Paul's Heart

Life As A Dad, And A Survivor

Cancer’s Effect On The Smile

Sure, the last thing you expect to associate with the word cancer, is “smile.”  This post is not about the emotional impact on the smile of a cancer patient or survivor.  Like many of the issues medicine never prepared us survivors for way back when, was the impact that our cancer treatments could have on our teeth.  And seeing how we only have one set of our adult teeth, it is obvious we need to take care of what we have.

But we can only do so much preventative, such as flossing, brushing, and using mouthwashes with preventative care.  We can also take supplemental vitamins and make sure we eat or drink enough Vitamin D and calcium loaded drinks and food.

Radiation and high dose prednisone treatments though have a huge impact on our teeth, and our jaw bones, in strength and healing.  And it is important to know as much as possible about your individual exposure, so that your dentist or oral surgeon can make the choice that is best for you.

For me, because I have no spleen on top of everything else, there is an extra level of precaution I must take, whether for a standard cleaning, filling a cavity, or an extraction.  I typically take an antibiotic a few days before any procedure, just to make sure I do not have any stray bacteria that could cause any problems for me with an infection afterwards.

Once I get passed my initial hesitation of going to the dentist, something my dentist can attest to, is a major task.  For a while, I would have been more calm going to my cardiologist than my dentist.  No pun intended, but my dentist went above and beyond to get to the “root” of the fear.  It took her several months to alleviate my concerns, but she soon earned my trust when it came to pain management during procedures.  Most patients, if not every one, may not be aware that when you are given novacaine prior, if you still have sensation, you are able to ask for more.  I was always under the assumption, that was it.  All those years, I was given just the first dose, of a possible twelve.  She could see in my eyes, I was still having sensation, and stopped what she was doing, and asked, “can you still feel that?”  To which I answered, “yes”.  A motherly lecture followed about telling her if I needed more, and that was followed by another dose, and the procedure went on.

For the most part, that is how my simple appointments go, cleaning, exams, and cavity repairs.  It is when things get more complicated, when I hear the word “crown”, root canal, abscess… that is when things get really complicated, besides expensive.  With or without dental insurance, any of these three options are expensive, and out of my scope, not just because of money, but risk.

Because of the high dose radiation to my upper body for my Hodgkin’s Lymphoma, and the high dose prednisone I took as part of my chemotherapy, healing and stability are compromised when it comes to dental work.

I am lucky.  For the most part, I have done well taking care of my teeth, especially those in the front.  As for the ones in the back of my mouth, closer to the radiated neck area, it is a different story.  Since my heart surgery in 2008, also courtesy of radiation damage, I have had to lose four teeth, three to abscesses, and one to a broken tooth.  The broken tooth was going to require a crown, which I could not afford, and the abscessed teeth, were going to require root canals and crowns.  I definitely could not afford.

I needed to have them pulled.  Now of course no one wants to lose teeth, so then conversations began about other options, such as bridges and implants.  Still, both expensive options, and potentially quite harmful.  One of the potential risks I faced, was something called “osteonecrosis”, which literally means “death of bone”, and to my jaw, that is not good.  That left me no other choice, than to surrender those four chompers.  The good thing is, all are in the rear of my mouth, so only I am aware of that, and my dentist and hygienist.

Some antibiotics before and after, some gas, some novocaine, and I was good to go.  Sort of.

Again, as I have spoken before of healing issues when it comes to the bones in my body, the jaw is one of those bones.  There is going to be a huge hole in my jaw, that needs to heal, at the least have some help doing so.  My first two teeth, I went into blind not knowing about what I am writing about now.  But for my next two, and potentially any more that may come up, I needed to be aware of the risks of healing.

One option, and really the only one that gets offered, is hyperbaric treatments.  This involves breathing oxygen in a pressurized chamber.  For the average person, not a big deal, and often used to regenerate a person’s energy and health.  And in my case, it was recommended, rather, required before I could have any teeth pulled and after.  Besides the obvious expense I could not afford, because of another chemotherapy drug, Bleomycin, I am not able to go through any treatment involving oxygen.  A complicated issue that I cannot cover in this post.  But with this option off the table, I had no one able or willing to pull those two teeth.  Which means my situation risked getting way worse, if something developed with the abscesses.

Then I met an oral surgeon who offered a new type of treatment for the hole left in my jaw.  It is called “platelet rich plasma” or PRP for short.  Basically, they use your own blood, spin the hell out of it, leaving only the plasma, and inject that into the hole of the bone to enhance healing, and then stitch up the gum.  It is a bit more complicated, but this is now the new technology available, not just when it comes to any tooth work, but any kind of injury that would require another treatment impacted by my cancer and treatment past.  And because it will not involve any further cosmetic option, it is also less costly.

More importantly, it works.  So far, 2 for 2.  The oral surgeon not only understands my past, but respects my knowledge of what I have gone through, and that helps him to do what is right for me.  Of course I hope I am done, but the realist in me knows I am likely to have more that will come out.  But at least I know I have a good option.  And I am still able to keep that smile.


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