Posted By: MikeC Five years PT - teeth! - 03-06-2015 06:50 PM
So... about to switch on annual scans after slowing scaling out the frequency over the last five years.

Yesterday I had a front lower tooth completely break off at the gum line... no pain. The tooth was dead. Most likely from the radiation. Makes me really worried about the cost and what options might be if they're all going to do that over time.

Depressed and stressed out over this...

I had to cancel a trip to a conference where I was supposed to be giving presentations. Lost $200 canceling my wife's ticket to go with me. The conference was going to be in Miami, so a chance for both of us to escape was has been a wet, cold, dark, gloomy, depressing winter in Texas. I know, not like we live in Boston, but it's not been any picnic here either...

Just when you think things are behind you - now what I am about to get myself into??

I've already been told I am not a candidate for implants because of the radiation.

Bummed in Texas.
Posted By: Alpaca Re: Five years PT - teeth! - 03-06-2015 09:35 PM
The dental aspects are awful. Will your insurance pay for a denture?

I'm getting free but very slow treatment to replace broken teeth in the form of partial metal dentures. My remaining teeth act as anchors. It's free because I'm in New Zealand where we don't have free dental treatment unless it's a serious oncology issue like mine. Unless it's a medical issue carried out in a hospital.

My former temporary denture was all plastic-like material and could have a new tooth added quickly if one broke off. (I've had a couple break at gum line.)

A denture with one tooth is possible and could be done relatively cheaply and quickly for cosmetic effect. Wouldn't be the most comfortable of things to have in your mouth but could be good for temporarily use while you and your dentist consider future options.

Sorry about the horrible winter but have to admit I'm sick of summer (sacrilege) because it has been so damn hot and humid with no respite. Kind of atypical for NZ where we generally have variable weather patterns.

Posted By: MikeC Re: Five years PT - teeth! - 03-06-2015 09:53 PM
I'm not sure what will happen insurance wise. I have dental coverage, but it only covers basic cleanings, etc. To me, this should be covered by major medical, as it is 100% a direct cause of the radiation. I have major medical, and I have a small cancer rider insurance policy that I will also file on. But no guarantee that either will pay anything. I will out of pocket for thousands of dollars up front...
Posted By: Uptown Re: Five years PT - teeth! - 03-07-2015 06:30 AM
MikeC, you're screwed. It is going to be costly and most likely out of pocket. I had the same thing happen around year 4 while biting into a chip at Tupinamba. Better get into someone that knows what they are doing. You have two choices in the area. Round 1 cost me around $20,000 and I never did Round 2.

As bad as it seems today, try to process your grief in something that is somewhat of a lifechanger and get a plan in place. My teeth have done well since those dark days with no issues since. That was 7 years since Round 1.

Hang in there.
Posted By: Alpaca Re: Five years PT - teeth! - 03-07-2015 07:58 AM
It is a medical issue caused by radiation so head and neck cancer patients form a special group of dental patients. Here in NZ patients who had their own dentition during treatment are NOT funded for the dental surveillance they need for the rest of their lives. This is a big issue with head and neck groups around the country. In a way I'm "lucky" because I'm getting free treatment on account of major issues. If I survive the hospital might fling me out to take my chances with my local dentist. This problem is a "survivorship" issue. People damn well survive. How does the medical system deal with this long term survivorship? The specialist nurse at my hospital said there is some good material at MD Anderson in relation to future survivorship problems.

Posted By: MikeC Re: Five years PT - teeth! - 03-09-2015 02:31 PM
I saw my oncology dentist this morning. He has to get all of my treatment information from my radiologist before he can determine what the treatment plan will be. I'm in limbo for now.
Posted By: Uptown Re: Five years PT - teeth! - 03-10-2015 01:19 AM
MikeC, mind me asking who you are seeing?
Posted By: MikeC Re: Five years PT - teeth! - 03-10-2015 01:59 PM
Dr. Dennis Abbott in Garland. I met him via the dental center in the Baylor Sammons Cancer Center, at big Baylor in downtown Dallas. But his private practice is in Garland, on Beltline Rd just off I-30.
Posted By: MikeC Re: Five years PT - teeth! - 03-16-2015 06:42 PM
They say I am not an extraction candidate because of the radiation. I don't really understand that... will talk to them again... but root canal on the broken tooth, and new lower bridge. They will write a letter as to the cancer/radiation being the cause, but you have to file it with your major medical and/or cancer policy yourself. So yep, up front and mostly out of pocket. US dental insurance is a joke - it doesn't doesn't pay for much other than basic cleaning and checkups.
Posted By: ChrisN Re: Five years PT - teeth! - 03-16-2015 11:47 PM
Dennis Abbott is THE Man! Lots of horror stories of well-meaning docs not up to speed on radiation effects getting in trouble.
Posted By: Uptown Re: Five years PT - teeth! - 03-17-2015 04:46 AM
Did you have a pre-treatment exam?
Posted By: BrianPK Re: Five years PT - teeth! - 03-27-2015 08:54 PM
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 $$$$.


Posted By: donfoo Re: Five years PT - teeth! - 03-30-2015 01:57 AM
[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.
Posted By: Uptown Re: Five years PT - teeth! - 03-30-2015 10:55 AM
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.
Posted By: PaulB Re: Five years PT - teeth! - 03-30-2015 02:18 PM
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.
Posted By: donfoo Re: Five years PT - teeth! - 03-31-2015 04:33 AM
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.

Posted By: BrianPK Re: Five years PT - teeth! - 04-01-2015 03:56 PM
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.
Posted By: donfoo Re: Five years PT - teeth! - 04-04-2015 12:21 AM
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.
Posted By: BrianPK Re: Five years PT - teeth! - 04-07-2015 04:39 AM
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.
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