Teeth !

Hi Sasha. Yes, teeth post-Head & Neck radiation is a huge issue - and the reason why all of us who have this treatment for our cancer have (or should have) the input of a Restorative Dentist before we start RT. Without writing an essay (I’m dentally qualified and had Chemo radio 3 years ago) the essence is this - RT significantly reduces our saliva flow. Saliva is an essential part of our dentition’s protection from dental disease - that’s tooth decay and gum disease. So in a nutshell, after RT we are much more likely to get dental decay (can be rampant) or more severe gum disease than someone who hasn’t had RT to the head & neck. High fluoride toothpaste is just one of the things which helps. You should be advised by your own dentist on keeping your teeth really clean, especially interdentally. Our oral hygiene needs to be a big step up from pre-treatment if we are to maintain our teeth in the long term. In addition we are more susceptible to dental decay from sugar - so we should be really careful about how frequently we consume anything sugary. This can be tough in the weeks and months straight after treatment when eating anything can be difficult, but in time hopefully we can avoid sugar between meals as much as possible.

So you are doing the right thing - brush carefully, remove everything from between your teeth with floss or interdental sticks and avoid sugar as much as possible, especially between meals. (I didn’t just eat a hot cross bun!!) You should get good support from your dentist, they are your go-to for advice and should be made aware of your treatment. The fact is that we are more likely to get dental problems in the future, but by working hard ourselves, seeing a dentist regularly and if necessary checking with your local Restorative Dentist at your Head & Neck Cancer centre, you should be able to maintain your teeth.(Does depend how they were to begin with of course!

I think Chris has made  the point in the past that Dental treatment should be free for H&NC patients after RT and this is a very good point- we can spend a lot of money on appointments, hygienists and treatment. Sadly I think this is unlikely, but keep asking your H&N teams. Someone may get the message in the end....

Do ask the Specialist Dentist you see as many questions as possible. In well-funded units some patients see the Restorative Dental Team for quite some time after treatment, and some units have no such person at all! POstcode lottery!

Good luck Sasha. Whoops - I wrote the essay anyway! Sorry

Hilary

Hi Sacha

I take great care of mine.

Brush for two minutes before breakfast to remove overnight plaque 

Floss and high fluoride BioXtra mouth rinse after 

Floss and brush 30 minutes after eating anything. ( I can't use duraphat as it brings me out in ulcers so use Oranurse)

Brush last thing at night with GC MI Paste Plus ( which is the fluoride version of the mousse)

Three monthly fluoride varnish at the hygienist, paying particilar attention to the tooth gum margin where we are most prone to caries.

Tooth care is important but just as important is to not eat anything sweet unless it's part of a meal.

I think that's all you can do.

I have discussed things with my dentist and any tooth starting to show damage at the gum margin will be crowned. We can't afford to have teeth out from our irradiated jaws.

Hope this helps

Hi Sasha

Yes, oral hygiene is vitally important after rt.

There's currently a thread going called Fortisips and Ensure (can't remember the exact title) where people have been posting their regimes.

Linda x

Hi Sasha I am 32 month post radiotherapy I use duraphat for if mouth sensitive Ora nurse I also use bioxtra mouth wash that high fluorides as well. I have dentist vist every 3 month and now she dies a fluoride varnish. Since treatment I’ve had one tiny filling which I probably would have needed anyway. I also use the interdental sticks . Keep doing what you are doing I brush 30 mins after food. 
I had a full dental check prior to treatment starting and prior I always went every 3 months I’m lucky have had the same dentist 20 years plus she knows my mouth better than me. She was gutted she didn’t spot my cancer but it was hidden in the tonsil crypt. 
Hazel 

Why 30 minutes after food?

Hilary, is it only the lack of saliva that raises the risk of decay or does the RT affect your teeth in other ways too? I’ve heard of people’s  fillings cracking, or even falling out, and know that extractions can be a real problem after RT. Trouble is, my dentist won’t see me as I’m now classed as vulnerable and there’s been no restorative dental service at my hospital for a year now. 

If there’s anything acidic in your meal it softens the enamel so that 30 minutes let’s your teeth settle down before  you attack them with a brush. Brushing too early in soft enamel can damage it. I suppose it might make sense slooshing your mouth out with mouthwash straight after eating 

As far as I know radiation doesn’t actually damage teeth but the lack of saliva alters healthy bacterial flora significantly which adds to tooth instability. Osteoradionecrosis while very rare remains a lifelong risk after extraction, particularly in the lower jaw which has a poorer blood supply than the upper 

Thank you everyone for taking the time to respond to this.  I'm glad I posted as I had got a bit slack but will get back on it with the toothbrushing regime. I find that if I don't brush my teeth after eating I notice bits of food getting stuck in my mouth so its necessary.  Although I have been drinking a chai latte which has a lot of sugar in - need to stop that !

I did have restorative dentistry before - well I saw a specialist dentist at hospital who looked carefully at my teeth and X-rays and they removed one of my back molars as I've had issues with a root canal in it for decades and I could imagine it needing extracting at some point.

Its very hard to find a good NHS dentist here and actually it was my private dentist who I first went to when I had my lump in my lymph node as I thought it might be something to do with the aforementioned root canal work.  It took a while for me to get my ultra sound but he asked his receptionist to ring me regularly to make sure I was getting investigated - as it turned out he was worried about the mouth cancer risk (which my gp hadn't picked up on).  Which was why he kept an eye on me.

He then kindly on Christmas Eve did an emergency filling for me when one fell out soon after my treatment started.  So this is getting long but he was amazing and didn't charge me for any of this.  I will see him and get him to check my teeth.  I do also have an appt via my hospital but I need to find the letter !

Do you know what is the best kind of toothbrush ?  I used to use an electric toothbrush but is this too harsh now ?  Thank you.

I'm also quite lucky in that I am producing saliva - but I can tell its not as much as I used to.