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jill_v Offline OP
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Hi everyone!
It's been 1 yr & 8 mths since radiation & despite being a bit sensitive to sweet stuff,my teeth look & feel fine.
I've had flouride application about every 4 months & was wondering if radiation can show any effects on the teeth in the longer term?
During surgery they removed gum & teeth(about3-4) on the lower end of the right side.Can they do implants without any gums ?
My RO even mentioned not to get any teeth extracted until after 2 yrs from radiation.Does anyone know the reason?

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Jill
My Husband is 3 years out and still having issues with his teeth....most of them have been capped. As time went by his gums eroded quite substantially... I hope some of the othere will be able to answer your questiom in more detail...Jerry is a dentist and very giving of his time and experience.
Marica


Caregiver to husband Pete, Dx 4/03 SCC Base of Tongue Stage IV. Chemo /Rad no surgery. Treatment finished 8/03. Doing great!
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Hi Jill,

First of all congratulations on your success of 1 year and 8 months. Most of the information that I have regarding dentistry after radiation has come from being a member of this forum. Basic dentistry is another situation and one that I am very familiar with.

First some basics. The amount of gum tissue that you have has no bearing on whether an implant can be placed. Even though you may have had some gum tissue removed with the extraction of your teeth, you do have gum tissue. What you need for successful implants is sufficient bone to place the implant into. This is best determined by x-rays. In the upper arch (you don't mention if you had extractions in the upper or lower) implants may be a little more difficult as the sinuses can make placement difficult as there may be insufficient bone available.

Radiation complicates the siruation due to osteoradionecrosis (ORN) which is best described below:

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, placement of an implant can result in bone that won't heal.

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

You can search this site and the internet using the words "osteoradionecrosis" and "hyperbaric oxygen" and get more information than you can imagine.

Hope this has been helpful. Please don't hesitate to ask questions here or through a private message and I will try to help. If I don't know the answer, someone else here will.

Jerry


Jerry

Retired Dentist, 59 years old at diagnosis. SCC of the left lateral border of the tongue (Stage I). Partial glossectomy and 30 nodes removed, 4/6/05. Nodes all clear. No chemo no radiation 18 year survivor.

"Whatever doesn't kill me, makes me stronger"
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Hi Jill,
I go on the 23rd of this month to FINALLY SCHEDULE MY IMPLANTS. We thought I would have them by now but such a drawn out process. The surgery I had, using bone from the leg to replace half my lower jawbone, was done specifically so I could have implants. I have two friends in the area that have had implants in their radiated jaws and they are THRILLED with them. If you lack gum tissue, they will just make the post of the implant a bit taller. Even if you do not have enough initial bone, they have procedures that can build up the bone. Joanna on this site has helped me the most about implants, she had them done and is very happy with them.
You will need to do 30 "dives" of hyperbaric oxygen treatment.
Let us know what you find out.
Minnie


SCC Left Mandible. Jaw replaced with bone from leg. Neck disection, 37 radiation treatments. Recurrence 8-28-07, stage 2, tongue. One third of tongue removed 10-4-07. 5-23-08 chemo started for tumor behind swallowing passage, Our good friend and much loved OCF member Minnie has been lost to the disease (RIP 10-29-08). We will all miss her greatly.
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My RO told me that ORN is a lifelong issue. I kept all of my teeth. I used dental trays with prescription flouride every week for years and get my teeth cleaned every 3 months. There was a slight receding of the gums but they remain healthy. I have had a few minor filing repairs and one porelain filing in a molar in the radiation field. The dentist tells me my teeth and gums are in better shape than many of his other patients. I would still need HBO for any extractions, especially in the radiation field (or any area receiving over 62 cGy). I had IMRT and still use Biotene. I also use woven floss which is much easier on the gums.


Gary Allsebrook
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Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
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i'm only about 6 months out from radiation and 3 from surgery but so far everything is cool. A dentist I saw at UCSF told me I'm 8 times as likely as a normal person to have gum disease and other dental problems now.


