I had radiation treatment to the tongue, and this damages the surrounding areas, including the blood vessels to the lower jaw. Reduced blood flow makes it much harder for the body to fight infection.

So my question is for other for those who are in the same situation. Have any you gotten an infection in the lower gum? If so, what was the situation and how did it turn out?

Hi Andrew,

I had numerous infections/abscesses in the gums, mainly lower, which required the use of antibiotics, pain meds occasionally, for the most part of several years, which were mainly due to rampant caries from radiation causing dry mouth, I'm sure diabetes didn't help, but was unable to have any teeth removed due to persistent recurrent cancer, and contradiction of HBOT. I was under the care, and close monitoring, weekly at times, by a cancer oral/maxillofacial surgeon, as well as my other doctors, who took panorama x-ray, oral CT, to see the extent of infection, rule out cancer, and other scans, blood work by others, and was prescribed chlorhexidine--Peridex, in addition to the antibiotics, practiced proper oral care, used dry mouth products, NeutraSal rinse too, and ultimately had all my teeth removed with the required 20/10 Marx protocol HBOT, being they were not restorable, and had no infections thereafter.

I did try to stay away from sharp textured, and other foods that would irritate or injure the mouth. I'm not too sure if infections have a role in developing ORN, as has happened after the extractions, I heard may not, as it is a cause of Injury, such as extractions, plus radiation, but that's for a doctor to say.

Doctors also don't like to mess around when it comes to infections/abscesses, which can go systemically, to the brain, heart, as I was warned, and has happened to me with other infections like thrush, so such should be treated appropriately.

Good luck, and hope this hops.

Yes, very helpful.

I didn't realize tooth removal was possible. I thought they could only be sheered off at the gum line plus root canal. Were your teeth pulled, or were they extracted a different way?

As for me, the main infection problem I have occurs after periodontal cleaning. Some areas of the gums (usually near the back) become very painful. The first time this happened the periodontist said the cleaning probably stirred up resident herpes virus. I asked what we could do and he said the immune system will take care of it. And then in about a week the pain was gone, and I assume so was the problem. It doesn't happen every time, but I got scared this past time because of the severity of symptoms. But now it feels almost all better.

Do you (or anyone else) know of antibiotics (or other steps) I should take before and after dental scaling. Or any other steps I should take?

Andrew,

My teeth were down to the gum lines, broken or chipped with the prior root canals and fillings falling out during the course of a short time. The oral surgeon basically didn't want to touch me without HBOT, which wasn't possible going through cancer treatments, and without a clear scan, which took about 2 years. All my 29 teeth were surgically removed, but you're right, other measures should be taken whenever possible to avoid extractions such as root canals.

Prior to ORN this year, my first tooth infection problem started in 2011, 3 months after radiation, in the mandible 3rd molar on the cancer side, which probably received more radiation in the mouth, which had some bone exposure, did HBOT, but didn't have it extracted due to a blood transfusion, and then a recurrence.

I have heard of taking prophylactic antibiotics, antivirals in other medical cases, but with that comes risk of resistance, other super infections, but you can ask. Maybe your blood work can be checked prior, but not sure what immune boosting strategies can be taken other than sleep, nutrition, and avoiding infections, but maybe if your wbc levels are low such cleaning can be delayed, use a lower scaling pressure, I was also told at times, more so when off antibiotics (Augmentin), to rinse my mouth out with salted warm water, and didn't always have to use chlorhexadine either.

Good luck.I had a scheduled visit tomorrow, but postponed it being the Pope is in town.

Andrew,

Have you tried Chlorhexidine (aka: Peridex, Periogard, and a few others)? It is used to treat gingivitis and periodontitis and it is by prescription only. My doctors have recommended I use it before and after certain dental procedures. It is pretty potent so they have me dilute it with water before using. It does stained my teeth, so when using it I end up with more frequent cleanings.

I've also used an antibiotic before & after some dental procedures.

And like PaulB and so many others, I also had teeth removed post-RT and had HBOT to promote healing.

[quote=Susan2992]Have you tried Chlorhexidine (aka: Peridex, Periogard, and a few others)? It is pretty potent so they have me dilute it with water before using.[/quote]

I'm going to ask for this. About how much did you dilute it?

[quote=PaulB]I was also told at times, more so when off antibiotics (Augmentin), to rinse my mouth out with salted warm water, and didn't always have to use chlorhexadine either.[/quote]

How did the Augmentin fit in. Was this only as needed, or did they do it before dental procedures.

I was rinsing my mouth with salted warm water because I know salt solution can dehydrate bacteria on contact. But they kept telling me not to bother, and so eventually I stopped. And I was insisting on antibiotic before cleaning. But my primary care doctor told me that is only for people with heart valves. So I stopped that.

After posting here, I realize I should have kept at it. And I'm going to start again.

