My husband starts treatment soon with chemo and radiation for tonsil cancer. We are looking for help in finding a dentist in our area that can keep an eye on Todd during his treatment to assure his teeth and gums ar ok. Any suggestions?

Linda,

If he's being treated at a major cancer center, his medical team there should be able to provide some referrals to dentists who have experience with radiation-treated patients. Having that type of dentist is essential, not only during the treatment itself, but for the rest of his life (I'm almost 18 years post-treatment and still have frequent dental and periodontal checkups to look for any long-term after effects).

Also, very careful dental hygiene is critical going forward. This typically includes regular fluoride applications, teeth cleanings 4 to 6 times per year, and keeping the mouth as moist as possible to prevent deterioration of the teeth and gums.

Cathy

Cathy is right. Any reduction in saliva whether salivary glands are removed during surgery or damaged during radiation, in turn, reduces the amount of natural clensing (flouride, etc.) that is done on the teeth. Since saliva is what carries flouride, etc., supplements are usually required.

I have a flouride rinse I use that I brush in after brushing with Biotene toothpaste (special toothpaste for drymouth folks). The dentist has in the past given me a prescription flouride toothpaste to use.

Flossing becomes more important as well. Saliva is usually thicker after radiation and does not do as good a job cleaning between the teeth. This is the part of oral hygene I struggle with because of the surgery I had. They removed 1/3 of my tongue on the right by basically taking the chunk out around the tumor and sewing it back. In the process the nerve endings got rerouted. So when I floss between my right lower teeth, it feels like someone is poking me with a needle in the right side of the tongue. I am 4 years out from surgery and it still hurts to floss that side, so the dentist has said, do the best I can.

If your husband still has his wisdom teeth, you may want to see about having those removed pre-radiation treatments. The oral cavity will change during radiation and when it was done, I no longer had room for my four wisdom teeth. Pulling them was a much bigger ordeal post-radiation.

Jim

Saliva has no flouride in it. There are natural enzymes in it that help protect your teeth and the rest of your mouth for that matter. A reduction in saliva reduces these, and the Biotene products help replace these enzymes when you use them. In addition to all this being on top of your hygiene and using your high concentration flouride toothpaste or gel/foam in trays is a must.

A friend of mine who was treated at M D Anderson Cancer Center in Texas was furnished with stents prepared by her dental oncologist to protect her teeth AND her saliva glands during her radiation treatments.

Dental Stent

If you aren't already at a Cancer Center, you might check with the Moffit Center in Tampa regarding this.

Linda,

If you want I can ask my dentist (friend) if there is anyone he knows in Coral Springs or a Dental Assoc number that can make a referral.

David:

Thank yousooo much for the offer. Yes I would like a referral, as UM Cancer Cenete advises that they are not aware of any Dentist that specializes in this type of treatment.

Linda and Todd --

You should go to the Oral Cancer Foundation web site itself and check out the extensive information available on dental issues. Since dental problems are one of the MAJOR side-effects of radiation to the mouth I am astonished that your cancer center does not focus on this. Hopefully David can find you a referral and you must see him/her BEFORE treatment.

To summarize: Generally, a CCC will have the person who is about to undergo radiation therapy affecting the mouth and throat to have:

1. An up-front complete dental examination to ensure that all the teeth in the radiation field are sufficiently sound. They can have fillings or crowns but need to be healthy. Reason is the need to avoid, as much as possible, extensive or invasive dental procedures after treatment, as these areas may be slow to heal and in some cases, may develop radionecrosis of the jawbone.

2. Any dental work (fillings, etc.) needed will be done beforehand. Any unsound teeth may be removed. In the latter case, the area needs to heal somewhat before treatment.

3. Dental "trays" may be made (most CCCs do this) for the daily application of a flouride gel during and post-treatment. This will, in part, help prevent the rampant decay that can affect radiated teeth. This procedure will need to be continued indefinitely post-treatment.

4. Meticulous oral hygiene is needed during treatment and afterwards. However, mouth sores and inflammation associated with the radiation may make some procedures difficult and painful. This can be ameliorated by brushing with an ultra-soft toothbrush, such as the one made by the Oral Balance folks (can also use a baby's toothbrush), use Biotene toothpaste (none containing sodium laurel sulfate), and using a mouthwash that does not contain alcohol. Biotene dry mouth mouthwash is best. These products are widely available at Target, Wal-Mart, Rite-Aid and other vendors. Using a salt/soda rinse often (several times a day) also helps. There is also a soft "ultra floss" which is less apt to cut a fragile mouth.

5. There is risk of trismus (again, check OCF web site) - this is the inability to open the jaw. The best thing to use is a device called TheraBite (my husband used one all through treatment for his tonsillar cancer and has no trismus) -- it was prescribed by his ENT and insurance paid for it. If this is not an option, there are exercises that can be done with one's fingers to help preserve jaw function.

6. Saliva is very important to dental health (and many other things such as swallowing!) and it would be good to know about your husband's radiation plan -- wil he be getting IMRT and if so, how much of his salivary glands will be affected by the radiation field? Do the doctors feel that he will retain some salivary function? (Usually IMRT allows this, but how much depends on the radiation planning). Is amifostine (Ethyol) available? A nasty drug but it does help preserve salivary glands -- my husband took it throughout (with effort) but even a short course helps.

Anyway, much more on the OCF web site -- Gail

I feel that I shouldn't be adding anything to Gail's detailed account above, since I was fortunate not to have had radiation. However, I do have a dry mouth problem at night, and I have found great comfort in using a small trigger-style spray bottle, as is used for misting plants or laundry, which sends out a very fine mist. I spray it all though my mouth and into my throat. It moistens my throat and mouth and teeth (which want to stick to my lips because of their dryness) without contributing much that needs to be swallowed......I can spray enough for a small drink if I prefer, and still it is easier than drinking out of a glass. I keep it beside my bed, and I use it a number of times during the night. I find it a great comfort. Maybe this idea would be of help to someone with dry mouth, or with sores in their mouth, and with difficulty swallowing.

I start 7 weeks of radation for tonsil cancer in 2 weeks. I first went to my regular dentist to get clearance for radiation, but he did not have enough experience with head/neck cancer patients. He did make my flouride trays. I am very glad I saw a specialist who was able to describe what will happen to my teeth (no extractions needed before treatment)and educate me on my ongoing responsibilities. Looks like I'll be using nightly flouride trays forever. One piece I was unclear on was the use of stents. The specialist suggested them (due to my crowns?); however, the oncolgist said because she is using IMRT, stents wouldn't be needed. The tumor was removed (T1N0M0) and does not have appeared to spread, so the radiation to the non-tonsil areas will be limited. Do most people use stents during treatment?