I'm really discouraged by the few things I've read regarding replacing a patient's teeth. All of my sister's teeth were extracted during surgery. She will start radiation next week. Meanwhile, the doctors don't seem particularly concerned about her having to go around with no teeth which angers me to no end. I read one of your posts regarding an acrylic gizmo called a "flipper." Where might this gadget be available?? From what I've read on others' experiences, she won't be fitted for dentures anytime soon, and especially not by the time she plans to return to work. I'm totally boggled on this subject. Thank you Brian.

A flipper (a simple removable PARTIAL denture made from plastic) is only a temporary device, custom made for a particular individual, by a dentist and lab, that will replace one or two teeth. It is no good for eating, only looks. A person who has had all their teeth extracted needs a complete denture, and this is a whole 'nuther animal. Teeth that are marginal for long term survival, have extensive decay, have periodontal problems, etc. must be extracted before radiation, as any post radiation extraction will cause severe consequences. If the teeth were extracted, the doctors must have felt that they were in bad shape or the surrounding tissue and bone had perio problems that might have caused them to be lost after radiation. Teeth are not arbitrarily extracted prophylacticly

That "bigger issue" you mentioned IS the most important thing, and I knew you were going to say that. But I thank you for the information.

Tammy,
Brian is right about the risk of osteoradionecrosis. I had all my teeth removed prior to radiation treatments, so I know how your sister is feeling. She will not think so much about having teeth during her treatments. After radiation is over she will need time to heal, and during this period is when it got to me. When I began to feel better I wanted my teeth back. It was one year before they fitted me with a top denture and eighteen months before I got a bottom denture. Of course, no two people are the same and your sister may get them sooner. I just want you and your sister to know that it will happen and things will get better. It took me awhile to go out in public without teeth (fear of people looking at me), but I got over that and she will too. I'll be praying for you and your sister and if I can help in any way let me know. Anita

In reading my previous post this AM, I realize that it came across a little harsh as to priorities. I'm sorry, this has been a week of several OCF acquaintances losing their battle, and I'm a little sensitive to priorities right now. It has nothing to do with whether or not your esthetic concerns are important, they of course are. The whole person is being treated, and esthetics and self-confidence are of course a genuine and valid concern.

If your sister handles the radiation treatments well, there is an intermediate step that the prosthodontist may take to give her more comfort in public or at work. This is commonly referred to as an "immediate denture," which while still made of hard plastic and plastic or porcelain teeth, is lined with a soft resilient liner. The soft liner is readapted to the changing contours of a patients mouth every couple of weeks in a simple chairside procedure. Since this denture is for esthetics primarily more than chewing, it is likely that just the maxillary denture would be initially made, as this impacts the shape of the face and the smile more than anything else. But even this step may be some time off. The doctors are going to want the soft tissues to heal from the radiation induced mucositis as much as possible first, and that means after radiation has ended.

One of the issues that she should be aware of, and working on during treatments, is radiation induced trismus which you can read about in the web site. With totally edentulous patients, the tendency for the vertical dimension between the two arches to decrease is more likely since there are no teeth to help maintain the space. As the effects of trismus become more pronounced, this will potentially cause problems later when her final dentures are made. It is important that she maintains this inter-arch space through stretching exercises throughout her treatments and for months after radiation has ended.