Sorry I'm so late in getting into this thread. As I've mentioned in other threads, I am so limited on time that I don't get to the forum as often as I have in the past and would like to continue to do. When I do get here, I start at the top, as most of us do and then run out of time before getting into the lower forums. Now with the walk over, I hope to ge here more.

Dr. Mike as usual has most thoroughly covered the topic of the need for antibiotics prior to dental cleanings or scalings. I wholeheartedly agree with his thoughts on the subject. The latest AHA recommendations, as far as I can remember, as well as any past recommendations, have never indicated the need for antibiotic pre-medication for patients that have undegone radiation or chemo.

As far as the question of scalings causing oseteoradionecrosis (ORN), since these procedures have nothing to with trauma to the bone, as they are limited to the gums, there is no fear of ORN developing. Suggesting that scaling lower than 2mm and therefore, allowing any periodontal disease that might be present to progress, is absurd.

Jerry

I am having a very rough time here getting to see another person for a second opinion. My radiation oncologist is not returning my calls. Two cancer centers I called use the same prosthedonist I see. A third one refused to talk to me without a doctor referral. A fourth one told me they never heard dental care with tongue cancer treatment, and could not help me. I also called a radiation oncologist at UCLA, and he told me to contact their Beumer Center. SPOHNC told me the same thing. (I'm in Los Angeles). But when I contacted the Beumer Center, I was told they are not taking new prosthedontist patients. And I don't want to go straight to the phone book. I want to find someone who routinely works with oral cancer treatment post care.

I am going to keep trying, but it is not easy. I have been so sick for so long it is hard for me to just type this message. Hard for me to make phone calls. If anyone has some ideas, please let me know. The only idea I have now is trying to contact Dr. Beumer directly and asking his advice.

Beumer spends most of his time out of the country lecturing on maxillofacial prosthetic reconstruction, and less at UCLA. He also does not use email but communicates via an assistant. More than all this he is a prosthodontist that specializes in the replacement of facial parts, and is not a soft tissue expert. Whoever suggested that he was the guy to talk to for an opinion abou tscaling your teeth post treatment clearly doesn't know much about his training or what his practice is based around. I've known John for 30 years and you are looking to talk to the wrong guy. Find a periodontist associated the the head and neck department, but to be honest I think you are over thining this. I have never heard of a cancer patient getting antibiotics for scalings, and as I said before 2mm is nothing. As Dr. Mike stated clearly most people have a periodontal sulcus of between 1-3 mm dee around all their teeth where the tissue is not attached to anything.

Tell the hygienist that you have been radiated and heal slowly if she gets too aggressive. I bleed sometimes after a cleaning for a day and they are sore, But that's it. But after more radiation than you have had, in ten years of having my teeth cleaned aggressively, since with NO saliva I have a huge plaque and calculus issue, and have to have this done every 90 days to maintain things, infections have never been an issue. I have never heard of a patient getting antibiotics just because they were radiated before scaling.

Beumer was recommended for second opinion by Steve Lee (radiation oncologist) at UCLA. He was also recommended by the radiation department at Cedars Sinai.

And I think it makes sense for me to get a second opinion from someone who actually looks in my mouth, etc. to see what my situation is. My dentist is not going to simply ignore the instructions he was given.

Also, I would still need a max prosthedontist on my side for doing advanced work. From what I understand, the average dentist is not qualified to do extractions or other advanced work on post-radiation patients.

So if you know anyone who can give me a good referral for this, I'm all ears.

Anyway, I appreciate all the responses I get here. I realize I am asking a lot of questions, but I'm just plain scared. And that's why I'm trying to cover the bases.

Thanks,

Andrew

I just realized I should get about all of this. Bottom line, I went back to the dentist and told him why I thought he was wrong. I asked him to consider where I would be in 10 years, given my current state of bone loss. And then compare that to the risk of infection from cleaning. I also asked him to consider the fact that the research he was citing was old, and that research trends are not meant to be used on a case by case basis.

Bottom line, he immediately referred me to a cancer-literate periodontist. And later referred me to a cancer-literate endontist. Both of them told me that the 2mm thing is out-dated thinking. I also found out I should have had a cleaning before treatment, something I had asked about, but the treatment place told me not to.

Might as well add to this old thread too. What happened is I went back to the dentist and got into a lengthy argument with him. He was even raising his voice at me. But I asked him "where is my bone loss going to be in 10 years, and how will deal with my teeth then." He got a very worried look on his face and immediately sent me to a periodontist. I've been getting scalings ever since.

But I found out where this idea about no scaling comes from. It comes from a study in the 1930s. And you can see the advice as given by CDC here on the following link: Scroll down to where it says Osteoradionecrosis http://www.oralcancerfoundation.org/cdc/cdc_chapter7.php