The Whole Tooth, And Nothing But The Tooth
If there is one thing that does not get near enough attention for cancer patients and survivors, it is proper dental care. Sure, during the active treatments, extra precautions are often suggested, or even delaying cleanings and other procedures. But what about long after treatments, radiation or chemotherapy, should a cancer survivor be concerned about? The answer… a lot? It makes sense to wonder “but why? I am not dealing with cancer anymore.” If you have followed me long enough, you know time means nothing, when it comes to potential late side effects developing. No, these health issues are not guaranteed to come up for everyone, but they need to be watched for. And it does include the teeth.
As is often the case, a post on one of my feeds prompted this post, an opportunity to explain “why?”. The writer is experiencing an issue many of us who have been exposed to radiation therapy also deal with, the degradation of the teeth and jaw. For those unfamiliar with cancer and its treatments, patients are advised on the potential issues faced during and after cancer treatments. Dental issues are rarely, if ever discussed. But the truth is, they are more common than not.
The next three slides are from the “Survivorship Guidelines” of the Children’s Oncology Group. It is a very comprehensive guide covering aspects of the various treatments and potential issues. It may not cover every cancer, and it may not cover every treatment, but if you can find a chemo drug in this guide, read it. But anyone being treated with radiation will benefit from this guide regardless of the cancer.
I often use the quote from Maxwell Smart from the television show “Get Smart,” “missed it by that much,” a sarcastic snipe for really blowing it, or missing it by a mile, in reference to warnings about dental issues. You can see for yourself, there are quite a few issues to be concerned with, in addition to the salivary gland, which also has an impact on the health of the teeth.
Then again, I have already been living this reality. Whether I am dealing with a teeth cleaning, a cavity being filled, or something more serious, I am prescribed an antibiotic a few hours before the appointment, as a result of having cardiac issues and no spleen (thank you Hodgkin’s Lymphoma). But my teeth are definitely brittle, from the radiation thirty-five years ago. I broke a tooth soon after my emergency heart surgery in 2008, and over the years have broken three more.
Fixing the teeth is where it got complicated for me, and expensive. As the person who wrote the original post stated, the dentist want to “do all kinds of things costing thousands of dollars.” If you were lucky through your childhood and your adulthood, all you ever had were cleanings and fillings. But if you ever needed a root canal or crown, you know those are expensive procedures, even with dental insurance.
This is how each of the last three of the four broken teeth that I had were resolved. I saw the dentist. They wanted to do a root canal and crown. I said “no, I can’t afford that. Just pull the rest of the tooth.” The dentist would try to talk me out of it, but I insisted that unless they were going to make a huge discount, there was no way I could pay them. Then I was sent to an oral surgeon as the dentist had nothing more to offer.
Though a less expensive option, it still ended up costing a lot for each tooth. But before I get to that, the oral surgeon was looking to cash in himself, with not enough of a profit margin from a tooth extraction. He recommended an “implant” tooth. Again, I declined, as explained in the slides above, the radiation I went through, has left my jaw compromised and at risk of osteonecrosis, simply, my jaw risked being broken. His profit dashed, he had one more idea. He wanted me to go through hyperbaric treatments that would help my jaw heal from the extraction. He went from ka-ching to ka-bong. I cannot go through hyperbaric treatments having been given the chemotherapy drug, Bleomycin for my Hodgkin’s Lymphoma. It seems, regardless how long ago it was that I had received it, the remnants of the drug remain in my body, and could reactivate with oxygen of any kind, creating a “bleo toxicity”, as bad as when it was originally given to me.
By now, I have frustrated any attempts by anyone to make any major money off of my dental situations. I was at risk enough from infections due to no spleen and being in congestive heart failure. I did not need any more complications. Then the oral surgeon had a different idea. And this one, while I had never heard of it before, sounded like it might actually be worth it for me, to help heal, and reduce the risk of any complications.
It is called Protein Rich Plasma, PRP for short. It is used for many healing opportunities, but for the purposes of this post, I am referencing the jaw bone. Blood is drawn from the patient, then spun until a concentrate of platelets rich in protein remain. Once the tooth is extracted, and before the gum is sutured shut, the PRP is placed into the hole left behind, assisting the bone in its healing. I am three for three with this process, having no complications, even with my complicated health.
And though I expect to go through this process at least a few more times, because of the radiation damage to my teeth and jaw, a new issue was discovered dentally. All along the gum line, decay is starting to develop at the base of the teeth, and enamel is disappearing. A new situation that I was unaware/aware of, an extremely dry mouth, no saliva as I sleep, is caused by my salivary gland, of course in the radiation field over thirty years ago, has failed, causing sugar and other stuff, to remain on my teeth in between brushings, causing an intensified destruction of my teeth. There are some therapies that I am doing, including flouride rinses, and other saliva substitutes (gives new meaning to the term “swap spit”, depending on your age, you may not get that innuendo). This is something new happening, so I am not sure where it will lead.
Nobody told me over thirty years ago that I would be having these problems because of my treatments. Then again, they did not know then what they do now. And I am blessed because I do have a dentist that knows and understands the risks and progression of what I am dealing with. Not everyone is as lucky. But the truth is, if you received radiation therapy to the head and neck areas, then this is something you should keep on top of. I am not saying something will happen, but it is better to keep an eye out for it.
Paul's Heart 