I guess each case is different, and some of my doctors know my history better, like my oncologist, having had Staph/MRSA/cellulitis issues before, so antibiotics including pain meds, were prescribed pretty much as needed when a new infection appeared, and long term before dental surgery by the oral surgeon. This was over the course of several years, so I can't give exact figures, but it was chronic, and the oral surgeon insisted on Augmentin, which is Amoxicillan combined with clavulanate potassium over other antibiotics like just amoxicillin, different doctors had prescribed being when you're in pain you go to the nearest, and quickest person that can help you or used what I had on hand.

When I was in long term antibiotics I was told by the oral surgeon I didn't have to do the salt water rinse either, the same with chlorhexidine after a while, and that was stopped too when the infection appeared gone.

Now I just have to keep the back slowly 3rd molar open socket clean with syringe, which is going to take time due to radiation, and it's already been 10 months, with one conservative surgery failing to close it.

Post surgeries, my oral surgeon insisted I must take the Augmentin to prevent infection.

My doctor has me dilute the Chlorhexidine with water in a 50/50 ratio. If I have an irritation in my mouth, which is common for me since treatment, I'll use this for a few days and it usually clears up. Ask your doctor and see what he/she recommends.

Hey Pau;
>>Now I just have to keep the back slowly 3rd molar open socket clean with syringe, which is going to take time due to radiation, and it's already been 10 months, with one conservative surgery failing to close it. <<

Did you have this molar pulled 10 months ago? Hard to keep up with you. If so, this much time later the hole where the root was is still not healed over?

Did you do HBOT before/after the extraction?

Even a healthy mouth takes awhile to close up such a big hole.

Hi Don,

Correct, I had the bottom 3rd molar surgically extracted and stitched along with all my other teeth, including molars, last November, and did the Marx Protocol 20/10 HBOT before and after, but the 3rd molar socket opened up, had exposed bone for four months, which required another surgery in March along with bone shaving, buccal flap to close the socket, and stitched, which helped briefly, but it opened and after 4 months it still didn't fully heal, and had exposed bone, so I had to see another oral maxillofascial surgeon, who basically specializes in ORN, for possible major surgery, but he determined it was healing over, slowly, and will take a while, but I'm still not out of the woods yet, and was eventually released back to my regular oral surgeon for close follow-up, cleaning, which were weekly for quite a while.

After radiation, if you have exposed bone in the mouth longer than 3 months you're talking about possible ORN, which have different grades, and with such the doctors didn't take it lightly, and took quite seriously to the extent of treating like a cancer being the consequences can be so debilitating.

What I used to do is take a single high dose (2000mg) of amoxycillin one hour before cleaning. I don't remember where I got this idea, but the periodontist went along with it.

My new primary care physician told me not to do this. So I stopped. Now I wish I had never listened to her. Because now I cannot simply run out to the periodontist because I'm having trouble. I have other ongoing health problems which make travel very difficult, so I have to arrange for a caregiver. I also have to decide if it's worth it, because half the times the travel wipes me out and puts me into bed for days.

My periodontist wants an endodontist to have a look at this, and luckily he was able to recommend one closer to me. I'm trying to get an appointment now.

Also, I just want to add my thanks here for the information and follow-up on all my questions.

Andrew, did you have rheumatic fever at one time? I had it as a child, and for a long time some dentists required that I pre-medicate with an antibiotic before certain dental procedures, including cleanings (depending on what dentist I went to). They may have had me take the antibiotic after the procedure also, but I don't recall. I believe this was because rheumatic fever could cause heart valve problems (which you mentioned in this discussion).

Then a number of years ago (pre-OC), I was told this was not necessary. I even questioned a heart doctor about this, had some tests, and was told it wasn't necessary as they weren't any problems with my heart.

However, in recent years (post-OC) some dental professionals required pre-medication again. Manly for an extraction, but also a periodontist required it before a cleaning. This could be because of ORN danger, rheumatic fever, or both, but I was glad to use if as a precaution. Now my regular dentist does not required it for routine cleanings, but I'll use the Chlorhexidine (diluted) before and after a cleaning.

Wishing you the best!

I did not have rheumatic fever.

But I just remembered how I got started on antibiotics. The perio doc asked my primary care doc if I needed antibiotics. The primary said "no." I told the perio my doctor didn't know what he was talking about. I said that because so many doctors had given me bad information about post radiation care, and I was worried about infection. Later, a new primary doctor explained more about the reasons. I told her about post-radiation risk, and she said it didn't matter. So I stopped.

The thing is though, I have gotten lots of bad guidance from doctors. My original treatment team told me zero about post treatment follow-up. The only reason I went to see an ENT post treatment is a nurse elsewhere suggested it to me. The ENT said I didn't have to see him for another year, and this was immediately post treatment. This is not consistent with guidelines. The cancer maxillofacial doctor told me to never get a perio cleaning for the rest of my life. This turned out to be outdated information.

