Anyone with any good references as to whether third molars should be removed prior to radiation? I can only find one study with inconclusive results

What do the radiation oncologist, oral surgeon say? Is it erupted? Will it be in the radiation field? Radiation Dosage? Impacted?

They say if the 3rd molar is erupted, and in the radiation field, it should be extracted before radiation, as well as any other teeth that are in disrepair and unrestorable.

The below older study mentions preirridation extractions, and ORN.

Impacted 3rd molar teeth extracted have risk of ORN. I'm dealing with that now.

Less than 50Gy is less likely to have ORN, but with chemo it increases the risk.

Any extractions should be done 21 days, minimum 14 days before starting radiation to prevent ORN later on, even with chemo to prevent infections.

http://www.ncbi.nlm.nih.gov/pubmed/14762744

http://www.oralcancerfoundation.org/complications/osteoradionecrosis.php

I hope this helps, and good luck.

In addition to Paul's excellent questions, The PREVENTION section of this article will be of interest to you: http://www.researchgate.net/profile...dible/links/0c960515ea3c62bcb3000000.pdf

A dentist/oral surgeon familiar with oral cancer at a major cancer center is most important. We have gotten conflicting advice - In general, healthy teeth are not extracted pre-radiation. However, wisdom teeth present additional problems due to their size and difficulty keeping the area clean. The only complaint I have with our RO is that he sent us to our general dentist for pre-tx dental evaluation, instead of stressing the need to contact an expert.

As you can see from my signature, one wisdom tooth had to be extracted post tx, leading to early stage ORN. I believe this can also happen without an extraction, although rarer. My husband received induction chemo, probably another risk factor for developing ORN.

If you go to search box (upper right side) on the forum page and enter ORN, you will find discussions related to the frustration of dental advice & care for oral cancer patients.

It is difficult in the midst of an already anxious time. I wish you the best.

Lottie

Much thanks for the advice. The oral surgeon turned out to be quite knowledgeable. The tooth was not impacted, not erupted and not extracted. A bit of a relief since he had already had much work done in the last few weeks. Gearing up for radiation to start in 10 days. Have another meeting with oncologist tomorrow to resolve different recommendations regarding chemo from our second opinion.

Kate, thanks for the update. Im very glad you have a good oral surgeon for your husband! Its very important to pay close attention to dental care, especially during and after rads. If your husband hasnt had flouride trays made yet, this should be done right away.

If your husband is able to eat, now is the time for him to eat all his favorites. Rads will have a big impact on his ability to eat and drink. The best thing you can do to help minimize the radiation side effects is to concentrate on what is within your husbands and your control... his intake. This is something I cant stress enough! Every single day he needs at least 2500 calories and 48-64 oz of water. If he can take more in that will only help make this easier. When I went thru this, the others urged me to watch my intake and I failed miserably causing more hospitalizations and suffering than I thought was ever possible. Please be a better listener than I was and begin right away with pushing your daily intake to meet the minimum numbers.

Stick with us and we will help you both get thru the upcoming weeks of rads and recovery.

Best wishes!

Thanks Christine. It's been a roller coaster week. Poor communication between 3 dental providers and Radiation oncologist. I am now sitting in the oral surgeons office and Hubby is having 4 lower front teeth extracted. We had to delay chemo and radiation for a week, and will have go again for another radiation simulation/mask. I will be heartbroken if he comes out and they tell us he cannot get a permanent bridge done before end of next week. He has been amazing but this may put him over the edge. We are thinking we may have to delay treatment even longer if it can't be done right away.

Hi Kate,

Your husband's issues sound a bit like mine. My doctors recommended removing my wisdom teeth pre-radiation, mainly because of how crowded my teeth were and to avoid issues post-radiation. They did find a cavity on one of the wisdom teeth and I know from prior experiences any work on my molars was always difficult because of the crowding. So I had all 4 removed 9 years ago. Now just this month they found a cavity on one of my upper molars, and it was difficult and painful to have it filled (difficult to open mouth wide enough).

Post-radiation I had a lot of dental issues with loose teeth. I eventually had all 4 lower front teeth removed (required HBOT) and had a 10-tooth bridge made for the bottom. In order to provide enough stability, they had to include 3 teeth on each side of the ones removed. This was a long, drawn out process (over a year), before I was able to have the permanent bridge installed (12/2013).