Diagnosed 6/05. Stage III SCC of the oral tongue. Nodes showed negative upon biopsy. 7/25/05 started Chemo of Cisplatin & Erbitux & 30 IMRT Sessions + daily Ethyol. 12/9/05, 75% hemi-glossectomy. Recovering since.
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A so called dental oncologist also at UCSF advised me to have ALL of teeth pulled, which I flatly refused to do. Three years later I still have all of them and NO gum disease.

I did go the distance with dental hygiene however:
1.


Gary Allsebrook
***********************************
Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
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Sorry my time elasped during the edit...

1. I had all of dental work, even minor stuff done prior to Tx.
2. I had dental trays made and got a prescription flouride (same stuff they use). I did flouride treatments at home several times a week.
3. I use a "Water Pik" and also used a portable battery operated one on the road.
4. I use a "Perio-Aid" - A plastic curved tooth pick holder to clean the sides of the teeth that the floss can't reach.
5. I have my teeth cleaned 4 times a year (under the gums with ultrasonics) and also an industrial strength flouride treatment.
6. I used and still use Biotene toothpaste and used the mouthwash as well.

My dentist informs me that my gums and teeth are healthier than most of his regular patients.

It look a lot of work to do the maintenance when I was wracked out during the first 18 monthes post Tx but it was well worth it.

Because of the IMRT I have most of my salivary function back and it's much easier now.


Gary Allsebrook
***********************************
Dx 11/22/02, SCC, 6 x 3 cm Polypoid tumor, rt tonsil, Stage III/IVA, T3N0M0 G1/2
Tx 1/28/03 - 3/19/03, Cisplatin ct x2, IMRT, bilateral, with boost, x35(69.96Gy)
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jill_v Offline OP
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thank you all for your responses!I never knew that ORN might be a gradual process & may take years to appear as all this time i've been thinking that since the dental nightmares didn't pop up now,it's unlikely to trouble along the road!

Jerry...i found your post very informative...hyperbaric oxygen is something my dental surgeon never bothered to mention..he just said a big no to implants.I just need to know:
1)do they need to do an x-ray to determine the bone damage before a tooth extraction(radiated site) after 1.8 yrs post radiation.
(as i was under the assumption that the bone would have healed itself after all this time).

2)How do i find out if i have ORN?Are there any symptoms to look out for?
(my teeth seem fine at the moment but i think i need to be proactive to avoid dental issues in the future).

3)Are there any negative issues related to the hyperbaric oxygen treatment?
(I'm really surprised as to why, neither my RO nor my dentist have mentioned these treatments to me as not only does it seem beneficial for radiated tissues but might even help with the neck stiffness as a result of dissection).

During surgery the flap they did from the thigh, was lost & after few days they had to do a new one from another part.Just when i thought i was over & done with the operating room,i had to be wheeled in again & ofcourse not to mention the long scar on my thigh..all wasted...& now to find out that the HBO treatments might actually have saved the first flap.sorry to keep on & on but i just feel so mad at the moment.I can't wait for my next follow up with the docs..they have some serious answering to do!!

Gary...thanks alot for reminding me that you simply can't do enough for dental hygiene & maintenance.I think i was taking it for granted a bit & i needed a wake up call.I just need to know what exactly you use for your home flouride treatments.My dentist mentioned that they mix different substances to make the paste & it's not available in the market.

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1. The loss of micro-vascularization in the bone to radiotherapy is permanent, but for brief periods of time, the lack of healing response because of this (important for a vaiety of situations including implant placement) can be overcome with 02 dives in a chamber. This doesn't make new microcapillaries appear, it makes whatever you have left more efficient.

2. If you have ORN you will know. You will have a non healing wound in your mouth.

3. I think there are several people here who can comment on this who have actually been down this path, but there isn't much of a down side to the dives in comparisom to the benefits.

4. It is unlikely that 02 dives are going to help with your neck stiffness.


Brian, stage 4 oral cancer survivor. OCF Founder and Director. The first responsibility of a leader is to define reality. The last is to say thank you. In between, the leader is a servant.
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