Hello, I am a 39 year old male who is very fortunate to be approaching the 2 year anniversary of the end of treatment with no sign of any return. However, I have two impacted wisdom teeth on my bottom row, which have very deep pockets "6 to 7 cm plus" and worried that they're not responding to my effort to contain or kill the infection. I received about 5500 Rads (I believe that was it) and previously my oncologist recommended not pulling any teeth due to the risk of Osteonecrosis (strictly due to the amount of radiation received) but that was when it was elective, now I'm wondering if the small risk of ON is outweighed with the problems this infection could cause. Does anyone have any experience with this to share?

thanks,
Brian

Welcome to OCF, Brian!

You do NOT want to get ORN. Its death of yoru jawbone. They treat that with hyperbaric oxygen treatments (HBO) which is no big deal. But if that isnt effective then you would lose your jaw. Why treat this after the fact, you can do HBO before your dental work to prevent ORN. Ive gone thru losing my jaw and I am very very lucky to be alive! I was in the hospital for 2 months, 3 weeks of that in a medically induced coma. My originally 10 hour surgery failed and I became disfigured with the doctors fighting to save my life. There are members on this forum who live with ORN. They are in agony!!!! Pain meds only make it slightly tolerable, they live in constant pain every single hour of every day. Now do you still consider ORN a small risk?

You should be seeing a prosthodontist. That is a dentist who specializes in patients who have things like oral cancer, need implants, things like that. That kind of dentist would know you would need to go thru hyperbaric oxygen treatments (HBO) before they would attempt any dental work. This is called the Marx Protocol. You would do 20 before the dental work and 10 after. that will help to significantly lower your risk for ORN. Basically its a clear glass tube that you lay in for about 2 hours a day breathing pressurized pure oxygen. Its no big deal, doesnt hurt. But it is very time consuming. You may also need tubes in your ears prior to going thru the HBO.

Hi Brian,

I would like to reiterate Christine�s comments. I had nearly all my tongue and floor of my mouth removed due to cancer from what originally appeared as a tiny ulcer. That was, and still is incredibly difficult. However, the aftermath of having nearly all my mandible jaw removed due to Osteonecrosis (ORN) has caused irreversible damage and major quality of life issues for me that are much worse than having my tongue removed. It is difficult to explain the damage osteonecrosis (ORN) can cause. Surgery for ORN is brutal.

The damage from having my jaw rebuilt and reconstructed with bone from my hip is with me every moment of the day. Titanium plates & screws holding my lower jaw together, my lower facial bone structure disfigured, muscle damage, nerve damage, drooling, chin/neck flap, removal of lower gums and teeth. The list goes on. If required, HBO treatments are nothing compared to the consequences.

Anything recommended by your medical team to help improve or prevent bone damage, and therefore lessen the chance of surgery should be followed.

Karen

I think you meant mm not cm in the depth of those pockets. Most roots are relatively short and a 7 cm pocket would be longer than many (2.8 inches). I agree with the first two posters, except for one thing, a prosthodontist is not the type of dental specialist that you should see. They are great at replacement of things in your mouth which is their specialty sub training, but if you wanted to try and salvage the situation, which would be a worthwhile first try before you do something more radical, for a deep pocket, and dealing with it I would want to see a periodontist, and an oral medicine specialist. The second might be harder to find since they are mostly at dental schools and not in private practice. But if you have one close to you they really have the big picture on this issue.

Cleaning out a deep pocket can be done, and a manual cleaning with local application of peridex can get you on the right track. Also you want you generalist to confirm that you have no fillings or anything near these problem areas that is creating a "food trap" that keeps this situation chronic. This kinds of things can be easily repaired making it easier for you to maintain this area once it is back in line. Of course once that is taken care of you have a daily battle to keep it healthy. But in the end I would rather fight to keep the teeth that I have, see my hygienist every month, since I can't get to everything, than run the risk of a non healing wound n my mouth.

As you have read before this post there are some serious downsides if that extraction socket does not heal. Also you didn't appear to have the highest number of grays of radiation possible, and you MAY heal nicely after some 02 dives and an extraction. Other factors were if you had IMRT radiation, did this particular area end up right in the main field of the radiated area or was it outlying, If it was away from the main targets, it could have gotten even less radiation, sparring you some of the loss of the micro vascularization in the cancellous bone that is one of the main reasons for poor osseous healing after radiation and ORN. It can be a complex idea, and you have lots of choices.

I agree with all of the posters above. After my radiation TX, my wisdom tooth cracked. My prosthodontist tracked down a root canal specialist (an endodontist) who used the dental version of "robotic surgery". My prosthodontist had to intervene to stress that I should NOT have an extraction due to risk of ORN which he deemed unacceptable. Believe Christine when she tells you about the horrors of ORN
Your oncology doctor should have recommendations for dentists with cancer experience or be able to get an intro to the oral medicine specialist that Brian mentioned- don't delay - start calling and get this fixed.
Charm