To start I am 11 years post radiation this year. I had 1/3 of my tongue removed and the teeth on that side of my mouth have started to 'fall in' (for lack of a better term) which has caused my front teeth to push together as well as one tooth that's being pushed up. I'm considering Invisalign and neither my dentist or ortho seem to think it's an issue that I've had radiation however I'm in a new city with doctors that aren't as familiar with what I've been through as my doctors in Phoenix. I've yet to find anyone who has had orthodontia done post radiation that can give me feedback.

My dentist did say that having all 4 of my wisdom teeth removed within the first 2 years post radiation (also did HBOT) was likely more serious than orthodontia but I just want to be careful and make an informed decision. Thanks in advance.

Having been on faculty in an Orthodontic dept at a dental school, I would question the status of your bones. moving teeth requires bone to dissolve and slowly regrow if teeth are being moved around.

best wishes

I recently had XRays done with my current dentist and told her my history. She didn't seem concerned. Is there anything other than XRays that I should have done to assess the condition of my bones?

My personal opinion is this is not a good idea. You’d be the first person out of thousands I’ve dealt with that I have heard considering this. Doing anything that involves radiated bone is risky for not healing properly or triggering ORN or other negative issues. While some may argue that this is a function of field of radiation and GY exposure, these dentists don’t know any of that. There are no other bone quality tests that can be done. This is all related to the loss of microvascularization in the bone from radiation which they are not going to see on x rays.

Orthodontic movement involves pressure die back of bone on one side and new bone growth on the other to granulate into the void. Radiated bone is not going to behave like normal bone and like young bone where it is the most adaptable.

If they are so confident, ask them if they are willing to accept the liability for damage to your bone if this all goes south. Note that for you and them that liability could be a fibula free flap surgery if ORN is an outcome of this idea.

Thank you Brian. This was my fear and why I searched for answers for a while before just jumping into this decision.

I've asked to have a retainer made for the way my teeth are now so they don't continue to move and become worse to the point where I have to have them extracted or they become too painful. 3 to 4 of my teeth on the side are falling in sideways causing my front teeth to push together, pointing inward. While I wish that the 3 different dentists I voiced my concerns to about my teeth moving on their own would have not been so nonchalant and made a suggestion sooner there is nothing I can do now. I didn't realize early on that a retainer was an option for me. I really wish I had but there's nothing I can do now. The curse of having gone through radiation is the pain level is unmatched so I just didn't realize how bad it had gotten until I caught a visual of myself talking in a mirror and I saw my bottom teeth.

Honestly, story of my life since I've gotten cancer. I can advocate for myself until I'm blue in the face but if I don't have the correct professionals on my side I end up right where I am in this moment, feeling let down and frustrated by the people who were supposed to be looking out for me in the first place.

I’m not sure what u are describing as “falling in” So you mean towards the tongue? If you had a panorex image taken, ask them to email that to you, and let’s have a look at it. I’d like to see the quality of the bone, and get some sense of why they are moving. If you haven’t had any extractions done that left spaces for them to move into, they shouldn’t be doing this. Teeth literally stay where they are because they have teeth adjacent and opposing them. Take out one tooth and everything distal to it starts to move/drift towards the midline/forward until over time that space gets much smaller. That can take a couple years to happen and it ultimately creates malocclusion.

Having a retainer made could keep them where they are, but that sounds like something you already have a problem with. If this is about esthetics you can live with it no one sees your mandibular teeth anyway. If it’s about function that is something else.

You're correct they are falling inward toward the tongue and creating malocclusion. Definitely the words my previous dentist in Phoenix used. The only extraction I had post radiation were my 4 wisdom teeth for which I also had to do HBOT, that was within the first 3 years following my cancer treatment.

When I had 1/3 of my tongue removed that was the extent of it, there was no 'flap' as they do today to fill the space, there was only empty space between my teeth and tongue on the left side. I assumed this could have very well attributed to this, whether or not it was the sole cause. I've heard from others my age and younger who have had teeth movement post radiation as well. There is a group on Facebook called "Yongue Tongues" for younger patients and survivors of oral cancer that I began to follow.

I wouldn't say that this is simply for aesthetics, I fear that my teeth will continue to move if I don't do something to fix or stop it and I'll find myself in a much worse position. I have discomfort in my teeth and jaw where there has been movement as I feel like the movement is only continuing slowly.

I'm not sure what type of XRay was taken but I've asked the dentist to email it to me.

Well the tongue doesn’t exert any force of consequence on the teeth. People that have total glossectomies do not all have their teeth tilt towards where the tongue was.

I’m a member if some of the Facebook groups and have been asked by most but not joined. The reason is simple, I don’t have time for it ordinarily, and they are unmonitored by anyone that actually knows what they are talking about, (except their own interpretation of what happened to them, seldom based in science and hard facts) which means there is a ton of poor information in them. I get asked to come into a couple occasionally, to set things straight that have gotten out of hand, but really except for emotional support which is valuable, I worry about some of the ideas expressed there. Ultimately someone is going to get hurt by misinformation. Here everything is monitored by professionals in the background, even my posts. If someone suggests something off the wall to others, the post is going to get edited or deleted if not salvageable.,

have you called the Texas dental school? Since dental school is my background, I know often they have resources that the general dental practitioners might not have or be aware of.

I just looked....there is a dental school in El Paso. I would call them and ask for some direction.