Last week I went for a root canal on a back molar. The tooth was crowned and actually supported a bridge.

When the endodontist got into it he found a huge cavity under the crown and had to cut off the crown/bridge. So it wasn't a root canal issue to begin with, just a cavity due to the crown leaking.

He also had to remove most of the visible tooth and knowing he shouldn't pull it, he did the root canal on what was left. Now he says it may not be adequate to support a post and another crown/bridge.

Anyway before all of this my regular dentist said the endodontist might want to go through the gums, so I checked with the Cancer Center and they expected him to call so they could unarchive, review and transfer the radiation data for that area.

Today the CC called and I told them the endodontist went through the bottom of the tooth, (not the gums) and what has happened. They seem upset that the endodontist didn't check with them first, just to be prepared.

Tomorrow I have to go to the CC and see their Prosthodontist for an evaluation. Then I see my RO and they will decide how to best deal with it.

Apparently trying to reuse what is left of the molar for another bridge might be too risky, crack and lead to an extraction.

They had not unarchived my data, so they really don't know if I would need HBO or not, so maybe they will decide it is OK to pull and get an implant, or try an reuse what is left for another crown/bridge.

What a mess... Any experiences like this?

Ouch Don- I am so sorry! Sounds very painful and confusing too...I too find it completely confusing on what to do regarding my dental health. I wish there were dentists out there who specialized in taking care of patients who have had cancer and radiation because there are so many issues related to it. Can you see if the CCC has some reccomendations for dentists who have familiarity with cancer patients?Maybe just calling around to the best dentists out there- Even if they haven't dealt with a cancer patient they would at least be very knowledable about what to do.

This morning the Prosthodontist at the Cancer Center evaluated what remains of my molar (basically the root). He had the digital xrays from the endodontist and had spoken with him.

The Prosthondontist offices have moved into a new building (nice digs!) and they were having network problems so he apologized that he hadn't fully reviewed the actual Tomo dosimetry but said he had reviewed the planned dosimetry along with his and endodontist xrays. He felt the tooth (number 14) along with that area of my upper jaw should not have received enough GY's of RT to require HBO.

His recommendation was to put a gold post deep into a root of remains of the molar and although sub-optimal rebuild the bridge. He said in event it were to ever crack it could be safely extracted but might take a bit more time to heal, but my ENT could deal with that.

He will pass his evaluation on to my regular dentist (or recommend one) since their practice is limited to the Cancer Center patients needing evaluations and difficult reconstructions of medical necessity.

He said to check back after I get it fixed so he can replace my upper fluoride tray and that would be at no-charge as long as I promise to faithfully use it.

Next I met with one of my RO's. No network problems in her building, so she had reviewed all the dosimetry and told me that area of my upper jaw had received less than 20gy which is less than half the dose it takes to require HBO prior to an extraction or implant.

She mentioned that HBO is normally more necessary for lower jaw teeth than for upper jaw teeth, but to always have them check.

Also the Prosthondontist mentioned that HBO should not be given to a person with active cancer because it will fuel the growth of the cancer. I have never heard this before!