The prosthodontist I am seeing as part of the cancer care team told me that my dentist should not use an ultrasonic scaler or do any manual scaling more than 2mm down. I asked him about the problems from plaque building up below to 2mm. He really put a scare in me, and said that if a dentist does lower it could result in my loosing my jaw. I assume this would be from infection. But I just spoke with an oral cancer survivor on the other coast who was told that deep scaling is important because periodontal disease is more dangerous for people like us, and scaling helps prevent this.

So now I'm very confused and worried.

I'd like to know what you were told about having your teeth scaled, and how deep they can be scaled. And/or any thoughts you have about the information I was given.

Well I would like to hear exactly his reasons for advising against it.

I was never advised like that and I haven't heard anyone else say they were and I have had my teeth cleaned twice a year as always since my Tx ended. I did start using the fluoride trays 1 month pre Tx and have used them every nite since.

Jerry, comments?

Where's Dr Mike anyway?

Andrew, that is an interesting comment. I have been getting standard cleanings every 4 to 6 months for 8 years. I have never heard this. It would be interesting to know if this is her/his own opinion or something new in the field. I too would assume it to be out of concern for infection and then Osteoradionecrosis ORN which might follow the infection.

Would you be able to ask this prosthodontist for more detail and references to any study?

Hmmn. My prothodonist who specializes in head and neck cancer after specific training at Sidney Kimmel CCC has only done regular cleanings with his ultrasound. But I don't know how deep he went. Let us know what you find out so I can see what he thinks. I love his panoramic X ray- no sharp cardboard squares to poke my tender mouth, even if I could open wide enough right now. It was fun to see my titanium plate with screws holding the front of my jaw together

[quote=davidcpa]Well I would like to hear exactly his reasons for advising against it.[/quote]He had told me previously that the radiation destroys blood vessels that supply the mouth, and so the body has a lot of trouble fighting infection there. He also said that if an infection starts, it is very difficult to deal with, and can lead to serious problems. When I found out that he told my dentist not to clean below 2mm, we just assumed that he said this because scaling there could lead to infection. And later when he said I could destroy my jaw, I assumed it was the infection.

What I'd like to do is hear from as many others as possible who had radiation and then talk to him about what other doctors are recommending. Because from what I know, built up scale can lead to periodontal disease, bone problems, and even bleeding.

I've been getting my teeth cleaned every 2-3 months for the past year. I go to a prothodonist who treats a lot of the cancer patients in the area. He does have me take an antibiotic 1 hour before any cleaning or other dental procedure. I do have some loose teeth due to bone degeneration from the RT. I have been using chlorhexidine 0.12% oral rinse daily for the past few years because of post-treatment issues. This does cause staining of the teeth which is one of the reasons I go for frequent cleanings.

Geez. My periodontist scaled my teeth every two weeks during radiation and has been cleaning/scaling them every two months since for the last 12 years. Maybe the reason they clean mine so often is so they won't have to go so deep. I'll have ask.

Take care,
Eileen

Well,
Hi all...here is my two cents worth.
There are no known contraindications to scaling and/or root planing in conjunction with chemo or radiation therapy. Mechanical removal of calcified deposits on teeth and tooth roots do not interfere with cancer therapy.
There is as well no indication that cleanings with sonic, ultrasonic, infrared or other types of cleaning are detrimental to patients who are undergoing chemo and/or radiation therapy.

Dr Mike,

What about post radiation Tx?

Hi. Thanks for jumping in. I am post-treatment, and the prosthodontist is not saying that scaling will interfere with cancer therapy. His concern is that because of the reduced blood supply to the jaw bone, scaling below 2mm creates a risk of infection that outweighs the benefits of scaling beyond 2mm.

[quote=Dr. Mike]There are no known contraindications to scaling and/or root planing in conjunction with chemo or radiation therapy. Mechanical removal of calcified deposits on teeth and tooth roots do not interfere with cancer therapy.
There is as well no indication that cleanings with sonic, ultrasonic, infrared or other types of cleaning are detrimental to patients who are undergoing chemo and/or radiation therapy. [/quote]

This dentist should have his head examined. 2mm of scaling isn't much - this is not deep root planing. And if you develop significant periodontal disease in an area that is going south now and needs professional cleaning, you are going to have the very problem he thinks you are going to avoid by letting the bacterial plaque and calculus remain. Freakin' unbelievable. I hope Doc Jerry chimes in here cause I am sure he is going to mirror Doc Mikes Comments.

Dear Brian and other list members:
What would you suggest for dental cleaning prior and after chemo/radiation treatment. I had an oncologist dentist examine my teeth prior to induction therapy. There is a lot of metal restoration, but teeth look okay.

