30 and the oncologist was already gone for the day and he is always off Fridays so he wasn�t available. The nurse seemed to think he would defer to the dentist�s opinion. I did ask the oncologist�s nurse about the hyperbaric treatment again and she just told me to talk with the hyperbaric doctor again. I know my husband really did not like the hyperbaric treatment and he feels his hearing and vision have still not recovered fully. I tried to call hyperbaric doctor and he was also gone for the day. It is just really scary and my husband who is usually the calmer of us was also really pretty upset about the whole thing. He sees the dentist again on 8/2 and we are supposed to go away next weekend before then so it won�t be too much fun with this hanging over us. He just finished the last round of antibiotics on Monday, saw the dentist Monday and the dentist thought it looked better, and by yesterday, Thursday the infection was back and worse with the bleeding. We live on the Gulf Coast of MS ( I am previously from outside Buffalo, NY and my husband is from MO) with not a lot of specialists available here in any areas. We went to MD Anderson at the beginning for a second opinion and their dentist thought his teeth looked good at that time. Just hope we are doing everything we should to get rid of this infection at this point.

After someone has had radiation they must be obsessive with their dental care. Having a drier mouth is one of the after effects most of us suffer from. A dry mouth also makes it easier for infections to begin. Ive done many HBO's and wouldnt think this is an instance for it. HBO is normally used for healing lingering wounds and to prevent osteoradionecrosis. A strong antibiotic should take care of an infection. Does your husband have an ENT or oral surgeon? Maybe seeing one of those doctors would be beneficial. Best of luck with this problem.

I'm with Christine about being obsessive w/dental care. His teeth may have looked good at one point, but I guess that was before treatment? The oncology dentists at MDA definitely know what they are doing, if it is not too far it would be worth going back to them. Folks like your husband are the only patients they see!

Depends on the oral surgeon how many oral cancer patients they see; often they are only seeing them at the beginning of treatment, such as when they biopsy. If it is a root canal was he not seeing an endodontist? Radiation makes it all different. They probably have some patients who have had radiation, but do not have the expertise of oncology dentists, how could they? Root canal procedure can go sour sometimes even when the patient has not been through radiation therapy.

You and your husband know your situation and have to make your own decisions.
Best,
Anne

Thanks for the in � put. He does have an ENT, oral surgeon, two endodontists � one who did the root canal and one who cleans his teeth, a regular dentist � who is seeing him now and of course the oncologist. He also has a primary doctor at the VA � who basically just prescribes cholesterol meds for him and shows him his dog�s latest pictures. He really did not like the oral surgeon and I didn�t either. He had a general anesthetic for the extraction and he was barely conscious when they came to get me to send him out the back door and home with me. He could barely walk. The oral surgeon also did NO follow up. If he ever needs another extraction we are going to see someone different. Unfortunately down here on this MS Gulf Coast there are not a lot of choices for specialists in any medical areas. Michael likes his regular dentist and the two endodontists. I just am hoping the current antibiotic works. He is pretty good I think about his dental care after all of cancer issues. It just seemed weird to us that three + months after the extraction it would get infected. I gather all the bleeding yesterday really was scary to him and I know hearing about it while I was at work was to me. I may still call the hyperbaric doctor just to ask. Michael isn�t really fond of the ENT either since he has been the source of several post treatment �false alarms� and has also scared us and we know that he and the oncologist frequently don�t agree on things and the oncologist is the one we both trust the most. Thanks again.

Barbara,
Our previously radiated mouths just do not respond the same way unradiated mouths do. It sounds to me like you and your husband, and perhaps the dentist(s) are not certain if it is the extraction or the root canal that is causing the problem. I guess if it were me I would consult with the doc you most respect/trust, and ask them what you should do, although I don't know how much your oncologist likes to mess with dental matters. Still would not hurt to ask them for guidance. And maybe the antibiotic will finally prevail, it happens.
Anne

In rereading your previous post, I saw that you did consult the oncologist & the nurse though he would not want to mess with dentistry. So sorry, I got confused with all the doctors--I have the same situation in my life now! So seems like your options are go somewhere else in dentistry, getting another opinion (like MD Anderson) or stay the course where you are, at least for a little while longer. Sorry for the confusion.

