Last monthly ENT appt was on 8/31 with neg findings! ENT emphasized how important it is to get through that first year, as majority of recurrences occur during the first year.

Had some peace of mind until husband's routine dental appt in Sept. which showed suspicious apical pathology #17 (wisdom tooth). I will have the actual report by tomorrow. Endodontic evaluation is being recommended. I have left messages with RO and ENT before proceeding.

Questions: Do we need a dentist at a CCC for evaluation and/or root canal work, if that's the recommendation? Nurse at RO said most post-rad H&N patient do NOT go to cancer center for routine work. My understanding is that an extraction would be a different issue.

My husband thinks I might be making this too complicated and my anxiety level is very high once again. Any advice? Lottie

I was fortunate that my CCC recommended a prothodontist who specialized in oconological dentistry. He sees a lot of oral cancer patients but is not affiliated with the CCC.
You may be reassured that after my 33 first radiation treatments and 8 chemos, I developed a similar issue with my left wisdom tooth but even worse, the wisdom tooth had developed a crack. The opinion was that an extraction risked jaw osteonecrosis so I had a root canal done and then a crown fitted. It was very very tender for almost a year before settling down (of course since I haven't eaten any food nor chewed since February that may be a factor). This was on top of getting another root canal in the molar next to the wisdom tooth that had already been crowned. It can't hurt to ask for a recommendation from the CCC and I was sent to a root canal specialist who operates through a microscope instead of the jeweler loupes type magnifier like my other root canals were done. He could do the entire root canal in one session. You are right to be careful and worried and your husband is lucky to have you as a caregiver
charm

I just made an appt with ENT for tomorrow. She said she would review the dental x-rays and hopefully direct us. This gives me some confidence that we'll be directed to the correct dentist for evaluation/tx. I don't want to find out after the fact that something else should have been done. I already came across a recommendation for low epinephrine- containing local anesthetic and systemic antibiotics in post-rad dental cases. Anyone heard of this?

She asked for date of last scan, as she is in same office taking over for our regular ENT, who is out on maternity leave. They both have good credentials - oncology fellowship H&N @ U Pittsburgh/the other did surgical fellowship @ MD Anderson.

Could this be a sign of a recurrence showing up on dental x-ray? Has anyone had that happen? Thank you, Lotttie

My ENT and Oncologist both reccomended the sam Oral surgeon to remove all of my teeth. He came to the same Hospital that they work in to do the removal. My ins wanted to squabble until they both told them that it was a medical necessity to have the teeth removed. I miss my teeth and it's going on 2 years in Jan .

Hi Lottie,

I certainly don't know what's typical and it seems if it's atypical then my daughter seems to get it. Sometimes I really am afraid it's by osmosis. LOL

My daughter completed her treatments in May and when we went in to see her H&N surgeon for a follow up a couple of weeks ago one of her remaining teeth on top was loose. He xrayed and said it was dead most likely due to the radiation and it must come out along with the bone. They ended up doing surgery and her H&N surgeon actually did this surgery and not the oral surgeon or prosthedontist. We have been informed it may cause us some issues and we go back for follow up on October 5. She actually ended up losing two teeth along with bone instead of just the 1.

This is mainly due to her two previous occurences are in her maxillary and her mouth took full dosage of rads in those areas.

Right now all I do is pray, so many things seem to go wrong with us that there isn't much choice.

God bless and I will be thinking and praying for you.

Bonnie

Thank you for responding Bonnie, Charm & EZJim,

I'm fearful that we're falling into the atypical category of things always going wrong ... so many complications in the last few years. I'll post again after ENT appt - I never considered that ENT could do extraction in a complicated case. Hopefully we just need a good endodontist. Lottie

I wouldn't pick an ENT instead of an oral surgeon to do a tooth extraction. Please note that the previous poster said that the surrounding bone was removed with the tooth. Removal of part of the maxilla or mandible IS in the normal realm of surgically trained ENT head and neck surgeons, (not all ENT's) - simple tooth extractions are not. With any luck at all, this tooth can be treated endodonically (root canal) and extraction can be avoided all together. It is wrong to equate a tooth that is going south by itself, with with a situation where the removal of an area of surrounding compromised/unhealthy bone, which within that area has a tooth in trouble. They are apples and oranges. Teeth removed fro health bone are a special situation, they often have curved roots and other issues that require a finesse to remove unlike the removal of a block of surrounding bone with the tooth. Prothodontists rarely do extractions, so that specialty is not in consideration.

Your comment about so many things going wrong. While complication rates are more common in some small regional treatment centers than others, I don't think I have ever spoken with a cancer patient in which 100% of everything happened textbook without some complications. It's part of the process, everyone responds to the treatments prescribed differently, and doctors cannot predict the implications in every person of their treatments.

Low epinephrine anesthesia is only related to the fact that anesthesia can stay a very long time in those of us that have had radiation which destroys some of the micro vascularization that would normal move it out of the regional area. Carbocain with no epi in it is what I get these days, (1/2 to 1 carpule is plenty) I don't need a vasoconstrictor in the anesthesia to keep it around in the treatment area, it says there for way too long already. This is of course is not harmful, but it is a pain to drool, and accidently bite my cheek for the entire day and night before it wears off.

I hope that you have gotten some additional information today. I would like to add to what Brian has said already.

Removal of lower wisdom teeth can be very difficult in many cases. Extraction, if needed, would surely be best done by an oral surgeon. However, with the information that you have given us up till this point, you are getting ahead of yourself.

Although endodontic treatment on wisdom teeth is usually not done, for many reasons, in the case of a radiated jaw, I would think it should be attempted, as opposed to having the extraction. Not seeing the x-ray, of course, I couldn't say whether it would even be possible to attempt it.

If extraction becomes necessary, then HBO treatments my very well be needed.

Just to add to what Brian has said about the use of a vasoconstrictor, it is almost never needed in the lower jaw as local anesthetics without epinephrine last on average of 3 hours.

Jerry

Jerry ,
How many HBO treatmants are normal for a tooth extraction? Pete`s previously crowned wisdom tooth needs to come out and we go see the surgeon next week. He was informed he would need the treatments but I am wondering how many and for how long?
Marica

Hi Marica,

I believe that the most common protocol is 30 dives before the procedure, followed by 10 after.

I'm sure someone that has had it will chime in.

Jerry