This dentist should have his head examined. 2mm of scaling isn't much - this is not deep root planing. And if you develop significant periodontal disease in an area that is going south now and needs professional cleaning, you are going to have the very problem he thinks you are going to avoid by letting the bacterial plaque and calculus remain. Freakin' unbelievable. I hope Doc Jerry chimes in here cause I am sure he is going to mirror Doc Mikes Comments.

Dear Brian and other list members:
What would you suggest for dental cleaning prior and after chemo/radiation treatment. I had an oncologist dentist examine my teeth prior to induction therapy. There is a lot of metal restoration, but teeth look okay.

I've finished chem and have 4 weeks until radiation. Time enough for my mouth to heal, and I'm thinking about removing the metal filling, cleaning the the cavity and replace the filling with other material, but for the present only on the side where the cancer is located.

What's everyone's opinion. Also, I'm very confused. What should be my dental tx during and after radiation. I know my mouth will be extremely sore. Everyone seems to be doing something different.

This info will really help me choice the right dentist.

Thanks
Sandy

Has anyone mentioned the fluoride trays? I was told to begin 30 days before the rad began and I still use them nightly. The fluoride is to help strengthen the teeth against the damages of radiation.

I've been using fluoride trays. I don't remember when I started. Maybe when treatment started. But this is another area where opinions are different. I was told to put them in for 5 minutes, remove them, but then I should NOT rinse, brush, eat or drink for 30 minutes after that. The fluoride is OMNI Gel 0.4% Stannous Fluoride.

[quote=davidcpa]Has anyone mentioned the fluoride trays? I was told to begin 30 days before the rad began and I still use them nightly. The fluoride is to help strengthen the teeth against the damages of radiation. [/quote]

Andrew,

I was told to put them in before bedtime for a minimum of 3 minutes and not to drink for 30 mins after. I just keep them in for 30 mins and go to bed after I take them out. I have never had a problem keeping it in my mouth for that long. My dentist says I should continue to use the trays forever but he isn't really adamant about that. I also switched to a generic brand that costs 1/3 of what I use to pay.

Fluoride is a great idea but for patients undergoing head and neck cancer therapy, chemo and radiation, it is an essential component of maintaing and improving your oral health and prventing your teeth from breaking down. Chlorohexidine 0.12% rinses are also excellent in lowering and controlling periodontal bacteria in individuals with gum disease, ulcers, and compromised immune systems.
Fluoride has been discussed at length in many threads and posts on this site many times. Just type "fluoride" in the search bar and you'll have plenty of information to read.
As for the scaling below 2 mm being detrimental...I do not agree. The average healthy sulcus is 3mm. Bottom line is bacteria, plaque and calculus are toxic to tissue and need to be removed. They are pathogenic to gums and bone and in order to maintain gum and bone health they need to be removed at any depth.

Cheers,
Mike

Can we have a show of hands - how many of you receive antibiotics either pre or post cleaning?

Patty

Not here and I went right back to my pre Tx cleaning routine in every way possible. I have had the same dentist for about 18 years and he even came to my house twice during my Tx just to check up on me.

Patti,
I have NEVER been given an antibiotic before or after dental scaling and cleaning.

Andrew,
I had a cleaning appt with my prosthodontist who specializes in oral cancer patients and he said he has never heard anything so silly. 2mm is nothing. He said if the patient has a 5mm pocket you scale to 5 mm because not getting the plaque out would create more problems. Basically you scale as deep as necessary to remove the plaque. I have several very deep pockets that I had even prior to radiation (my teeth have very long roots) and have never had a problem with them being scaled. I think I'd find a new dentist if I were you.

Take care,
Eileen

Antibiotics prior to dental treatment this is a great topic and, in my humble opinion, misunderstood by many dentists and patients.

Antibiotics are prescribed to patients who are percieved to be at risk of developing bacterial endocarditis as a result of dental treatment. The basic regulations as to who needs them and how much has changed very little over the last 20 or so years. Here is a link to a site that explains the rationale and science of this situation; http://www.aafp.org/afp/980201ap/taubert.html

A long story short, the simple facts are that when you have your teeth cleaned bacteria that are already present in your mouth are introduced in large quantities into your bloodstream (the same thing happens when you brush your teeth.) Individuals who have prosthetic parts in their bodies especially in or around their hearts are at risk for the potential colonization of bacteria on these prosthetic parts which could lead to a potentially fatal result.
The American Heart Association; http://www.americanheart.org/presenter.jhtml?identifier=1200000
publishes guidlines for medical and dental practitioners to follow to best prevent this situation in patients who are at risk.
Radiation therapy and/or chemotherapy to the head and/or neck do not put a person at a higher or abnormal risk of developing bacterial endocarditis after dental treatment. There is no science or research that I am aware of that supports prescribing antibiotics to patients who are undergoing radiation and/or chemotherapy to the head or neck to reduce the risk of bacterial endocarditis.
So relax everyone and don't get anxious if your dentist doesn't prescribe an antibiotic before your filling or hygiene appointment. If you are at all concerned about this ask your dentist. I'm sure they would be more than happy to discuss it with you.

Cheers,
Mike