Dental care post treatment

Your team should have prescribed high fluoride toothpaste, Duraphat. This is free on prescription and is to be used twice daily for ever. Get into a routine with flossing and using interdental brushes. Brush your teeth 30 minutes after every meal and before breakfast.

I use Duraphat and Oranurse toothpastes. For mouthwash Bioxtra is mild, soothing and high fluoride. I get this on prescription too

For some time I couldn't use Duraphat as it was too painful so I had a fluoride varnish every three months.

I think it's best to see your hygienist every three months and your dentist every six. 

We are at greatest risk of decay at the gum margin rather than the occlusal surface and need to keep on top of dental hygiene for ever and that in reality means NO SUGAR unless part of a meal

Hope you get what you need and tell us what your dentist says

Oh and NEVER EVER allow your dentist to do any invasive treatment. They have to refer you to a  hospital unit

Dani

agree with all you say, except as far as I know Duraphat, (certainly the 5000) is not free on prescription? O, that I might have had access to the follow up care that you have clearly experienced! My own post therapy pathway has been somewhat different, not helped perhaps by my oncologist leaving before the end of my course, my ENT surgeon retiring 2 months after my treatment, (and neither being replaced), and then final insult my local commissioning group finishing their contract with my DGH and sending patients to a Uni department 40 miles away. They didn't think commissioning any follow up was value for money either. Plus the small matter of CV19! Just shows how NHS cancer care remains a post code lottery?

So, having had excellent dental health all my life, and regular care, I am left with xerostomia, waking every couple of hours because my mouth is so dry, and significant enamel loss, principally to my incisors. Tomorrow, I am off to BUPA dental centres for advice on implant surgery, which will no doubt be another huge bill!

Your guidance  is well researched; high fluoride toothpaste and mouthwashes mandatory. Wash and spit as often as you can, but not immediately after food when the enamel is vulnerable. I did not find the xylitol melts or chewing gum to help very much with my loss of saliva. Glandosane sprays give some symptomatic help for the dry mouth, but my bottom line was that I take water with me at all times. It was certainly not helpful that the taste modality which returned first was "sweet" and that also I strangely have found that hot/ spicy food or sauces are entirely palatable!

My therapy was completed late 2016, so I view my dental consequences as a "necessary evil" in context of still being alive! I note wistfully your advice to seek hospital dental care, also a luxury not available to NHS patients in my locality.

Reinforcing Dani's advice, time and effort invested in your teeth and gums post oral DXT is not just advisable, it is absolutely essential. Good luck, Phil

Hi I also get duraphat  50000 on prescription n from my dentist  I used to get bioxtra mouthwash from there   But  it but that was taken away during covid. I  can get that from my g p every month thankfully. Sorry you’ve not had the required follow ups I am very lucky in that respect my oncologist sees me once a year and ent see me now every 6 months,

Have you tried xyimelts at night time I still find those invaluable m we do have to buy those.

As for implants I’ve always been told no especially not in the lower jaw due to possible ORN a please be careful if yiu do go down that route. 
Hazel

Hi Phil. I think in England you get free prescriptions for five years with cancer? I live in wales where scripts are free. I certainly can’t fault my treatment and Hazel and I have often said to each other that we thank God that we got cancer before Covid. 
As an aside re invasive dental treatment. You must make sure you are seeing a dentist familiar with radiotherapy and what it does to teeth. 
I have improved my saliva by chewing gum. It’s stimulated what was there and I know one parotid was spared. Also have a look at Auricular Acupuncture. There are two entries in my blog. It certainly kick started my salivary recovery and I’m the worlds biggest sceptic. 
All the best. 

Hi Phil  as Dani says we in England as cancer patients over 60  age get free prescriptions  in England and under 60 if you have cancer get an exemption for 5 years ,I too  had auricular acupuncture it did help kick start my saliva.

Hazel 

Thank you for all of that information! I’ve enquired locally about auricular acupuncture. I will make sure I ask for duraphat and bioxtra. I’ve just started trying xylitol melts after reading Hazels blog. I seem to be plagued by thrush at the moment and luckily knew to ask for the tablets rather than the drops, although I keep having to ask for an extra week because it’s taking so long to clear and the GP will only give me a week at a time. Your blogs and advice are so helpful, thank you so much!

Hi you’re welcome. I still use the xyimelts every night during day my saliva is at ieast 90% normal.  We all get there just takes time. Oral thrush can take a good  few weeks to clear I remember I was plagued with it. 
Hazel xx

Hazel, Dani. Having spent 2 hours yesterday with a reconstructive dentist discussing the consequences of DXT on oral and dental health, my regret is that I didn’t go and see him 2 years ago, (before allowing my local dental practitioner to remove 2 of my teeth “because there’s no alternative “). Cannot turn the clock back sadly. 40 years in the NHS should have taught me the value of second opinions! So my added message to your previous collective advice is that for anyone who has concerns re their dental health, consult an expert sooner rather than later, ( again unfortunately not a service available to me locally on the NHS). Just as an aside re your warnings about invasive dental interventions, there is actually a large body of evidence confirming that as long as bone condition (jaws especially obviously) is sound, then implants etc are very safe and effective. Unfortunately, despite best efforts with prevention/ fluoride etc etc, salivary function is one of those consequences of DXT that may actually get worse with time rather than recover. If your salivary glands have been fried, they sadly don’t recover.

Sorry, quickly, in addition to comment above; the two outcomes to the attrition/ enamel loss that lack of saliva causes that MUST be avoided at all costs are a. Dentures, and b. Dental extraction/ clearance. Modern materials, epoxy etc, make nearly every tooth repairable and preserving our original dentition at all costs should be the absolute priority 

Thanks salar for the info on implants.It’s very useful.  I guess that the only person who can give you an accurate opinion on the state of one’s jaw is a practitioner with experience of RT.