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#190246 07-11-2015 11:53 AM
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Kate12 Offline OP
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I've read so many posts here about the difficulty with teeth, saliva etc. But no one mentions at what radiation dose these problems occur. Our RO is planning 60 guys??on affected side of mouth, a lower dose on affected side neck and even lower dose on contralateral neck...below salivary gland. We are assuming he will have saliva throughout this process. Are we mistaken? I realize lower teeth on affected side may be at risk, but didn't think teeth on his "good" side would be impacted. I'm freaking out.

Last edited by Kate12; 07-11-2015 12:01 PM.

Kate, wife of husband with
May 2015, SSCA left lateral tongue, T2N2bM0 Stage 4 , Age 58
06/01/15, L hemiglossectomy, modified L radical neck, clear margins, 2 nodes positive, no extracapsular extension. Perineural invasion on lingual nerve in tongue.

Tx completed 8/28/15, IMRT and 2 high dose cisplatin.
12/15 negative PT scan
5/16 negative PT scan
2/16 fitted with partial denture
12/16 3mm area of exposed mandible identified. Started on pentoxifylline regime
3/17 completed 40 HBO dives.
Joined: Jan 2006
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Most of us had 7 weeks of RT (30+ days). I was able to each and drink somewhat normally for the first few weeks, but towards the end of RT I was on a liquid diet. This lasted for months after RT was completed (I was a extremely slow healer). My RT was aimed on the right side of my mouth and neck, so the salivary glands in that area have been permanently damaged. I do have dry mouth issues to this day, but the salivary glads on the left side still function

There is medication they can give your husband to increase saliva production (salegen - sp?). Most of us were also prescribed "magic mouthwash" to use during RT - it is a compound prescription rinse that typically contains 3 different medications (something for pain, nystatin, etc.).

Many patients get a feeding tube (peg tube) because if is difficult to maintain adequate nutrition during treatment. My mouth was full of painful blisters/ulcers towards the end of RT (and months post RT), but my throat was not. So I was able to drink a lot of nutritious smoothies for my nutrition, lost a lot of weight, but not too much so I was able to avoid getting a peg tube.


Susan

SCC R-Lateral tongue, T1N0M0
Age 47 at Dx, non-smoker, casual drinker, HPV-
Surgery: June 2005
RT: Feb-Apr 2006
HBOT: 45 in 2008; 30 in 2013; 30 in 2022 -> Total 105!
Recurrence/Surgeries: Jan & Apr 2010
Biopsy 2/2011: Moderate dysplasia
Surgery 4/2011: Mild dysplasia
Dental issues: 2013-2022 (ORN)
Joined: Oct 2008
Posts: 246
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Kate,

Per OCF under Cancer therapy: http://www.OralCancerFoundation.org/complications/xerostomia.
When the total radiation dose exceeds 5,200 cGy, salivary flow is reduced, and little or no saliva is expressible from the salivary ducts.
RO should be able to advise you about mapping/dosage to salivary glands.

My husband had higher dose radiation and was surprised that salivary flow & taste kept improving, even 2-3 years post rad. This has become a minor side effect for him.

How did your husband make out with dental extractions? What changed from concern about a wisdom tooth to 4 front teeth?

This time prior to therapy starting is extremely stressful. I took anti-anxiety meds in the evening so that I could sleep. Otherwise, my mind kept going over every possibility. Once therapy was underway, I was ok without it. In part because we checked in daily with our cancer team - an opportunity to ask questions and get advice for immediate problems instead of worrying about everything at once.




CG to husband, dx @ age 65, nonsmoker/social drinker. Dx 5/08 SCC Stage IV, BOT T1N2aM0. 33 IMRT - completed 9/12/08. Induction Chemo (Cisplatin, Taxotere & 5FU), plus concurrent Cisplatin.
1/09 PEG removed; 5/09 neg PET/CT; 5/10 PET/CT NED
Dental extraction & HBOT 2013; ORN 2014; Debridement/Tissue Transfer & HBOT 2016
Joined: May 2015
Posts: 18
Kate12 Offline OP
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The teeth are a major concern for us now. We are going to meet with RO Monday to discuss. What happened was the peridontist told us he was done with his work(extractions, gum surgery, scaling and root planing) and just needed consult with oral surgeon about wisdom teeth. Then he faxes note to RO about additional teeth he is concerned about and leaves for out of country vacation next day. He never mentioned this to us. We have been seeing him weekly beginning 15 days post op. And he send the fax 4 days before treatment was to start. Needless to say his office staff has been very apologetic and arranged for extractions the next day. We had to cancel chemo and rads for Monday. After these 5 additional teeth were pulled last night,he can't bite into anything, can't chew, and it's to late to get bridges made. We are very frustrated. He has been so positive and upbeat until now. We are questioning the health of additional teeth and worried about all the future issues I am reading about here.


