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#193097 09-26-2016 10:16 PM
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well, It has been a while since I was on the forum, hello to old friends. I am doing pretty good. I still do triathlons but have certainly slowed down, could be age!!! And I never gained back my weight, still a bit tough to eat but I anm stuck in the Mid 150's from 185.
Just recently I was told I need a tooth removed. I know this can be complex. I had a wide field of radiation due to the unknown origin of the tumor, so eveytthing below my nose gor it. The tooth is an upper in the front. I have taken very good care of my teeth , trays, 3x year cleaning and serious daily care.

So how tough is it to get a tooth removed??? Will /should I need the hyperbolic chambers?? and advise tryly appreciated. I also live in Southern Orange County CA so if there are any any recommended oral surgeon please advise. All my treatment was done at Mission

Thanks

Steve


70 male, athlete...again
SSC of undetermined orgin , early july 09
40 tx radiation, 8 chemo cisplatin and ebuterx
finished TX in mid Sept 09
Clear at the 6 year mark!
Back to swimming, biking and running! just a tad slower
never regained my weight, even when I eat lots and lots, just a skinny guy now

Just way glad to be seeing the green side up!




tristeve #193100 09-27-2016 05:26 AM
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It is not enough to find a good oral surgeon - you must find an oral surgeon experienced with H&N cancer. It is scary how many dentists and oral surgeons are ill informed about this. Shouldn't they be aware of what they don't know...

We had one "good' oral surgeon recommend extracting extra teeth, just in case, to avoid future problems. Without this forum, I would not have know how wrong that was. I don't expect every dentist to be able to treat and understand this complex issue. However, why aren't they educated to know that they need to refer H&N patients to someone with experience.

This must be coordinated with your RO and an experienced oral surgeon. My husband ended up at Head, Neck & Thyroid Cancer Institute in New York City (3 hrs from our home and absolutely worth the travel).

Hyperbaric, although still controversial, is usually recommended. There are many posts about extractions. It is a very difficult problem requiring vigilance.
The good news is that several years later, my husband's ORN has been keep under control.


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
tristeve #193106 09-27-2016 07:07 AM
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thanks, I know he intends to talk to my RO. BTW, I am not familiar with the term ORN

Thanks, Steve


70 male, athlete...again
SSC of undetermined orgin , early july 09
40 tx radiation, 8 chemo cisplatin and ebuterx
finished TX in mid Sept 09
Clear at the 6 year mark!
Back to swimming, biking and running! just a tad slower
never regained my weight, even when I eat lots and lots, just a skinny guy now

Just way glad to be seeing the green side up!




tristeve #193108 09-27-2016 12:58 PM
Joined: Oct 2008
Posts: 246
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ORN is abbreviation for Osteoradionecrosis. Dental extractions increase the risk of developing this serious side effect. It is scary, but should be understood before undergoing an extraction. Everything possible should be done to avoid dental extractions post chemo-radiation in order to avoid this risk. Sometimes a root canal can be attempted.

Information: http://oralcancerfoundation.org/complications/osteoradionecrosis/


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
tristeve #193113 09-27-2016 07:16 PM
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Thanks for the link!!!! I had wanted to add this but it was being updated when I tried to post it.


Christine
SCC 6/15/07 L chk & by L molar both Stag I, age44
2x cispltn-35 IMRT end 9/27/07
-65 lbs in 2 mo, no caregvr
Clear PET 1/08
4/4/08 recur L chk Stag I
surg 4/16/08 clr marg
215 HBO dives
3/09 teeth out, trismus
7/2/09 recur, Stg IV
8/24/09 trach, ND, mandiblctmy
3wks medicly inducd coma
2 mo xtended hospital stay, ICU & burn unit
PICC line IV antibx 8 mo
10/4/10, 2/14/11 reconst surg
OC 3x in 3 years
very happy to be alive smile
tristeve #193144 10-04-2016 07:01 AM
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am update. I did see the oral surgeon, and a most folks have pointed out, I will need HBOT. The tooth is in the front of my mouth, upper jaw. The doc said that a implant was possible because there was a lot of bone up there and also it has been7 years since radiation, so things are a bit better. Any thoughts????

