I am 21 months out of treatment. Three months post rad my dentist said that I had peridontal disease and that unfortunately I would lose my teeth. My cancer doctor told me that I must go to an oral surgeon and not a dentist. After seeing an oral surgeon that lives nearby in this small community he puts me in touch with a prosthodontist whom he's worked with in the past. Together they decide that implants are the best solution for me. I already have an upper denture so the surgeon will remove the teeth on the bottom and then place four implants and "snap" a plate onto that. Then they will make a new upper plate to accommodate the bottom one. They tell me that I will have a beautiful smile and a lot more function. It's pricey but I think well worth it. They both assure me that they have spoken with my cancer doctor and we can move forward. Before making the final steps I go to see my cancer doctor for a routine check up. I mentioned about getting implants soon and the doctor says that I have had more radiation in that area then he previously thought (5000 units to lower jaw). He says that I should go with conventional dentures and not implants. He says he will speak with the oral surgeon. They talk and get back to me. Surgeon says I'll need hyperbaric treatments before and after implants. He says it's more trauma just pulling the teeth rather than placing implants. My cancer doctor repeats what surgeon says but will not give me his opinion one way or another. Now I'm stating to feel apprehensive about the whole procedure. I discover that the surgeon has only had experience with a handful of cancer patients. I was initially under the impression he had more then that. So now I go to a well known cancer center forty miles away in Pittsburgh for a second opinion. I am examined by an oral surgeon/MD. He says "absolutely no implants". He said "look, if you were my mother or my aunt I would tell you this...get the teeth removed and wait six weeks for the gums to heal and then get dentures". He said that he strongly reccomends hyperbaric treatments, twenty before and ten after. He tells me that if I had 5,500 units he would INSIST on hyperbaric but just being short of that it is my call. He further adds that if any implants or dentures were placed on top of sore gums then it would defeat the whole purpose of hyperbaric and do me no good.
Now I'm really confused. Why would I be told two totally different approaches? I have a gut feeling that the second surgeon has my best interests at heart and he certainly has experience with cancer patients but I can't even imagine walking around with no bottom teeth for six weeks. My concern is that if I go without teeth for a period of time then I won't keep them in when I do get them. Before cancer I got my upper plate day of extraction and kept them in since. Has anyone had experience waiting until the healing process is over and then have you adjusted and worn your dentures since? And where could I get the best custom fit denture made?

Barbara, After radiation treatments, my husband's teeth started to break apart. He went to oral surgeon and had to have all his teeth pulled out. He was told he needed hyperbaric treatments which he did. Implants were not recommended by dentist or RO. He got full dentures and never had a problem. He went to a dentis who has worked on cancer patients. He was expensive but well worth it as they never were a problem to wear. This dentist is in Princeton, NJ. If you are interested I can email you his name and number. Eileen

It would seem that your dentures would fit just as well having the impression made from your healed lower jaw. The professional to do them would be, of course, a prosthodontist, but hopefully one that works hand in hand with the cancer center, so that he understands the issues involved with the irradiated mouth.

Hi Barbara,

I'm sure that you will hear from members that have been through what you are facing right now. In addition, there is a prosthodontist who has recently joined the board and hopefully he will see your post.

It might be best if you heard some basic information. If we take the radiation out of the picture for a minute, dentures can be made either as immediate ones or after healing has taken place after extractions. If done as the immediate type, most likely they would need to be relined to fit the mouth after the bone reshapes itself. Everyone is different and the time frame for when relining of dentures would be necessary can vary greatly. Waiting for healing, about 6 weeks, will put off the need for relining them for a longer period of time, but most people will still need it done at some time in the future. The downside of waiting is obviously being without teeth during the healing phase as well as while the dentures are being made.

Now if you add in radiation to the mix, you have to deal with the possibility of osteoradionecrosis, which is caused by the radiation. The following is a response that I posted on this forum in December of 2005:

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Osteoradionecrosis...bone that has received doses of radiation may lack the ability to repair itself after trauma. Radiation destroys the blood vessels in the area causing a reduction of circulation to the area of oxygen and other nutrients. This then will prevent normal healing in that area if the bone is injured.

Hyperbaric oxygen to the area will stimulate new blood vessel growth and therefore stimulate bone healing.

Without hyperbaric oxygen, removal of a tooth will probably result in bone that won't heal.

This is a good article: http://www.virginiamason.org/dbHyperbaricOxygen/sec181033.htm

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It is certainly understandable that you are confused with the situation that you find yourself in as you are getting mixed messages. There is no doubt that the safest way to do anything in a mouth that has been radiated, is to use hyperbaric oxygen which has proven to help healing.

