Did you have a pre-treatment exam?

Just having a chipped tooth dealt with this week as well.

As explained to me:

If you just extract, the other teeth will shift and rotate which will likely cause more chipping and breaking as we chew. Depending on your dosage chart you can be at risk for osteo-necrosis, the lower jaw being much more susceptible.

If the tooth broke off slightly above the gum line you have a much better chance of avoiding future caries after a crown/root canal.

an implant is the other way to go but also risky and $$$$.

[quote] Depending on your dosage chart you can be at risk for osteo-necrosis, the lower jaw being much more susceptible.[/quote]Did you have any discussion with the RO on this topic? For most of us it remains a mystery as to what might indicate any increased potential for ORN. It seems logical that if the map shows a lot of radiation in/around the jaw that would increase chance of ORN but I've not read any thorough discussion to that effect.

Don, radiation causes an increased risk for ORN. It can be accelerated by the injectable form of bisphosphonates or can just happen because of reduced blood flow to the bones.

Don,

ORN, also called PRON, Post Radiation Osteonecrosis, is a result of having radiation, usually above 60Gy, occurring in a small amount of patients, about 3-5%, with IMRT, and an injury, such as tooth extractions, alveoplasty, oral surgery, ill fitting dentures, which occurs in the mandible more often, as mentioned, whereby bone is exposed for a period of 8 weeks not resolving. Oral cancer patients are more at risk due the higher dosage, volume of radiation to the mandible, maxilla, than other head and neck cancers. Brachytherapy, an internal radiation, has an increased risk of ORN, as well as use of biphosphonates, called, BRON, Biphosphonate Related Osteonecrosis, as mentioned also. There are different grades, 1-3, with grade 1 is often treated conservatively with antibiotics, newer medicines, debridement, HBOT, which usually resolves most. My conservative treatment didn't heal one molar socket, another problem area, after 4 months from the extractions, so surgery was needed.

Thanks guys. Always learn something here. never ends. It is a quite low incidence disease and just last week I met with a fellow survivor who just finished up a 16 hour surgery to replace jawbone with a leg bone. He is doing amazing at 7 months. You can hardly see the scar along the lower jaw and just getting a partial to replace the teeth that were extracted.

He mentioned how the diagnosis was not all that obvious. I think the original cancer team are not experienced in such late side effects. RO, MO, even ENT just don't come across it often enough.

I think everyone needs to find a good oral surgeon that has experience with oral cancer patients as they are probably one of the professionals who can assess the onset of ORN.

Don,
PaulB went into detail that I couldnt. I got the info from my RO. She stated that >55Gy was the dosage amount where it becomes a concern, and >70Gy is high risk. She reiterated twice to me that upper jaw was at less of a risk, but didn't state any delta in dosage/risk between the two.

I was my own advocate. I called everyone asking about what I should do. With the arrival of my twins, I was thinking trying to save money and just have it pulled. Due to the fact it was the second to last tooth and not the last molar, it could cause more problems. The best approach agreed to by all was a crown.

The thing about the gray quantity is it is an average so not a very good indicator, at least to me I think it is the combination of dose and location that probably offers a more reliable potential of ORN.

I plan to schedule a visit with my RO at about two years out, just to have a check in and will ask to review the map they used on me and how my current physical state matches what is typically expected for the amount and location of the rads I received.

My RO said she checked the dose for the #3 tooth was 54Gy, based on some simulation software that was available to her given how the IMRT was done.

Pretty cool IMHO.