Anne,

I know that too many doctors / dentists are not necessarily good. The tooth that was extracted and the root canal tooth are next to each other so I gather the whole area is infected at this point. The oncologist is the one we trust the most and he is at a cancer center in Mobile, AL which is affiliated with MD Anderson. I did call the hyperbaric clinic and they don�t really know much either told us to call the oncologist, or the dentist or the ENT. The oncologist will be in Monday,
The oncologist has an oral surgeon who he referred us to previously and maybe we can see him again. This oral surgeon is also not �cancer� oral surgeon, but the oncologist did refer us to him. He just saw Michael once, thought that both teeth should be extracted ASAP � about a year ago. Michael didn�t want to do that at that time. Now he had one of them extracted and the root canal on the other. Life just gets too complicated sometimes. I guess I just want someone to promise me it will all get better soon and life can go on. Hopefully the antibiotics will take care of the infection.

Thank you.

Barbara,
I understand completely about not wanting teeth extracted. My husband told me if I ever had to have a tooth extracted it would be big trouble because having formerly been a tooth grinder the bone is extremely dense. So I try to do the best I can to avoid that scenario. Fortunately I used to have teeth that did not decay--have only one restoration in my mouth which is a porcelain crown. Yeah, I joke a little bit that my teeth did not decay but I got oral cancer.

Sounds like that first oral surgeon might be the one to see, though, if it doesn't resolve here soon. Wishing you the best!
Anne

I thought about your post for much of the day today. Something came to me that could help this make sense. Even though I had radiation in 2007, my immune system is still very delicate. My bloodwork numbers come up on the low side all the time. So I end up being very careful not to be around anyone who even has a cold as I will pick things up so easily. Since my immune system is now compromised, I also get infections easily. Could it be possible that your husband is similar to me? That his bloodwork numbers like the white count and red counts are on the low side. That would make him more susceptible to having trouble getting over a small infection, maybe making it much harder to treat? Just a thought.

Did your husband get tubes put in his ears to do the HBO? Some facilities insist on a patient getting tubes prior to doing HBO. I ended up getting them put in from having ear pain. Then one came out and I ended up getting a new set of tubes before I did my last 30 dives. My vision was getting pretty bad but it did return to normal about a month or 2 after I finished the HBO.

Christine,

Thanks for your thoughts. Michael has his primary medical care done through the local VA here and they do his blood work and it generally looks pretty good. He really doesn�t get sick that often. He does still have the on-going cervical neck / shoulder pains- osteoporosis, bone spurs, etc. He tried acupuncture, and he didn�t think it helped much. But as far as colds, flues etc he stays pretty healthily. He does get tired more easily than he used to. We actually �argue� about which of us is the most tired sometimes. I still think I am � but then I still work full time, have a cardiac condition (with no symptoms other than being tired).

No, he didn�t get tubes with the HBO. His (and my) hearing was pretty bad prior to it. He did actually just (on Tuesday) get two new hearing aides this week from the VA. I am not sure how much he actually worn them yet or how much he will wear them (another thing we �argue� about is which of us is deafer), but I am not a veteran so no VA hearing aides for me. I think his eyesight did get pretty bad for a while with the HBO, but seems better now � he says it isn�t back to where it was pre HBO. We both need current eye exams.

Good news was he wanted to go out to dinner last night and was really hungry and ate a lot � more than I have seen him eat at one time for a long time. I assume that means he is feeling better. He has been on several rounds of antibiotics for a number of years for various things � UTIs and other pre- extraction dental infections (maybe he does get infections easily so maybe my first paragraph was wrong). You could have the correct idea about the immune system issues. Anyway I do worry about him becoming resistant to the antibiotics. I do think doctors prescribe them too quickly for people though sometimes.

Thanks for your in-put. After cancer (and I am really very fond of him), I just get really scared with any little thing that is wrong with him and this infection business is scary especially since it is so relatively long after the actual extraction and root canal. He goes back to the dentist August 2 and hopefully this round of meds will have completely cleared it up.

Thanks again. I am so glad this forum is here - it really does help a lot when something comes up which is frightening and was very helpful when we were in the acute phase of the treatment.

Michael went back to the dentist today and he says his extraction is not healing and he thinks he is getting Osteonecrosis. The dentist wants to talk with the oncologist ASAP. I have a call into the oncologist, but am scared. What do they do for this? He did all the right things with the hyperbaric, antibiotics etc. Help, please..

Is he still getting HBO treatments? Sometimes they have to repair the jaw - I believe... Someone else who knows more than me will chime in... Good luck and I'll sat some prayers!