I could go on and on, but the net result is I have no sense of confidence with anyone involved with my post cancer care, except for the ENT I started with about a year ago.

For what it's worth, I found a chlorhexidine product that supposedly doesn't stain, or have other negative side effect normally associated with chlorhexidine. It's called Curasept. I see it available in the UK but I don't know about other countries. I live in the US.

I believe there is a non-staining brand available in the US, but don't recall the name. One of my doctors told me a number of years ago, but can't remember which doctor it was. I'm curious now, so I will ask my doctors the next time I go for a check-up.

Shortly after completing my radiation treatments I was advised to be seen by a dentist every 3 months for cleaning. I had been advised that any surgery exposing the bones in my jaw could result in osteonecrosis, even minor procedures like scaling of my teeth. The dentist prescribed Clindamycin starting several days prior, and continuing for 1 week after. I still got infections; both bacterial and fungal repeatedly.

Unfortunately within 2 years what was left of my teeth started breaking apart. At 5 years my teeth were so fragile I had to have them all totally removed. Prior to the extraction for 4 weeks I received Hyperbaric Oxygen Therapy. Then for 2 more weeks after the extraction. I was given high doses of Clindamycin and an anti microbial rinse (can't remember the name) throughout the process. Fortunately I did not develop osteonecrosis and my gums healed totally.

Since the extraction I still get both bacterial and fungal infections in my gums, mouth, tongue, throat, and nasal cavity; however perhaps only once or twice a year. They are cleared relatively easily. Although I lost my teeth, I am grateful to not be constantly burdened by the pain I had been suffering with.

I know I've probably given you more info than you requested, and it all sounds horrible but, if I got through it, anyone can. Good luck to you, I will pray you won't have to go through the same ordeal.

[quote=PaulB]
Now I just have to keep the back slowly 3rd molar open socket clean with syringe, which is going to take time due to radiation, and it's already been 10 months, with one conservative surgery failing to close it.
[/quote]

I've been thinking about this. If hyperbaric oxygen therapy encourages healing, why not give this a try to help your open socket heal over?

Hi Andrew,

I did the 20/10 HBOT before, and after, the dental extractions, and inquired about additional HBOT when it was showing early ORN after 3 months, but my Oral Maxillofacial Surgeon said it wouldn't help, it failed twice before, and needed additional surgery/flap to close the socket, and after that too seemed to have failed after several months I was sent to the Chief Oral Maxillofacial Surgeon, who is a known authority with ORN, but he said it was granualization, not showing bone at that point, so I inquired about HBOT to speed healing, and he too said it wouldn't help.

Actually, I was relieved not to do it again. After I did HBOT in 2011, for the same 3rd molar, I had a cancer recurrence about a month after I finished. Plus it really tired me out like radiation did, messed with my vision, balance, increased neuropathy, sinus, and needed a blood transfusion in 2011 midway. Wether or not some of these were related or not just doesn't make me want to do it unless necessary.

So far, so good. Went for my last follow-up visit about two weeks ago, and now on a 3 month follow-up plan. Still can't get dentures though.

I usually use warm water with salt and baking soda to rinse my mouth when my gums are bothering me it usually works for me

[quote=PaulB]Oral Maxillofacial Surgeon said it wouldn't help...
Actually, I was relieved not to do it again. After I did HBOT in 2011, for the same 3rd molar, I had a cancer recurrence about a month after I finished. Plus it really tired me out like radiation did, messed with my vision, balance, increased neuropathy, sinus, and needed a blood transfusion in 2011 midway. Wether or not some of these were related or not just doesn't make me want to do it unless necessary.[/quote]I can understand that.

You have really had a tough time. I hope things get better for you.

[quote=msweet55]I usually use warm water with salt and baking soda to rinse my mouth when my gums are bothering me it usually works for me [/quote]

I've been confused about this stuff. Can you give some specifics. Like how often. What concentration. Do you mix them together.

Follow-up. I had to argue with my dental person twice before he would prescribe Peridex. At first he refused because he said it changes the bacterial fauna of the mouth. A week later I emailed him and told him I'd rather risk temporary change in bacterial fauna than risk osteonecrosis or brain damage. He immediately phoned a prescription to my pharmacy. I rinsed full strength twice a day for 10 days and the areas of tenderness in my mouth calmed down.

My whole reason for posting this question in the first place is I had a painful infection following a dental cleaning. I also started to get headaches, nausea, and trouble keeping balance. My primary ordered a brain scan, which was clean. The problems mostly subsided but there were still tender areas throughout my mouth. Salt rinse was not helping. And so I asked here.

Anyway, it's been several weeks with no more problems. Thank you all for your help.