Hello again,

Well, my treatment date is already in sight even if it hasn't been set. The radiation oncologist said she would like to start two weeks after a particular tooth was pulled. That happened this Monday. Next Monday I go in for my radiation prep (set up the mask, positioning?) and presumably am on track for beginning my 7 weeks of treatment the Monday after that. (Woo hoo!?)

So about the tooth thing then. The radiation oncologist and my every day dentist went over my existing xrays and I was sent to an endontologist for a new 'cone' xray. Everyone agreed that of the two teeth (#3 and #4) under suspicion that #4 was fine and that #3 should go. I had the molar extracted (:shudder: awful, even though numbed) and am ready to move on. My dentist would like to continue to address the now missing molar (prep for a future bridge, etc.) but understands that this isn't where the priority is for the oncologists and I supposed I can always have the 'gap' dealt with in the months following treatment. If it needs to be said (it is in the subject), the goal here in pulling the tooth is to reduce the risk later of radiation caused 'osteo-necrosis' or bone death in the jaw bones.

So my questions really are; how common is this for those of you with head-and-neck cancer who have had IMRT (and Cisplatin; but I guess it's really the rads)? I concede that my teeth are actually pretty bad; lots of cavities, fillings, crowns and some root canals in my 47 years so far. I'm doing a lot better in the past 3 years taking care of them but this one, #3, was a root-canaled molar from days gone by and when it came out they did find infection underneath it all (indicated on the cone xray as well as a somewhat faulty root canal to begin with however many years back it was).

And what are the repercussions with waiting on getting work done (bridge) for a few months until well after treatment and I'm up to it?

Also - I have seen many people (whether they got teeth pulled or not) talk about 'trays' for flouride treatment of their teeth. This is due to the lack of saliva and difficulty brushing/cleaning? Nobody has talked to me about trays yet.

Thanks in advance - you guys really are an invaluable asset.

Paul

You really need to talk to your dentist about getting fluoride trays made prior to treatment. They are like mouth guards that you put the fluoride in and put on your teeth for the recommended amount of time. They keep the teeth strong. One problem with radiation is that the teeth lose enamel afterwards and they become brittle. At our hospital, the dental oncologist recommends using the trays for the rest of the patient's life.

I'm not sure what work is involved with getting a Bridge but any work would involve cutting the gums that can be done pre Tx the better.

My dentist had me start wearing the Fluoride Trays 1 month before Tx began and I wore them all thru Tx (as much as I could stand) and for 5 years post Tx. My teeth were in good shape pre and cotinue to be in good shape 8 years later, toes and fingers XXXX.

Hey I'm thinking there's not a lot of work involved in the bridge. It's not invasive as far as I know so waiting should be okay. Anything like implants that involves drilling into your actual jaw should not be done after rads! This is why pulling of bad teeth except era needs to be done prior to, hugs,

The suggested wait period is 21 days after an extraction before starting radiation treatment, but some doctors say 14 days is ok. Anything sooner my involve being on prophylactic antibiotics. If you still have an infection, I would think that needs to be cleared before starting Chemoradiation, which can compromise your immune system further, go systemic.

As mentioned, you should have a dental tray, prescription fluoride, dental rinse like chlorhexadyne, and some are fitted with a latex dental guard to prevent radiation scatter from the dental fillings, which can help with mucocitis.