Cheryl,

No, he isn't still getting HBO treatments - he got the 10 following the extractions and that ended at the end of April. He is scheduled with the oncologist on Thursday. He is off today and his nurse already mentioned more antibiotics and more HBO as possible treatments. Michael is now saying he doesn't want any more HBO - says he still can't see or hear normally since the first round. I am hoping he will change his mind if that is the recommended treatment. One major problem is that none of these people have seen many oral cancer patients or treated osteonecrosis. His cancer center is affiliated with MD Anderson however. It is just really frightening getting this relatively close to the five year mark and now this.

HBO is used for osteoradionecrosis. Sometimes a picc line with IV antibiotics are done along with the HBO. It makes me nervous seeing specialists who are not familiar with oral cancer patients. We are a different breed! There are many little things that must be paid attention to when treating one of us OC survivors.

If Michael doesnt want to do what is necessary then he wont get better. How about showing him these posts and what other OC patients have said about this? It cant hurt. He really needs to understand that none of us like going thru all this stuff but there isnt a choice. Either do what the doctors say or you dont get better. I really hope he will think it over and decide to comply with his doctors orders. If not and he has osteoradionecrosis, things will get very bad for him. It will cause intense pain and could lead to needing a mandibulectomy which is removal of his jaw. That is one surgery I wouldnt wish on my worst enemy! It took me about a year to recover from it. So Michael really needs to weigh all his options and make a decision. Hope he makes the right choice!!!

Christine,

Thanks for your response. Michael usually does listen to his oncologist and yesterday when I mentioned HBO again he didn�t fuss as much as he did before. I guess we both just wished life wasn�t so hard sometimes, but we all do. He claims his vision and hearing aren�t back to where they were before the HBO � his hearing wasn�t good before it all started. He recently got hearing aides and he isn�t using them much at all so he isn�t adjusted to them yet. I have offered previously to let him read the posts on the forum and he has briefly a couple times � I will try again. I think both of us want our lives to be more than just dealing with cancer and its aftereffects. Just so much of it around � just this week I have three new people in my life with cancer scares/ diagnoses. Thanks again you do seem to be the HBO expert.

Agreed - I know the feeling of not wanting to give up your life to this disease - so I compartmentalize - I do what I have to - there are certain things you have to do that normally aren't part of your routine - but I work them into my day get them over with then go on living my life. - even when I was in rads - I would do my treatments then i would do something for me if I felt up to it!! Like go to whole foods, shop a little, drop by my favorite vegan restaurant. So you get it over with then reward yourself. GOod luck! Hopefuly he does the treatments.

We saw the oncologist today and he said the spot of concern is smaller than the dentist had lead him to believe. He also said that it is NOT infected - that is good news. He referred us to an oral surgeon - one Michael saw once a couple years ago (not the one who did the extraction in April with no follow -up care) and to the wound care center affiliated with the oncologist's hospital and not where he went for the hyperbaric treatment.. We will see what they have to say. He indicated that they might still recommend more hyperbarics, but there are some other oral treatments to promote healing. I found out today that Michael had thought he had cancer again and did not really know what osteonecrosis was - that was part of the reason he was so upset. So we have more appointments coming up. I would like immediate answers and a cure, but we are going to see some other people soon and hopefully will have a definite plan soon. Michael's oncologist also had another oncologist look at it too and he agreed that it was not that large a spot and it does appear it has maybe already healed some more since the dentist saw him on Tuesday since it is smaller than what the dentist told him.
Thanks for all the help.

Barbara, I have a question. Im sorry if somehow I missed this. So many people have looked at the spot but what about having a biopsy done on it? How long has the spot been there? Im glad to hear it has gotten a little smaller, thats a good sign.

no one has suggested a biopsy. I gather it is where the extraction was and the bone is showing so they are assuming it is just not healing very fast, but it is healing faster since the infection has cleared up. Our oncologist is very cautious so I think he would have suggested a biopsy if he had any question. He did say very directly it wasn't cancer since I gather that was what my husband was thinking too.

Awesome - no cancer despite the circumstance is good news!

BArbara,
Did your husband have any issue with the root canal or just the extraction? I am asking because I may need a root canal. I had crown placed last week, and that area is still in a lot of pain, and the surrounding tissues have become swollen, red, and painful. Thanks

Angelia,

The tooth that had the root canel and the extraction are next to each other, so it is a bit hard to tell for sure which is the problem, but I belive it is the one that was extracted and is not healing. My husband's oncologist had recommended hyperbaric treatments when they thought he was going to have two root canals and no extraction - they later decided to extract the one tooth. Are you on antiobiotics? Good luch with the root canal.

I was on antibiotics for a week prior to the crown procedure and continued them for another week.