I've finished chem and have 4 weeks until radiation. Time enough for my mouth to heal, and I'm thinking about removing the metal filling, cleaning the the cavity and replace the filling with other material, but for the present only on the side where the cancer is located.

What's everyone's opinion. Also, I'm very confused. What should be my dental tx during and after radiation. I know my mouth will be extremely sore. Everyone seems to be doing something different.

This info will really help me choice the right dentist.

Thanks
Sandy

Has anyone mentioned the fluoride trays? I was told to begin 30 days before the rad began and I still use them nightly. The fluoride is to help strengthen the teeth against the damages of radiation.

I've been using fluoride trays. I don't remember when I started. Maybe when treatment started. But this is another area where opinions are different. I was told to put them in for 5 minutes, remove them, but then I should NOT rinse, brush, eat or drink for 30 minutes after that. The fluoride is OMNI Gel 0.4% Stannous Fluoride.

[quote=davidcpa]Has anyone mentioned the fluoride trays? I was told to begin 30 days before the rad began and I still use them nightly. The fluoride is to help strengthen the teeth against the damages of radiation. [/quote]

Andrew,

I was told to put them in before bedtime for a minimum of 3 minutes and not to drink for 30 mins after. I just keep them in for 30 mins and go to bed after I take them out. I have never had a problem keeping it in my mouth for that long. My dentist says I should continue to use the trays forever but he isn't really adamant about that. I also switched to a generic brand that costs 1/3 of what I use to pay.

Fluoride is a great idea but for patients undergoing head and neck cancer therapy, chemo and radiation, it is an essential component of maintaing and improving your oral health and prventing your teeth from breaking down. Chlorohexidine 0.12% rinses are also excellent in lowering and controlling periodontal bacteria in individuals with gum disease, ulcers, and compromised immune systems.
Fluoride has been discussed at length in many threads and posts on this site many times. Just type "fluoride" in the search bar and you'll have plenty of information to read.
As for the scaling below 2 mm being detrimental...I do not agree. The average healthy sulcus is 3mm. Bottom line is bacteria, plaque and calculus are toxic to tissue and need to be removed. They are pathogenic to gums and bone and in order to maintain gum and bone health they need to be removed at any depth.

Cheers,
Mike

Can we have a show of hands - how many of you receive antibiotics either pre or post cleaning?

Patty

Not here and I went right back to my pre Tx cleaning routine in every way possible. I have had the same dentist for about 18 years and he even came to my house twice during my Tx just to check up on me.

Patti,
I have NEVER been given an antibiotic before or after dental scaling and cleaning.

Andrew,
I had a cleaning appt with my prosthodontist who specializes in oral cancer patients and he said he has never heard anything so silly. 2mm is nothing. He said if the patient has a 5mm pocket you scale to 5 mm because not getting the plaque out would create more problems. Basically you scale as deep as necessary to remove the plaque. I have several very deep pockets that I had even prior to radiation (my teeth have very long roots) and have never had a problem with them being scaled. I think I'd find a new dentist if I were you.

Take care,
Eileen

Antibiotics prior to dental treatment this is a great topic and, in my humble opinion, misunderstood by many dentists and patients.

Antibiotics are prescribed to patients who are percieved to be at risk of developing bacterial endocarditis as a result of dental treatment. The basic regulations as to who needs them and how much has changed very little over the last 20 or so years. Here is a link to a site that explains the rationale and science of this situation; http://www.aafp.org/afp/980201ap/taubert.html

A long story short, the simple facts are that when you have your teeth cleaned bacteria that are already present in your mouth are introduced in large quantities into your bloodstream (the same thing happens when you brush your teeth.) Individuals who have prosthetic parts in their bodies especially in or around their hearts are at risk for the potential colonization of bacteria on these prosthetic parts which could lead to a potentially fatal result.
The American Heart Association; http://www.americanheart.org/presenter.jhtml?identifier=1200000
publishes guidlines for medical and dental practitioners to follow to best prevent this situation in patients who are at risk.
Radiation therapy and/or chemotherapy to the head and/or neck do not put a person at a higher or abnormal risk of developing bacterial endocarditis after dental treatment. There is no science or research that I am aware of that supports prescribing antibiotics to patients who are undergoing radiation and/or chemotherapy to the head or neck to reduce the risk of bacterial endocarditis.
So relax everyone and don't get anxious if your dentist doesn't prescribe an antibiotic before your filling or hygiene appointment. If you are at all concerned about this ask your dentist. I'm sure they would be more than happy to discuss it with you.