Thanks all


70 male, athlete...again
SSC of undetermined orgin , early july 09
40 tx radiation, 8 chemo cisplatin and ebuterx
finished TX in mid Sept 09
Clear at the 6 year mark!
Back to swimming, biking and running! just a tad slower
never regained my weight, even when I eat lots and lots, just a skinny guy now

Just way glad to be seeing the green side up!




tristeve #193145 10-04-2016 09:56 AM
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Hi Steve,

I would tread very carefully if I were you. I had an extraction 1 year after treatment (no HBO treatment) and suffered horrible mucositis for about 2 months, was under watch for ORN. My dentist/periodontist had NO experience with oral cancer. I had planned to get an implant one year after the extraction, but my ENT surgeon nixed that idea. Now I just have a hole that I'm constantly swiping food out of...and still, my dentist keeps telling me he can do a crown on the adjoining tooth. Not gonna happen.

I realize you are much further out from tx than I was, but I would still reiterate the advice travelottie gave to not let anyone near your mouth who isn't directly experienced with head & neck cancer. Make sure any treatment plan is signed off on (preferably in blood LOL) by your oncologist.



female, 48 yo 3x survivor
5/2009 SCC left lateral tongue
partial glossectomy, left neck dissection, all nodes clear
12/2011 - recurrence, SCC left posterior lateral tongue
resection 12/2011
laser surgery 7/19/13 for leukoplakia, led to 3rd diagnosis
7/26/13 SCC left posterior lateral tongue
partial glossectomy 8/15/13 - margins clear
6 wks radiation 10/2013-11/2013
So far so good! Some remaining side effects (trismus, dry mouth, minimal tongue movement) but loving life!
tristeve #193152 10-05-2016 10:18 AM
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I 2nd what everyone has said, especially about the involvement of your other doctors. Each tooth may receive a different radiation dosage based on your treatment plan, areas of cancer, and not every area has the same blood flow as the mandible had more ORN than the Maxilla on average. It's not like every area receives 70Gy like the primary either, and other areas such as lymphs may receive 54Gy-60Gy, using myself as an example. Many reports say ORN is usually with radiation above 60Gy, although one has said even lower. As far as ORN risk as radiation time goes by, I thought I read it increases with age, but the average is 3 years, as low as 3 months, and a decade later, according to some studies if I recall correctly. I've seen reports of dental implants in radiated patients, and something about "loading" the implant at time of surgery, I hope to attach here.

https://www.ncbi.nlm.nih.gov/m/pubmed/15085959/?i=6&from=/21323003/related

As said, proceed with caution. Good luck

Last edited by PaulB; 10-05-2016 10:31 AM. Reason: Link

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






tristeve #193324 11-04-2016 03:01 PM
Joined: Nov 2009
Posts: 212
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well here is a great update. I did at first see an oral surgeon. He said no problem. I asked if he wanted to speak to my RO or my Dental Oncologist. He declined, said I need the HBOT and we will be fine....he gave me the willies.
So I did see my dental oncologist. He said tat the area where the tooth is was not in the radiation field. No need for HBOT. He also gave me the name of some oral surgeons who work with my ENT and RO.

So it will be a bit more simple that I thought, certainly a better path.

Thanks to every one for the advise


70 male, athlete...again
SSC of undetermined orgin , early july 09
40 tx radiation, 8 chemo cisplatin and ebuterx
finished TX in mid Sept 09
Clear at the 6 year mark!
Back to swimming, biking and running! just a tad slower
never regained my weight, even when I eat lots and lots, just a skinny guy now

Just way glad to be seeing the green side up!




tristeve #193326 11-05-2016 04:50 AM
Joined: Jul 2012
Posts: 3,267
Likes: 1
Patient Advocate (old timer, 2000 posts)
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Patient Advocate (old timer, 2000 posts)

Joined: Jul 2012
Posts: 3,267
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That's good news! Glad you went to the dental oncologist. Good luck with everything,


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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