Just returned from Dana-Farber (CCC) in Boston for dental consult in H & N cancer department. This dentist works almost exclusively with oral cancer patients. I will write a more detailed summary later, but regarding wisdom teeth, which is my husband's immediate problem, this was her advice:

Current guideline is that heathy teeth are NOT removed prior to rad. The decision regarding wisdom teeth is less clear. If a wisdom tooth has never been a problem in the past, it is usually left alone. If there have been flare-ups in the past, it should probably be removed before tx.

As Cheryl pointed out, extractions prior to rad, run the risk of delaying cancer treatment, especially if complications develop. This dentist sees 3-4 patients a week with infected/damaged teeth post rad. Not just wisdom teeth, but all teeth (especially molars) are at risk.

One comment on aggressiveness: One of my docs told me that most HPV positive disease was poorly differentiated and it doesn't have much significance for HPV positive disease vs HPV negative.

I would get a 2nd opinion from a dental oncologist re the extraction. Most prefer to remove teeth (that need to be removed) before radiation so the BIG ? is does it need to be removed. if you are going to need to have it removed sometime in the near future I would get it done now.

Okay guys here's an update:

Wisdom tooth will NOT be removed. When dentist checked the margins she said it had improved over past visits, so in light of everything else she can live with not removing it. She also took an x-ray of the tooth and was satisfied with it's under gumline appearance. We did make the fluoride trays, they will be ready Thursday so I can pretreat for about 4 days prior to onset of rads.
She also gave me about a dozen 2oz sample bottles of old formula Biotene dry mouth rinse and gel, the formula with lactoferrin, lysosome and sweetened with xylitol.

That means rads start on schedule, Monday, Nov 4th, a big relief as I still don't like my tumor path description...invasive and moderately differentiated.

In every piece of good news there also lies the bad (how's that for Zen duality Bart). After letting the throat culture grow for 4 days (two 48 hour periods), nothing has grown, ie infection is not bacterial in nature, that's why augmentin didn't work. So, it's likely viral and only thing we can do is let it run it's course. I've asked, there are no anti-virals to treat this. I know she got a good culture sample as I could see the green @#$% on the swab myself.

So, my week 3 treatment symptoms (sore throat, but not dry mouth) started 2 weeks prior to first rads, ain't life great! Let's hope it cures out prior to rads so I can get at least a little of the honeymoon period.

This too shall pass.

Tony

Good to hear rads will start when they were originally scheduled.

Fingers crossed that your throat improves real soon.

Yeah! Good luck.

You've got the idea, Tony, perfect attitude.

The ability to see the humor in the darkest of situations indicates perfect mental health. You will float through this as long as you keep that attitude!

And with this post, you've made my day! Thanks, Compadre!

Thanks Bart, Cheryl, Ambra; always good to hear from you.

The viral infection symptoms just got worse and worse, hurt all the time, wanted to sleep but couldn't; so called the clinic to discuss. They hooked me up with an ENT appointment this morning.

The doc said whatever green crud was there at time of culture is gone, throat is clear, surgery site looks to be healing normally with some granular tissue present but explainable since all the tumor wasn't removed.

He asked if I was having any fever (none) and noticing no swelling in the area concluded all my pain and misery is caused by the tumor tissue itself. He actually used the term angry tumor (don't laugh). Best course of action at this point is start rads on schedule Monday and take these really good pain pills I'm going to give you so you can sleep at night (but don't drive). He also gave me a bottle of chlorhexidine gluconate to use on the teeth.

I guess I'm satisfied as I can't argue with any of the things he said. I did ask if it could have been staph to which he replied it would have grown on the culture and thus been identified.

If you guys know anything that I obviously don't please speak up.

thanks
Tony

P.S. Oh, and I got my fluoride trays today also, really comfortable. Dentist says I can sleep in them if desired to better treat the teeth. Any reason not too?

I am not laughing at all at the angry tumor. Makes total sense.

Well, at least they seem to have a better idea of what might be going on. I am very curious to hear what you are told about sleeping with the trays.

Hope you have a nice weekend and manage to relax before Monday.

Tony
.......so funny you mention an angry tumor! The day before my surgery, my surgeon looked at my tongue and commented that my tumor was looking especially angry. I commented back that of course it is.....it's being evicted tomorrow! LOL.