A lot of the issues were because I already had RT, so since your husband did not have RT it may be a lot quicker process. He may need to wait for the extracted area to heal before they will start the work on the bridge. I don't believe they will take an impression if he has stitches in his mouth, unless they were able to make an impression before he has his teeth removed.

If you have any questions, let me know. Wishing you and your husband the best!

Susan, I was thinking at one of the newer flexible bridges would be tolerable during radiation. Are be being unrealistic?

Kate, I'm not familiar with flexible bridges. Mine is a 10-tooth one and it definitely isn't flexible. From what I've read it is better to have dental work done before RT, but I don't know anyone that had a large bridge done right before starting RT.

Radiation is tough on the soft tissue in your mouth. In my case I had a lot of ulcers and/or blisters, swelling, and thrush. Everyone is different, but I don't know anyone that hasn't had issues during RT and for the first few months afterwards.

What are his doctors recommending? Delaying treatment may not be in your husbands best interest.

Kate - as someone that used to own a dental prosthetic lab and is very familiar with the steps it takes to prep teeth, take impressions have the lab cast a metal substructure, build porcelain on it and then the last appointment to cement it, the timeline that you are considering may not be doable unless you can convince all the parties involved to pull out all the stops and get the lab to turn the prosthesis around in a couple of days. It's not impossible, and an understanding laboratory owner could pull out all the stops and get this done. If so you are just down to scheduling at the dentists office that is going to prep the teeth, take impressions and cement the final restoration. Other concerns would be that the tissue under the pontics ( false teeth in the middle of the bridge) is gong to change shape during the healing process, and a natural illusion of those resting against the tissue might be compromised if al this is done too soon. In the lower anterior month this is no concern at all as you cannot see that area when people talk or smile... but is is an area that if there are big gaps under the bridge between it and the tissue that they become food traps later and hard to keep clean and health when foods that are eaten pack into that space.

Me, I am less concerned about a prosthetic appliance that can be made after treatments, than I am of getting the necessary extractions done and that area healed before treatment begins. That is essential, restoration can happen down the road. Delaying treatment for prosthetics just allows the cancer to grow further and obviously that is more of a concern than temporary esthetics.

And to comment on the above, they cannot make an impression till some dentist preps (cuts down) the abutment teeth to accept crowns on top of them that are going to support this whole thing when it is made. Also I have never heard of a "flexible" bridge as everything out there is a metal subtraction with acrylic or porcelain coatings. Anything flexible to me means removable and temporary. So a plastic prosthesis that can be put in for esthetics could be made relatively quickly, but on lower anterior teeth he will not be able to eat with it and it will just be there for social occasions. Biting with the front of your mouth, which we all do, would create a lever pressure on it and it would just dislodge. So this is a transitional or temporary solution to wear while a permanent rigid bridge is being made for the most part. People with the inability to afford fixed bridgework may live with this kind of acrylic device for many years.

I have flexible bridges. . Love them. periodontist suggested it after I had to have a implant removed due to radiation scatter.
What's good about them is they are very light weight , you can eat with them . the turn over to get them back is under a week . Teeth can be added to them.
I think the tech company is Valplast but my dentist said ..just say they are similar to flippers but better...
Personally I would not get any bridges made until after rad because your mouth ,bite changes. I don't know why but it does. Also your mouth is being radiated and it causes many to get raw ,burns and sores. It would be impossible to wear a bridge.

What you are referring to is not a bridge, it is a temporary removable appliance used primarily as a transitional esthetic piece while something more permanent designed to be permanently affixed in the mouth is made. There are many reasons not to do one of these right now and the biggest in my mind is that they partially rest on soft tissue which is really sore area during treatments.

Again I would not worry about esthetics when treatment needs to get done and anything that delays that is not a good thing in my mind. And just to correct the post above since a bridge is cemented on remaining teeth or implants, it does not rest on any soft tissues and would be definitely more tolerable than a removable "flipper" (a derogatory term for the temp appliances because you can "flip" them around in your mouth with your tongue and dislodge them).

Thanks everyone. The flexible bridge is called Valplast, and it is temporary. Brian your insights about how useful this would be for bottom front teeth is appreciated. Therapy started Monday, without teeth, with first Cisplatin infusion and radiation. Will be researching a knowledgable dental provider to have something lined up for when treatment ends. Am hoping his mouth is not so sore that he won't have to wait to long. I am frantically researching things we can do to minimize oral side effects. Only 3 rad sessions so for and all OK. Only 27 to go.