Teeth and Radiotherapy

Hello Trish ,  i have never questioned what my consultant recommended and touch wood he was right in his recomendations , they need to remove the teeth so they get a better chance of targeting the radiotherapy also the radiotherapy will ruin the teeth in the long run causing problems futher down the line . Good luck with the treatment ,take care .

                                                                                               Chris .x 

Hi Trish,

I had four back molars removed before my radiotherapy.  The dentist explained to me that they recommend removal of teeth that lie in the path of the radiotherapy beams, because radiotherapy damages the blood supply to the teeth and the bones that hold them.  This means that if, in the future, the teeth need to be extracted then there is a much greater chance of the sockets not healing properly because that blood supply is needed for the healing.

In turn, that can lead to osteoradionecrosis, which is where the bone itself becomes infected and sometimes dies.  Nobody can predict whether they will need major dental work years or even decades in the future, so this is the one chance to pre-empt that.

The issues of trismus and caries are secondary compared to this, but they are important in their own right.  At the start of your treatment you should be given a set of exercises to stretch your jaw throughout radiotherapy and during healing.  Mine consisted of a sheet of different exercises that I had to do five times a day, and although it is difficult, it is well worth persevering with them.  My jaw muscles became quite stiff during treatment, but it recovered fully afterwards.

As for caries, I would recommend getting a full workthrough with a dentist and hygienist before the start of your treatment, and then make sure that the hygienist gives you plenty of advice about how to take care of your teeth and mouth.  During radiotherapy your mouth may get too sore to look after your teeth in all but the most rudimentary way, and it is a good idea to have a baby toothbrush ready just in case.  I had about six weeks where my mouth and gums were so sore that this was all I could use, but it takes a lot longer than that to develop caries so bad that it destroys the whole tooth.  Once your mouth has healed after treatment, there is nothing to stop you from looking after your teeth properly again, even if you have a few weeks or months where it is hard.

Best wishes,

Josie

I hear what you are saying, it seems that my resistance to them removing my teeth is likely to cause me problems in the future.

Thank you Josie, I think I shall probably amend my feelings on the tooth extraction.  Thank you for the advice and I am hot on the trail of finding exercises.  

It's so useful to get the feedback here.  Makes you feel more 'normal' (although certainly I have always been a little odd .  Good tips and advice as well.  Makes me feel a little stronger.  Knowing you got through it makes me feel more certain that I will too, eventually.

Hi

i developed osteradionecrosis in the jaw bone where the teeth had been removed- so that would have probably caused problems if they had still been there. 

Fortunately at the moment it appears to be a small patch and the dead bone worked it’s way out. 

As an update to this I would post that I did not let Eastmans remove 6 of my back molars.  When I got back to the Dr. treating me in Radiotherapy her response was that she had 'no idea why they wanted to remove 3 of my back molars on the right hand side of my mouth' because - in her words "we're not going anywhere near there.  

This is important, because I have spent most of the last 12 weeks chewing on that side of my mouth and at 7.5 stone for most of my life  it was important I did not start to drop what little weight I do maintain.  So I have not had to have a tube down my throat and not required additional supplements to my food, or a tube into my stomach.

Despite Eastmans assurance that the level of radiotherapy I was having would most likely lock my jaw - it didn't - and everyone at UCLH said they felt I would get through the process without my jaw locking... so it seems it was just Eastmans Dental Hospital that had this notion.

Prior to going into radiotherapy treatment I had a FLUORIDE VARNISH at my dentist (and i put this in capitals so that anyone reading this afterwards gets the information they need), because studies showed that this helps remarkably and it certainly did for me.  In addition I had the high fluoride toothpaste prescribed to me also by my dentist but the hospital can also prescribe it for you (which I started using 3 weeks prior to treatment), I also bought a water jet flossing machine (about £26 quid on Amazon), used Xlyimelts overnight (both to keep my mouth moist and because the germs in your mouth feed on the Xylitol rather than your teeth).  I have been brushing my teeth as soon as I have finished eating and I cut down as  far as I possibly could on sugar

At the end of the 6 weeks radiotherapy I returned to my dentist and he advised there was no decay at all, no problems with the jaw and he applied another fluoride varnish which you can have every 3 months.

So I think the up shot of all this is :  Don't do what someone else on here suggested and never question you Doctor.  ALWAYS question what's about to happen to you and make your own judgement for what is best for you.  For me having 6 (which is basically all but two) of my back molars removed would have been demoralising and made it difficult for me eat and maintain weight.  So I feel I made the right decision.

It is your path to walk :-)

Hi there,

I was diagnosed with Nasopharyngeal Cancer back in April 2017, 6 week daily treatment of targeted radiation and the nasty "Cesplatin" Chemotherapy.

Three weeks before treatment started, the hospital Dentition wanted to remove my upper and lower rear molars, he didn't force me or make me feel uncomfortable, but did reiterate that he recommended it, however, I have always looked after my teeth, regularly see my own highly respected dentist and decided on a second opinion, even though he did send his recommendation correspondence to her outlining his concerns. 

Although she respected his decision and concurred with his reasoning, she also pointed out that my molars were in fabulous condition, no eruption or signs of weakness or decay, therefore concluding that it was indeed my decision, and that it would be a shame to remove what were in her opinion, very healthy, and quite deep set teeth, plus, the chances of complete healing before Cancer treatment began and all that that entailed was very slim.

I therefore declined to have my teeth removed and went ahead with my treatment program with targeted radiation to the rear of the mouth / throat, and I must stress that at no time was i made to feel awkward or wrong for choosing not to have extraction.

I realise this is a purely personal decision, we must all do what we feel is right for us, both physically and mentally, my decision will not necessarily be yours, and i was, and still am aware of the complications that "may, or may not" have occurred in relation to my decision.

However, nearly two years on in March 2019 i am healthy, happy, free of pain or complications, with no repercussions and living my life as i once did........ for me it was the right decision, I simply felt i had gone through enough with the initial diagnosis and exhaustive tests, and as near as i was to starting what is a very harsh treatment regime, i simply declined further trauma and pain.

Whatever you choose to do, it must always be your decision, and yours alone.........

Wishing you and others starting, or going through their treatment, all the very best for the future ....things really do get better, it just takes a lot of time, never lose the belief in yourself.   

Marcus.

Interesting discussion this; I was in the camp of putting my trust in my team and going along with what they advised (possibly was referring to me in the, "Don't do what someone else on here suggested and never question you Doctor...." comment or maybe not, doesn't matter). My dental health wasn't great anyway and I knew at least one molar needed to be removed even before diagnosis, in the end they took out three (during my dissection so no trauma/pain involved).

I do though absolutely agree with the attention to detail in caring for your mouth and the water flosser is a great call, I see the hygienist every three months now and she's very happy with the health of my teeth, as is my dentist. Could I have kept the two seemingly healthy two that they took out? I'll never know, but I'm very comfortable with the decision I made which was to not question what my team judged was best for me.

Everyone needs to make their own decision, there's no right or wrong.

Hi TTiggy, I like MikeO had teeth removed during surgery so it was ready for radiotherapy, i never questioned it at the time and was never offered any advice. Although i lost all my bottom teeth due to cancer of the lower jaw my top teeth are decaying badly due to the radiotherapy, it does not help that i cannot open my mouth very wide due to jaw reconstruction. Maybe times and techniques have changed since 2009 for the better, lets hope so as teeth are very important. Thanks for this update, all the best.

                                                                      Chris x

I also questioned Doctor M since my cancer was in my voicebox why my all my teeth had to come out. She replied it was an Eastman decision not hers. I must add that they took them all out with hardly hurting me at all.