Hello,
My RAD start date has been set for 10/28 which is fast approaching and making me really nervous. I have completed my dental work today with a proper cleaning. The fluoride trays should be ready in couple of days and today the dentist prescribed me PreviDent toothpaste.

I am quite confused about the proper way to take care of the teeth throughout and after the treatment. I am very nervous about it as my teeth are not in good shape, I have had ridiculous amount of work done in the past two years. My dental hygiene used to be average, but now I am brushing and flossing 5 times a day, bought the Waterpick, a fancy pricey electric toothbrush, using Biotene mouthwash etc. I had heard a lot of contradictory things and would like to ask you guys for advice on many things.

1. My old dentist mentioned that I should be brushing and flossing every time I after I eat something. My current dentist says that one shouldn't brush more than three times a day, as it might wear off the tooth enamel and hurt the gums. In between, only to use mouthwashes/rinse. Also, he says to use PreviDent all the time (plus the trays), while some other sources claim max twice a day as too much fluoride can be toxic.
2. Flossing -read somewhere that it should be avoided during radiation treatment and one should only use Waterpik. The dentist claims flossing is essential.
3. Mouthwashes - I was using Biotene, but with the newest developments, not sure if I should continue. Also bought Act(with fluoride) for dry mouth and Crest Pro Health alcohol free.
4. Some sources say to avoid snacking/eating between the meals because oft he teeth. Unfortunately I can not eat much at once, and snacking/drinking Ensure was the only way I managed to stop the weight loss - I lost 7lb from 110lb, trying to gain some back, but so far only managed to stop the loss.
5. On the similar note, sugar. I know it is very bad for the teeth and it should be avoided, but it is everywhere, in Ensure, fruit juices etc. And it happens to be really my only vice, I love sweets/carbs and they are pretty much the only thing that might help gain some weight back. Obviously, I am not going to eat sugar candy, but would a piece of chocolate/cookies be that bad if I brushed the teeth immediately? If needed, I will give those up, just trying to figure this whole thing out
Many thanks!

Hi Ambra,

I think you are over thinking this with idle time. Moderation is the keyword here. Use the trays as recommended, waterpik after meals and use the fluoride toothpaste before going to bed.

Personally, that seems quite sufficient. When the rads get going, you are likely going to be hit with a storm of side effects that are going to make all the dental worries take a back seat anyway.

Just do what is reasonable and you will be fine.

The truth is there is nothing you can do the stop the rads from blasting your teeth and jawbones anyway and that is the greatest threat to your dental heath long term.

Good luck,
don

Heh, Don, I think you hit the nail straight on the head! You could be a great psychologist!

I do tend to over think and over worry about everything, no matter how minor; so you can only imagine how much I am over thinking in this situation. I was told this by many different people, in many different situations. It even includes my own boss who thinks I think waay too much (and we are both nerdy scientists who are supposed to think a lot). :-)

I guess it is just way of trying to take some control of things I realistically can not control at all. For some reason trying to come up with the best, most researched dental hygiene plan ( or even skin one,but I spared the forum those questions) makes me feel like I can control something.

Thank yuo for your honesty, much appreciated!

If your teeth are not in the best shape going into this than you must start using the flouride trays right away. You probably will need to use flouride trays daily for life to help you to keep your teeth.

I doubt you wont lose a tooth if you ate a cookie once in a while. But brush after every single thing you eat and always in the morning and before bed. The water pik has a water only tool that is what makes it so handy. You can add some mouthwash to water and get any minute piece of food that a toothbrush could miss. Use the water pik to get between your teeth. Do this at least twice a day.

You have control over your intake and right now you need to focus on building yourself up and eating all your favorites. Every single day you need a minimum of 2500 calories and 48 oz of water. If you can take more in daily thats even better. Dont be afraid to take in 3500 calories and 60 oz of water, its not too much. This will need to continue for at least the first year after you finish rads to allow your body time to recovery and heal.

The next week will go by incredibly fast so dont waste time worrying. Get out there and live life!

Have a GREAT weekend!

