Last week I posted regarding dental issues and have decided to start a new thread. On the day of my husband Bob's 5 year anniversary of completing tx, he found out that he has an abscessed wisdom tooth on the irradiated side. Today an endodonist's evaluation determined that a root canal will not save the tooth. In fact, there is bone loss and another tooth that may require root canal.

I am in touch with our RO and am aware that HBO will be required.

My first question to the forum and RO, MO & ENT:
- Do I need to find an oral surgeon experienced with cancer patients?
Is there such a thing? Do we need to go to a oral surgeon at a cancer center?

Tomorrow I will try to find out the protocol at Dana-Farber for oral cancer patients with these dental issues.

- Has anyone here had this done successfully?

Any guidance? I want to think clearly but panic is returning.

Thank you,
Lottie

Lottie, I will go over my experiences with a similar situation and hopefully this will be helpful.

First.... try to relax!!!! This is a walk in the park compared to what Bob has already been thru. In case I missed it before, congrats on the 5 year anniversary! HBO is time consuming but it is worth spending the time to avoid bigger issues down the road.

My oral surgeon is experienced with treating oral cancer patients. He is up to date with the current trends and wouldnt touch me without my completion of the HBO dives. He is not affiliated with a CCC. My teeth were loose and crooked after finishing rads so I planned on having them out so I could get dentures. Instead I wound up with my third round of OC (the teeth would have had to go anyway with that diagnosis) which had invaded my jawbone. I did the 20 HBO prior to the teeth being removed and 10 afterwards. I think this was early 2009 I had my teeth removed. This year my oral surgeon had to snip off a couple rough pieces of bone from my good side so I did the 20/10 HBO again.

If I were in your situation, I would make certain that whatever oral surgeon you decide upon that they are familiar with OC patients. I dont know if there are extra levels of education like there are with ENTs. I dont know if CCCs have an "in-house" oral surgeon as thats usually dental not medical.

Sorry that I was not of more assistance! Wishing you all the very best with this!

Thanks so much Christine. This gives me a good start and a plan of inquiry for tomorrow.

Of course you are right about relaxing. It would be easier to do if I hadn't read about possible osteoradionecrosis following extractions.

My anxiety right now comes from fear of making a decision without all the necessary information and finding out afterwards that something was missed. When getting a second opinion for initial tx plan, our local MO set up appts with Dana-Farber's team. After Dana-Farber approved the plan, I felt confident to move forward. I don't think that kind of help is available in this situation. That's the type of assurance I am seeking.

I believe HBO is covered under medical insurance. Is work by an oral surgeon ever covered by medical insurance (probably the surgeon's office will know this)?

Do you if dentists and oral surgeons who treat post-tx cancer survivors have a special title? Or is it more informal recommendations and asking what their experience is with cancer patients?

I want to make sure my dental provider is always aware and thinking about what is going on in my mouth always thinking through the fact my mouth has been through radiation and my body has been compromised thru chemo, etc.
thanks

A Prosthodontist is dentist who has additional 2 or 3 years of specialized education and training. They are more knowledgeable than a regular dentist.

I did read up a bit more on this specialty and obtaining board certification does take time and specialization. It seems this specialty is more focused on complex and restorative procedures, irrespective if the patient had cancer radiation or not.

It may be I'll just need to ask a few questions and get a better idea how much their experience includes post-tx cancer survivors. Thanks.

I am back to how I felt after Bob completed tx - more angry at the tx than the cancer. I know it saved his life but it is barbaric.

Oral surgery evaluation today was very frightening. High risk of ending up with ORN, but it looks like wisdom tooth and possibly another will have to be extracted. The surgeon himself said, "this can turn into a nightmare". He wants us to get another opinion, which is scheduled for tomorrow.

He is contacting our RO re:HBO, but said that some institutions (ex. Sloan Kettering) do not believe that it helps enough cases. On the other hand, if you end up with ORN and didn't have HBO, you'll wonder if it could have prevented it.

There is also concern about the tooth "blowing up" while waiting to complete HBO and then it's an emergency. He said we might want to consider a root canal prior to HBO (this would remove the time pressure risk) and still extract the tooth in the end.

It is getting so complicated that I feel sick. Why didn't they advise removal of wisdom tooth/all molars prior to tx? We were told to have his teeth checked out before rad. His teeth were healthy at the time. No one said we still might want to consider removal of molars to avoid this possibility. I'm very disturbed by this!

You should have been told to have any dental work completed prior to starting treatments. I always tell new patients to get any questionable teeth taken care of first. Its a darn shame the medical professionals werent more thorough. I feel your pain! GGRRRR!!!!!

We were told to have any damaged or questionable teeth removed prior to tx. Bob's teeth had always been very healthy, so it was decided to leave them. I think at least the wisdom tooth should have removed because it has more potential for developing problems.

Just spoke to nurse at RO - HBO consultation is being set up. The nurse was encouraging. She assured me that they have dealt with cases that turned out well.

Second oral surgeon consult in AM.

I had similar. Did the pre-treatment evaluation, filings, root canal, and an extraction, molars were fine, but six months after radiation, they were infected, and needed extraction, possibly necrotic. Radiation does direct damage to the teeth, loosens them, and causes caries even previously healthy teeth from lack of saliva. Not to mention what damage chemo can do similar. Now I need all my teeth removed, and can't do any HBO yet due to surgery. I don't fault anyone, and know other factors are involved even if proper care was made. Did you husbsnd have dental trays and prescription fluoride?

Good luck with everything.