well, It has been a while since I was on the forum, hello to old friends. I am doing pretty good. I still do triathlons but have certainly slowed down, could be age!!! And I never gained back my weight, still a bit tough to eat but I anm stuck in the Mid 150's from 185.
Just recently I was told I need a tooth removed. I know this can be complex. I had a wide field of radiation due to the unknown origin of the tumor, so eveytthing below my nose gor it. The tooth is an upper in the front. I have taken very good care of my teeth , trays, 3x year cleaning and serious daily care.

So how tough is it to get a tooth removed??? Will /should I need the hyperbolic chambers?? and advise tryly appreciated. I also live in Southern Orange County CA so if there are any any recommended oral surgeon please advise. All my treatment was done at Mission

Thanks

Steve

It is not enough to find a good oral surgeon - you must find an oral surgeon experienced with H&N cancer. It is scary how many dentists and oral surgeons are ill informed about this. Shouldn't they be aware of what they don't know...

We had one "good' oral surgeon recommend extracting extra teeth, just in case, to avoid future problems. Without this forum, I would not have know how wrong that was. I don't expect every dentist to be able to treat and understand this complex issue. However, why aren't they educated to know that they need to refer H&N patients to someone with experience.

This must be coordinated with your RO and an experienced oral surgeon. My husband ended up at Head, Neck & Thyroid Cancer Institute in New York City (3 hrs from our home and absolutely worth the travel).

Hyperbaric, although still controversial, is usually recommended. There are many posts about extractions. It is a very difficult problem requiring vigilance.
The good news is that several years later, my husband's ORN has been keep under control.

thanks, I know he intends to talk to my RO. BTW, I am not familiar with the term ORN

Thanks, Steve

ORN is abbreviation for Osteoradionecrosis. Dental extractions increase the risk of developing this serious side effect. It is scary, but should be understood before undergoing an extraction. Everything possible should be done to avoid dental extractions post chemo-radiation in order to avoid this risk. Sometimes a root canal can be attempted.

Information: http://oralcancerfoundation.org/complications/osteoradionecrosis/

Thanks for the link!!!! I had wanted to add this but it was being updated when I tried to post it.

am update. I did see the oral surgeon, and a most folks have pointed out, I will need HBOT. The tooth is in the front of my mouth, upper jaw. The doc said that a implant was possible because there was a lot of bone up there and also it has been7 years since radiation, so things are a bit better. Any thoughts????

Thanks all

Hi Steve,

I would tread very carefully if I were you. I had an extraction 1 year after treatment (no HBO treatment) and suffered horrible mucositis for about 2 months, was under watch for ORN. My dentist/periodontist had NO experience with oral cancer. I had planned to get an implant one year after the extraction, but my ENT surgeon nixed that idea. Now I just have a hole that I'm constantly swiping food out of...and still, my dentist keeps telling me he can do a crown on the adjoining tooth. Not gonna happen.

I realize you are much further out from tx than I was, but I would still reiterate the advice travelottie gave to not let anyone near your mouth who isn't directly experienced with head & neck cancer. Make sure any treatment plan is signed off on (preferably in blood LOL) by your oncologist.

I 2nd what everyone has said, especially about the involvement of your other doctors. Each tooth may receive a different radiation dosage based on your treatment plan, areas of cancer, and not every area has the same blood flow as the mandible had more ORN than the Maxilla on average. It's not like every area receives 70Gy like the primary either, and other areas such as lymphs may receive 54Gy-60Gy, using myself as an example. Many reports say ORN is usually with radiation above 60Gy, although one has said even lower. As far as ORN risk as radiation time goes by, I thought I read it increases with age, but the average is 3 years, as low as 3 months, and a decade later, according to some studies if I recall correctly. I've seen reports of dental implants in radiated patients, and something about "loading" the implant at time of surgery, I hope to attach here.

https://www.ncbi.nlm.nih.gov/m/pubmed/15085959/?i=6&from=/21323003/related

As said, proceed with caution. Good luck

well here is a great update. I did at first see an oral surgeon. He said no problem. I asked if he wanted to speak to my RO or my Dental Oncologist. He declined, said I need the HBOT and we will be fine....he gave me the willies.
So I did see my dental oncologist. He said tat the area where the tooth is was not in the radiation field. No need for HBOT. He also gave me the name of some oral surgeons who work with my ENT and RO.

So it will be a bit more simple that I thought, certainly a better path.

Thanks to every one for the advise

That's good news! Glad you went to the dental oncologist. Good luck with everything,

I have a question about dental work after radiation. The upper jaw was in the radiation field but the radiation also grazed my tongue, it was so close to the radiation field. I suspect that might be true for the lower jaw, especially back by the molars. Tonight I piece of the molar at the very back came out. I call my regular dentist tomorrow for him to check out. My question if he recommends a crown would anyone recommend HBO treatments or is that only for extractions?

You usually don't need HBOT for root canals, and believe crowns also. It's when a tooth is extracted, gum work, surgery that can cause injury. The majority of ORN is caused after a tooth extraction, not just after radiation, but if its done too soon before radiation also.

It may be best to involve your ENT, Radiation Oncologist to see what their input is, radiation dosage to involved area, and type of dental work to be done.

Good luck

Is there a dental oncologist at your treatment center that you could ask (or get your general dentist to ask)? My husband had a root canal done by his dental and he did not have HBOT.

HBO is not needed for a minor dental procedures like a filling, crowns or root canal. HBO is for when a patient is not healing (many OC patients have problems with delayed healing in the area they had their rads), having a tooth extracted, ORN or a piece of their jaw removed.

Thanks all, it turns out that it already has a crown on it. A piece of porcelain came off. Since I went to a stand alone proton center, there was only the radiology oncologist, no multi-discipline team. It turns out my general dentist here in Florida has had experience with patients that have had radiation treatments to the mouth, starting with his father.

A broken crown, That's the best scenario, isn't it?