Now here is my opinion in general. Doing extractions without HBO is something I would not suggest. Waiting the 6 weeks before taking impressions would be the safest thing to do since then the healing could be checked, the bone would be reshaped and the dentures would fit better.

Now as far as the implants are concerned, there are many members that have successfully had implants placed and I'm sure you will hear from them. HBO was most probably used in all successful cases as placing implants in radiated bone is just as much of a problem as extracting teeth from radiated bone. Whether or not you would need implants at all is something you can decide after you try your new lower denture. Many people can function very well with just a denture and many find that it is difficult to keep them in place. (Lower dentures are not as stable as upper ones as the tongue can cause dislodging of them and the surface area that they sit on is horseshoe shaped rather than a large area, as in the upper jaw). You have to see which category you fall into. There is no doubt that the security of having a denture clip onto implants can be a great thing, however the cost of the implants, the cost of the HBO treatments and the extra cost of the denture will certainly enter into the picture.

I personally do not have any experience with making dentures for post radiation patients, but am just trying to give you some things to think about and hopefully to clear up some questions you might have.

Jerry

Jerry,


If you dont have rad though you wouldnt need HBO right? I only ask cus I need to have like 2-3 (atleast ) removed..they have just been breaking for the past 2 years or so of course now i wonder could it be due to the cancer that was in my tongue or maybe could it be elsewhwere we dont now about ?

Shar

Sharlee,

HBO treatment is only needed if you had radiation. Cancer has never been linked as a cause of tooth decay. If you've been breaking teeth for 2 years, you can be sure that tooth decay is the problem. Get the bad ones out ASAP and get the rest fixed before they break and you will be much healthier.

Jerry

I came across this thread and hopefully I can help to shread some lights on this topic. Barb, I am very saddened to hear that 3 months post radiation treatments some teeth have to be removed due to periodontal disease. Usually this complication can be prevented with a proper dental consultation before a person undergoes oral cancer therapy. Anytime a patient undergoes oral cancer treatment, a dental consult must be initiated. The dentist would look at the condition of the teeth in terms of caries and bony support. If the teeth are questionable and MAY require extraction, then the teeth need to be removed BEFORE radiation rather than after. Dealing with ORN (osteoradionecrosis)after the fact is expensive and time consuming. Ofcourse this decision to remove the teeth depends on the patient's oral hygiene habit and the location of the radiation field as well as the amount of radiation recieved. It is very frustrating for me to see patients who had undergone radiation without any kind of pre-op dental evaluations. Managing patients with oral cancer is a two way street that requires the dentists as well as the surgeons to be collectively working together.

Regarding the need for implants retained versus conventional dentures (resting on tissue) depends on many factors:

1. Can the prosthesis be adequately retained in the mouth without the use of implants? If there are still adequate numbers of teeth left or if the ridge is "tall and big" enough, then you would not need implants. Experiences tell me that rarely the upper denture requires implants because the dentures can be succesfully retained from the peripheral seal of the upper denture borders. For lower denture with advanced resorbed ridge, implants do play a role.

2. How dry is the mouth? If the oral cavity is extremely dry, denture wearing can be difficult as saliva is needed to aid retention. Think of two wet glass pieces pressed together and try to seperate them. You need some saliva for retention as well as a lubricant to prevent sore spots. In severe condition like this, implant prosthesis that hold the prosthesis away from the gingiva will help.

3. Patient's ability to practice adequate proper oral hygeine. If a person lost the teeth because of poor OH, I would not put implants in because the implants will fail just like the teeth. You will not get cavities on the implants but will have periodontal problems if you do not brush them well. The plaque accumulation between the gum and the implant will cause bone loss and that means the implants will loose their anchor.

4. Is there adequate bone to put implants in? If not, you would need a bone graft and this is not easy especially after you had recieved radiation to the area. Radiation affects blood supply and if you don't have enough, the body can't repair the wound.

So by now, you are pretty confused. My suggestion is this. Choose the most simple approach that can give you the esthetics and function that you need. Implants sound really good but do you really need them? Try the conventional approach first then see if you are willing to consider implants. If you do then consider this. Where are the locations of the implants and where is the field of radiation and the dosage? If the implants are in the field and the dosage recieved is high enough to put you at risk for ORN, then I would a) reconsider the implant option or b) stick with the non-implant retained approach or c) get HBO treatment. I hope this makes some sense in your dilema. DP