Cheers,
Mike

Sorry I'm so late in getting into this thread. As I've mentioned in other threads, I am so limited on time that I don't get to the forum as often as I have in the past and would like to continue to do. When I do get here, I start at the top, as most of us do and then run out of time before getting into the lower forums. Now with the walk over, I hope to ge here more.

Dr. Mike as usual has most thoroughly covered the topic of the need for antibiotics prior to dental cleanings or scalings. I wholeheartedly agree with his thoughts on the subject. The latest AHA recommendations, as far as I can remember, as well as any past recommendations, have never indicated the need for antibiotic pre-medication for patients that have undegone radiation or chemo.

As far as the question of scalings causing oseteoradionecrosis (ORN), since these procedures have nothing to with trauma to the bone, as they are limited to the gums, there is no fear of ORN developing. Suggesting that scaling lower than 2mm and therefore, allowing any periodontal disease that might be present to progress, is absurd.

Jerry

I am having a very rough time here getting to see another person for a second opinion. My radiation oncologist is not returning my calls. Two cancer centers I called use the same prosthedonist I see. A third one refused to talk to me without a doctor referral. A fourth one told me they never heard dental care with tongue cancer treatment, and could not help me. I also called a radiation oncologist at UCLA, and he told me to contact their Beumer Center. SPOHNC told me the same thing. (I'm in Los Angeles). But when I contacted the Beumer Center, I was told they are not taking new prosthedontist patients. And I don't want to go straight to the phone book. I want to find someone who routinely works with oral cancer treatment post care.

I am going to keep trying, but it is not easy. I have been so sick for so long it is hard for me to just type this message. Hard for me to make phone calls. If anyone has some ideas, please let me know. The only idea I have now is trying to contact Dr. Beumer directly and asking his advice.

Beumer spends most of his time out of the country lecturing on maxillofacial prosthetic reconstruction, and less at UCLA. He also does not use email but communicates via an assistant. More than all this he is a prosthodontist that specializes in the replacement of facial parts, and is not a soft tissue expert. Whoever suggested that he was the guy to talk to for an opinion abou tscaling your teeth post treatment clearly doesn't know much about his training or what his practice is based around. I've known John for 30 years and you are looking to talk to the wrong guy. Find a periodontist associated the the head and neck department, but to be honest I think you are over thining this. I have never heard of a cancer patient getting antibiotics for scalings, and as I said before 2mm is nothing. As Dr. Mike stated clearly most people have a periodontal sulcus of between 1-3 mm dee around all their teeth where the tissue is not attached to anything.

Tell the hygienist that you have been radiated and heal slowly if she gets too aggressive. I bleed sometimes after a cleaning for a day and they are sore, But that's it. But after more radiation than you have had, in ten years of having my teeth cleaned aggressively, since with NO saliva I have a huge plaque and calculus issue, and have to have this done every 90 days to maintain things, infections have never been an issue. I have never heard of a patient getting antibiotics just because they were radiated before scaling.

Beumer was recommended for second opinion by Steve Lee (radiation oncologist) at UCLA. He was also recommended by the radiation department at Cedars Sinai.

And I think it makes sense for me to get a second opinion from someone who actually looks in my mouth, etc. to see what my situation is. My dentist is not going to simply ignore the instructions he was given.

Also, I would still need a max prosthedontist on my side for doing advanced work. From what I understand, the average dentist is not qualified to do extractions or other advanced work on post-radiation patients.

So if you know anyone who can give me a good referral for this, I'm all ears.

Anyway, I appreciate all the responses I get here. I realize I am asking a lot of questions, but I'm just plain scared. And that's why I'm trying to cover the bases.

Thanks,

Andrew

I just realized I should get about all of this. Bottom line, I went back to the dentist and told him why I thought he was wrong. I asked him to consider where I would be in 10 years, given my current state of bone loss. And then compare that to the risk of infection from cleaning. I also asked him to consider the fact that the research he was citing was old, and that research trends are not meant to be used on a case by case basis.

Bottom line, he immediately referred me to a cancer-literate periodontist. And later referred me to a cancer-literate endontist. Both of them told me that the 2mm thing is out-dated thinking. I also found out I should have had a cleaning before treatment, something I had asked about, but the treatment place told me not to.

Might as well add to this old thread too. What happened is I went back to the dentist and got into a lengthy argument with him. He was even raising his voice at me. But I asked him "where is my bone loss going to be in 10 years, and how will deal with my teeth then." He got a very worried look on his face and immediately sent me to a periodontist. I've been getting scalings ever since.

But I found out where this idea about no scaling comes from. It comes from a study in the 1930s. And you can see the advice as given by CDC here on the following link: Scroll down to where it says Osteoradionecrosis http://www.oralcancerfoundation.org/cdc/cdc_chapter7.php