Ambra,

Hope all is well. I agree that the dental hygiene piece can be a little daunting because in a way it's the one thing we feel we can actively work on during treatment. Given like me you have/had the tumor in your tonsil my RO explained that they are very good at missing the mandible area. There is some scatter which can cause short term problems (in my case bouncing off my bottom, back filling and causing a lesion on my tongue), in the long run we should fare well. Even going into this with so-so teeth you can keep what you have and over time repair the damage from before. It'll take time and money but it's worth it.

Best of luck and reach out with any questions. Everyone here has been so helpful to me.

-Rich

Thanks again for all the input everyone! Much appreciated and definitely calming.

I have one more question about fluorides. I finally got my trays and fluoride gel and prescription tooth paste today. Both the gel and the toothpaste contain 5000 ppm (1.1%) fluoride (Prevident 5000 brand). My dentist said to use the trays once in the evening and the toothpaste every time I brush my teeth. However, all the inserts for the products specify to be used only once a day; and furthermore, I have read that too much fluoride can be toxic. Obviously, I will use the trays once in the evening, but what should I do about the tooth paste - should I just use a regular one? Was anyone else told to use both trays and prescription toothpaste?

I was told by my dentist to only use the trays at night right before bedtime and he never mentioned anything else I should use fluoridewise.

A mouthwash of 0.5 teaspoon sodium bicarbonate to 250mls water is a good way to both keep the mouth clean and neutralise any acidity, especially after taking something like Ensure or other acidic drinks. Milk on its own is a safe drink for teeth as it is not acidic, also taking some natural yoghurt after eating acidic things would help neutralise the acidity. My consultant recommended Soda bicarb solution during my treatment, and I still make sure I always have a bottle handy with it made up. It also refreshes the mouth when feeling dry. Saves a lot of money on other mouthwashes, and can be used if you have a bit of heartburn by sipping some rather then spitting out. Some people recommend adding 0.5 teaspoon salt while the mouth is sore during treatment.

I have read that flossing at the end of the day is the most important time as the bacteria are most active over night.

I am also fairly obsessed about saving my teeth so I do brush with high fluoride toothpaste 3 or 4 times a day and floss at night. But I think it is important to be gentle with them. I remember being very confused as advice for what to eat to cope with a sore mouth/throat and problems of a dry mouth seemed often to contradict what was good for teeth! The important think is that you seem to already be aware of the need to look after your teeth, so many people do not understand this (my oncology dentist loves seeing me as I do as I am told, many of her patients come in to see her with a bottle of coke in their hand!) so I think now concentrate on getting through the treatment with eating and drinking plenty and leaving the worry about your teeth for now.

Thank you everyone!

Saxicola, I am glad to see I was/am not the only confused one about contradicting advice. When you say that you brush 3-4 times a day with a high fluoride paste, is that a regular paste or a prescription strength, which has about 1.1.% fluoride?

Hi Ambra, things seem to be a little different here in the UK. I was not offered fluoride trays, but instead I was told to use Colgate's Duraphat 2800ppm Fluoride toothpaste (on prescription but I think it can be bought over the counter) 3 or 4 times a day and importantly was to spit out the fluoride but not rinse or take anything orally for 30 mins, and to floss once at the end of the day.

Good luck with rads, remember eating and drinking should be your main at the minute.

Hi there - I brush twice a day with a high flouride toothpaste, and or sensodine. Usually brush after breakfast and before bed, that way there's only lunch, that doesn't get cleaned off right away. But I do rinse frequently to get rid of any starts gunk and minimize my processed foods (as in I rarely eat store made foods - I make it fresh) and sugar. And use my flouride trays right after I brush either in the morning or at night - usually at night though. I also use a water pick to clean the gum line and between my teeth. seems to be working - my dental oncologist is happy - so far.

Thanks Cheryl! That helps a lot, glad to hear someone else uses high fluoride (prescription strength?) paste in addition to the trays. I was worried about toxicity of too much fluoride.

I got the same advice as my fellow David, and I use the Prevident only at night in the trays. The rest of the time I HAVE BEEN using Biotene (R.I.P.) and will now looking for alternatives while watching my dwindling supply run out.