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Did you have a pre-treatment exam?


SCC Stage IV, BOT, T2N2bM0
Cisplatin/5FU x 3, 40 days radiation
Diagnosis 07/21/03 tx completed 10/08/03
Post Radiation Lower Motor Neuron Syndrome 3/08.
Cervical Spinal Stenosis 01/11
Cervical Myelitis 09/12
Thoracic Paraplegia 10/12
Dysautonomia 11/12
Hospice care 09/12-01/13.
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/2017
Cardiac Event 06/2018
Bilateral VFI 01/2021
Thoracotomy Bilobectomy 01/2022
Bilateral VFI 05/2022
Total Laryngectomy 01/2023
Joined: Nov 2013
Posts: 104
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Just having a chipped tooth dealt with this week as well.

As explained to me:

If you just extract, the other teeth will shift and rotate which will likely cause more chipping and breaking as we chew. Depending on your dosage chart you can be at risk for osteo-necrosis, the lower jaw being much more susceptible.

If the tooth broke off slightly above the gum line you have a much better chance of avoiding future caries after a crown/root canal.

an implant is the other way to go but also risky and $$$$.



Last edited by BrianPK; 03-27-2015 01:54 PM.

Brian
Stage IV TxN2aM0 HPV+ SCC 38 y.o. male
9/20/13 Sentinel Node Found
12/5/13 Start of 72Gy and 5 bags of Cisplatin
1/21/14 Treatment Ends
1/25/15 1 Yr clear
Joined: Jan 2013
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[quote] Depending on your dosage chart you can be at risk for osteo-necrosis, the lower jaw being much more susceptible.[/quote]Did you have any discussion with the RO on this topic? For most of us it remains a mystery as to what might indicate any increased potential for ORN. It seems logical that if the map shows a lot of radiation in/around the jaw that would increase chance of ORN but I've not read any thorough discussion to that effect.


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Dec 2003
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Don, radiation causes an increased risk for ORN. It can be accelerated by the injectable form of bisphosphonates or can just happen because of reduced blood flow to the bones.


SCC Stage IV, BOT, T2N2bM0
Cisplatin/5FU x 3, 40 days radiation
Diagnosis 07/21/03 tx completed 10/08/03
Post Radiation Lower Motor Neuron Syndrome 3/08.
Cervical Spinal Stenosis 01/11
Cervical Myelitis 09/12
Thoracic Paraplegia 10/12
Dysautonomia 11/12
Hospice care 09/12-01/13.
COPD 01/14
Intermittent CHF 6/15
Feeding tube NPO 03/16
VFI 12/2016
ORN 12/2017
Cardiac Event 06/2018
Bilateral VFI 01/2021
Thoracotomy Bilobectomy 01/2022
Bilateral VFI 05/2022
Total Laryngectomy 01/2023
Joined: Jul 2012
Posts: 3,267
Likes: 1
Patient Advocate (old timer, 2000 posts)
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Don,

ORN, also called PRON, Post Radiation Osteonecrosis, is a result of having radiation, usually above 60Gy, occurring in a small amount of patients, about 3-5%, with IMRT, and an injury, such as tooth extractions, alveoplasty, oral surgery, ill fitting dentures, which occurs in the mandible more often, as mentioned, whereby bone is exposed for a period of 8 weeks not resolving. Oral cancer patients are more at risk due the higher dosage, volume of radiation to the mandible, maxilla, than other head and neck cancers. Brachytherapy, an internal radiation, has an increased risk of ORN, as well as use of biphosphonates, called, BRON, Biphosphonate Related Osteonecrosis, as mentioned also. There are different grades, 1-3, with grade 1 is often treated conservatively with antibiotics, newer medicines, debridement, HBOT, which usually resolves most. My conservative treatment didn't heal one molar socket, another problem area, after 4 months from the extractions, so surgery was needed.


10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs






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Patient Advocate (1000+ posts)
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Thanks guys. Always learn something here. never ends. It is a quite low incidence disease and just last week I met with a fellow survivor who just finished up a 16 hour surgery to replace jawbone with a leg bone. He is doing amazing at 7 months. You can hardly see the scar along the lower jaw and just getting a partial to replace the teeth that were extracted.

He mentioned how the diagnosis was not all that obvious. I think the original cancer team are not experienced in such late side effects. RO, MO, even ENT just don't come across it often enough.

I think everyone needs to find a good oral surgeon that has experience with oral cancer patients as they are probably one of the professionals who can assess the onset of ORN.



Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Nov 2013
Posts: 104
Senior Member (100+ posts)
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Senior Member (100+ posts)

Joined: Nov 2013
Posts: 104
Don,
PaulB went into detail that I couldnt. I got the info from my RO. She stated that >55Gy was the dosage amount where it becomes a concern, and >70Gy is high risk. She reiterated twice to me that upper jaw was at less of a risk, but didn't state any delta in dosage/risk between the two.

I was my own advocate. I called everyone asking about what I should do. With the arrival of my twins, I was thinking trying to save money and just have it pulled. Due to the fact it was the second to last tooth and not the last molar, it could cause more problems. The best approach agreed to by all was a crown.


Brian
Stage IV TxN2aM0 HPV+ SCC 38 y.o. male
9/20/13 Sentinel Node Found
12/5/13 Start of 72Gy and 5 bags of Cisplatin
1/21/14 Treatment Ends
1/25/15 1 Yr clear
Joined: Jan 2013
Posts: 1,291
Likes: 1
Patient Advocate (1000+ posts)
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The thing about the gray quantity is it is an average so not a very good indicator, at least to me I think it is the combination of dose and location that probably offers a more reliable potential of ORN.

I plan to schedule a visit with my RO at about two years out, just to have a check in and will ask to review the map they used on me and how my current physical state matches what is typically expected for the amount and location of the rads I received.


Don
Male, 57 - Great health except C
Dec '12
DX: BOT SCC T2N2bMx, Stage 4a, HPV+, multiple nodes
1 tooth out
Jan '13
2nd tooth out
Tumor Board -induction TPF (3 cycles), seq CRT
4-6/2013
CRT 70gr 2x35, weekly carbo150
ended 5/29,6/4
All the details, join at http://beatdown.cognacom.com
Joined: Nov 2013
Posts: 104
Senior Member (100+ posts)
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Senior Member (100+ posts)

Joined: Nov 2013
Posts: 104
My RO said she checked the dose for the #3 tooth was 54Gy, based on some simulation software that was available to her given how the IMRT was done.

Pretty cool IMHO.


Brian
Stage IV TxN2aM0 HPV+ SCC 38 y.o. male
9/20/13 Sentinel Node Found
12/5/13 Start of 72Gy and 5 bags of Cisplatin
1/21/14 Treatment Ends
1/25/15 1 Yr clear
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