Your Teeth

Every physician is different when it comes to how dental health is handled.   All head and neck cancer patients receiving radiation should have a dental evaluation.  If there are any questionable teeth, they must be removed.  If the teeth are in direct line of treatment, some oral surgeons will suggest that all teeth come out. 

The mouth contains several sets of saliva glands.  When these glands are radiated, they do not function properly or they are damaged to the point of not working at all.  These glands are usually not spared because the margin of treatment around the cancer is very important to prevent spread of the disease.   The saliva glands produce spit, which contains an acid that keeps the enamel on your teeth hard.  Without this acid, teeth begin to break down and can eventually break off. 

A disadvantage of keeping your teeth is that over the long run, dental problems occur for all of us.  A simple cavity for a head and neck cancer patient can quickly escalate into osteoradiation necrosis.  This condition is when pieces of the jawbone break off because the bone is dead. These pieces of bone work up through the gums and are very painful.  The bone may become infected and require a surgical procedure to remove the dead material. 

Most oral surgeons recommend that patients undergo hyperbaric oxygen treatments.  These treatments are everyday Monday through Friday for 20 days before extractions and 10 days after extractions.  The hope is that the increased oxygenation of the bone will increase healing of the effected area. 

Warning: hyperbaric oxygen treatments should be done before any and every tooth extraction.

Failure to do this important step can lead to non-healing wounds, abscesses and bone breakage.  Sometimes these complications happen no matter what precautions you take, but why chance it?   This applies to having teeth pulled.  Fillings and root canals that do not involve the bone are usually treated with antibiotics before and after treatments to prevent non-healing wounds.

Remember if you have your teeth, meticulous care and dental follow-ups are a must.

Fluoride trays are recommended to help decrease the softening of teeth and must be done everyday.