Elin,
Dental hygiene will be most critical here. A dental oncologist I saw at UCSFCCC recommended pulling all of my teeth. I got a second opinion and refused. My teeth are far from perfect, many crowns, filings, etc., but I have always stayed on top of dnetal hygiene. This will become very critical as RT and ct progress, as this treatment and the loss of saliva, is very hard on the teeth and gums.

It will require a tremendous amount of tenacity to stay on top of this while you are sick, tired and weak. This is a commitment that cannot be relaxed - even for a day. This will also be a lifetime commitment. After 5 years I finally started only having 3X/year dental cleaning.

Even is he has IMRT it will take as long as 18 months to regain salivary function. This is the time of greatest sisk. Most liquid diets are high in sugar and the saliva is not there to protect and cleanse the teeth. I read somewhere that the average person secrets between 6-8 pints of saliva every day.

I would recommend the following deantal aids if you don't already have them:

1. Biotene toothpaste for dry mouth
2. Dental trays for in home flouride treatments w/pH neutral flouride foam
3. Water Pik
4. Sonicare
6. Babys toothbrush for the first year at least.
7. Perio Aids
8. Woven dental floss
9. GUM Soft Picks.

RT and ct are hard on the gums and teeth. I have exposed roots as a result of treatment and that increases the danger.

A cautionary note: If an extraction is required, there is a 10%possibility of osteoradionecrosis (ORN) due to infection. Literally translated this means "bone radiation death". It is caused by damage to the capillaries in the jawbone from radiation. This can cause loss of the jawbone in some instances. This can sometimes be mitigated with HBO therapy.

Routine dental work such as crowns, root canals or filings should be ok.