Kate, wife of husband with
May 2015, SSCA left lateral tongue, T2N2bM0 Stage 4 , Age 58
06/01/15, L hemiglossectomy, modified L radical neck, clear margins, 2 nodes positive, no extracapsular extension. Perineural invasion on lingual nerve in tongue.

Tx completed 8/28/15, IMRT and 2 high dose cisplatin.
12/15 negative PT scan
5/16 negative PT scan
2/16 fitted with partial denture
12/16 3mm area of exposed mandible identified. Started on pentoxifylline regime
3/17 completed 40 HBO dives.
Joined: Nov 2009
Posts: 644
Likes: 1
"OCF Down Under, Kiwi"
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Sorry your husband is having such a rough time with his teeth. I've been through similar problems. It's just the last straw to lose key teeth. It's not something we signed up for, is it? However, prosthodontists can do wonderful things.

One of my sons got married a week or so after the surgery and a couple of weeks before RT. I didn't want to go to the wedding minus front teeth so the hospital, feeling sorry for me, arranged for me to have a temporary plastic denture made to fill in for my front teeth and some side ones. My worries were cosmetic first and eating second.

This is a very difficult time in the process. Once the cancer is dealt with, your husband will be able to get his dental problems sorted. Eating solid foods is well nigh impossible during radiation anyway. I ended up living on Fortisip (like Ensure) with tinned peaches and chocolate icecream all blended together.

The teeth are kind of symbolic of the normal life we lose (for a while at least) in this process but there are solutions:)

Wishing you well:)


1996, ovarian cancer surgery + cisplatin and taxol.
September, 2007, SCC of left lateral tongue. Excision.
October, 2009 recurrence in scar tissue, T1NOMO. Free flap surgery from left wrist - neck dissection. 63 year old New Zealander. No chemo, no RT.
February, 2014. New primary in left buccal mucosa. Marginal mandibulectomy, neck dissection, right arm free forearm flap. T1N0M0 but third occurrence and some areas of concern: RT started 8 April and finished 19 May.
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I'm sorry to hear this. My radiation treatment was delayed in 2011 do to dental issues, and cobra insurance coverage to have the work done, which consisted of several root canals, fillings. Even with no teeth extractions I had to wait several weeks before beginning radiation. You'll have to discuss with your RO and MO if the additional teeth should be repaired/ removed before beginning treatment if there is already a concern with their health. As far as radiation with teeth extractions that will be in the radiated field, it shouldn't commence until 14-21 days healing time, to reduce the risk of Osteoradionecrosis later on.

As far as IMRT, they are able to dose paint, and can avoid, give less dosage to critical structures like the salivary glands, if possible. There are three major salivary glands, and hundred of minor salivary glands in the mouth and throat, so they might be able to recover, and later compensate for any loss. If one side of the head and neck is radiated, the other salivary glands on the opposite side will be preserved, and continue salivary flow. Radiation also effects thin saliva only, not thick, and is why we get the rope or thick mucus later on until salivary flow start producing again or others compensate for the loss. Thin saliva is mostly produced in the parotid gland. The other two major salivary glands produce a mixture of both, but a lesser extent of thin saliva. Usually the parotid gland, if radiated, and if possible without tumor risk, is radiated at 26Gy, and the radiation volume less than 49%, so it can later recover some saliva flow.

It's not discussed that often, but chemo can also damage the teeth and gums.

Hopefully there was already a discussion about impeccable oral care during and after treatment, use of fluoride trays, prescription fluoride, mouth guard during radiation to prevent scatter, and oral rinses. There are also prescription salivary stimulants, and OTC dry mouth products that may help.

Good luck.


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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