It's now 2 weeks since my husband's extraction.

Over the last few months, I've posted about the frustration and worry related to Bob's teeth. He is 5 years post chemo/rad.

The good news: biopsy was negative for cancer (inflammatory process reported) and healing is also good, so far. I mention "so far" because oral surgeon stressed that's too soon to fully know bone reaction. Return in 2 months for exam & x-rays.

Here are some of the issues discussed through this process, aside from the usual trays, flossing, cleaning, etc. I'm hoping to get feedback on what others have been advised.
Use of Peridex (chlohexidrine) oral rinse
More frequent panorex x-rays
Close monitoring of crown margins. X-rays will not find infections under crowns. At any suspicion of infection, removing and replacing crowns, after removing decay (expensive proposition).
Of course, immediate repair of any small cavity

What have I forgotten that others are doing?

Interestingly, our oral surgeon recently attended a conference in New York City. One of the presenters was Brian Schmidt, DDS, MD, PhD at NYU (you might want to google his name and check out his interesting research and background). He recommended, if at all possible, not to extract teeth - cutting them back and leaving them to fall out, which others on the board have mentioned. Even going as far as performing a root canal, I assume to control pain, until the tooth falls out. I will write more about this once I have time to research it.

Thanks for posting an update. Im sure this will help other long term survivors with their dental problems.

Congrats on the negative biopsy!!!!

Yeahhhhhh... on the biopsy and thank you for the information!!!!

So glad to hear that no cancer was found!

I know you searched high and low to find a dentist/oral surgeon to work with... so I have a few questions, if you don't mind sharing:
Who/where did you end up going?
Did they use local novocaine into the jaw area or a different type of anesthesia?
I believe he had HBO before the extraction; is that correct? Any needed post extraction?

I know all of us worry about our teeth and the effects of radiation and appreciate your sharing.


Thanks!
Nancy

Nancy, I'm happy to share and hope to hear about what others have learned.

Regarding search for a dentist, we found an experienced oral surgeon (DDS & MD) locally. He was recommended by RO & a first class endodonist that we trust. The oral surgeon had some past training at Roswell Park in Buffalo, so was well aware of ORN issues.

I still wanted a second opinion with a dentist who deals with this more often; there is no one in our area. After several attempts, a consultation was set up at Dana-Farber Cancer Center in Boston with a dentist from Brigham & Women's Hospital (several hours from our home). This is a new program. Dana-Farber's dental oncologists will only treat patients currently undergoing treatment.

This dentist sees 2-3 patients a week with post treatment problems. She was fabulous! She agreed with 20 HBOT prior & 10 post extraction. She encouraged us to have the extraction with the local oral surgeon, as he had already ordered HBOT, and was being cautious with his plan. She did say that sometimes it is better to cut the tooth down and seal it, although this approach is not problem free either. She agreed with the oral surgeon that Bob's tooth was beyond trying to save.

She gave me her email address and wanted me to keep in touch with her, which was a weight off my shoulders. She cautioned that several healing checks should follow the extraction and if not to let her know, use Peridex rinse until area is healed, and increase frequency of panorex x-rays. She said there was no way to determine ahead of time how healing would progress. Some patients heal in 2 weeks, some 2 months, and some never.

Mechanically, the extraction was not difficult due to bone loss - local anesthesia and little pain afterwards. Oral surgeon was relieved to see good blood flow, which is a critical issues. However, he still says good healing so far, but adds that it's too soon to know final outcome.