[Dave Grave]

Hello Bryanna and others,

I have noticed the helpful information posted in some of these threads and thought I'd ask a few questions based on my own current rather unique scenario.

Some quick facts:

* I had oral cancer (tongue) nearly 10 years ago at age 28
* I had a strong dose of radiation and chemotherapy
* I had surgical extraction of part of tongue
* I have had minor continuing issues since (off and on dry mouth, all liquid diet consumed orally, moderately bad trismus of the jaw)
* As expected in the last year I've started to have more dental issues, first many fillings, and a root canal. Now things are getting more advanced.

I was recently notified that one of my molars along the bottom on the right (where I was most heavily radiated) is suffering from external resorption. I received a poor prognosis, but because dental extraction is not advisable in irradiated patients, I was sent to an endodontist for root canal in the hopes of at least extending the life of the tooth for a longer period before extraction became inevitable.

The root canal went OK but as the dentist began the restoration a few weeks later, he stopped mid way and decided the damage from the resorption was more extensive then he'd first realized and decided extraction had to happen (and that resorption may be occurring on another of my front middle teeth).

I have been referred to an oral surgeon and have a consult about it in a few days. I'll be seeing my ENT as well a few days later to get her take on what I should do. In the 3 weeks since the failed restoration by my dentist, I have in the last 7 days been experiencing some minor pain in the hinge of my jaw and in the bone along the right bottom of the mandible. I suspect I may have an infection.

My questions are:

* Given my history and that extraction is ill-advised except as a last ditch effort, is there any other option to consider?

* I have looked into what happens if external tooth resorption is left untreated. All I can find is that the tooth will eventually be destroyed and fall out. This appears to be the same end result as extracting. So why not just wait it out? Is there some other risk or danger in letting it "just play out"? My dentist could not answer this question because he never let a case of resorption reach the end point.

* Is there anything in particular I should ask the oral surgeon about my case? And do you have any advice, recommendations or words of experience based on my information?

Dental extractions in irradiated patients can lead to ORN if the extraction sites don't heal properly and far more horrifying scenarios then simply some missing teeth. I know I will have to undergo HBO treatments prior to and following any extractions. And these extractions may just be the first of many as the endodontist noted that because of my past cancer treatments all my roots along the bottom are decaying despite my good oral hygiene habits (the visible teeth above the gumline look mostly healthy even compared to a non-radiated patient). Additionally my trismus condition allows my mouth only to open not even half so wide as a "normal" person, making extraction all the more difficult for the surgeon.

So I wonder if there's any other options I should consider?

Thanks in advance for reading, and for any information provided.

[Lara]

Hello Dave,

I can't really help you with technical dental questions I'm sorry, but I did just want to welcome you to the NeuroTalk Support Groups.

I'm sure you'll find very helpful information and support here.

take care.

[Bryanna]

Hi Dave,

I am curious....did you previously chew tobacco? Is that what caused the oral cancer? If not and you are comfortable with sharing more details of how the cancer occurred, we would be interested in hearing your story. But only if you are comfortable.

Generally oral cancer is extremely invasive and the cancer therapy is equally invasive. The deterioration from all of that can continue to be progressive and because of that my personal belief, based on my professional experience, is that it is never a wise idea to retain teeth that are infected. Although it is risky to remove teeth in your case, it may be more risky to retain infected teeth.

Your specific questions.........

My questions are:

* Given my history and that extraction is ill-advised except as a last ditch effort, is there any other option to consider?

NO THERE REALLY IS NOT. RETAINING AN INFECTED TOOTH ESPECIALLY IN YOUR CASE COULD BE MORE DETRIMENTAL SYSTEMICALLY THAN REMOVING IT.

* I have looked into what happens if external tooth resorption is left untreated. All I can find is that the tooth will eventually be destroyed and fall out. This appears to be the same end result as extracting. So why not just wait it out? Is there some other risk or danger in letting it "just play out"? My dentist could not answer this question because he never let a case of resorption reach the end point.

A TOOTH FALLING OUT ON ITS OWN COMPARED TO IT BEING EXTRACTED ARE TWO DIFFERENT THINGS. HERE'S WHY....

IN ORDER FOR A TOOTH TO JUST FALL OUT, THE TOOTH ALONG WITH ITS SURROUNDING TISSUE AND BONE HAS TO BECOME DISEASED IN ORDER TO RELEASE THAT TOOTH. IN VERY RARE CASES, THE BONE IS ONLY SOMEWHAT DISEASED WHEN THE TOOTH FALLS OUT. HOWEVER, IN MOST CASES, ESPECIALLY WHEN THERE HAS BEEN EXTENSIVE BONE TRAUMA AND CELL DAMAGE FROM CANCER AND/OR CANCER TREATMENT, THE BONE HAS NO RESISTANCE TO INFECTION CAUSING IT TO BECOME DISEASED ALONG WITH THE INFECTED TOOTH.

WHEN A TOOTH IS EXTRACTED, THE DISEASED TISSUE AND BONE IS SUPPOSE TO BE REMOVED AS MUCH AS POSSIBLE. WHEN THE BONE IS COMPROMISED FROM CANCER AND/OR CANCER TREATMENT, IT CAN BE DIFFICULT TO ERADICATE ALL OF THE INFECTED BONE.

THIS IS WHY IT MAY BE IDEAL TO REMOVE THE TOOTH AT THE FIRST SIGN OF INFECTION TO PROHIBIT THE PROLIFERATION OF THAT BACTERIA CAUSING FURTHER DAMAGE IN THE BONE.

<<* Is there anything in particular I should ask the oral surgeon about my case? And do you have any advice, recommendations or words of experience based on my information?>>

I WOULD ASK...
** HOW EXTENSIVE IS THE INFECTION FROM THAT TOOTH?
** WHAT IS GOING ON WITH THE HINGE OF THE JAW WHERE YOU HAVE PAIN?
** WHICH OTHER TEETH ARE INFECTED OR CONSIDERED HOPELESS?
** COULD IT BE TO YOUR ADVANTAGE TO REMOVE THE TEETH IN POOR CONDITION PRIOR TO HAVING THEM BECOME A FULL BLOWN INFECTION?
** MAKE SURE YOU GET A GOOD PROTOCOL OF THE HBO TREATMENTS AND ASK IF HE KNOWS OF A NUTRITIONIST TO WORK ALONG WITH THOSE TREATMENTS. I HAVE NO DOUBT THAT OUR BODY RESPONDS FAVORABLY WHEN WE FUEL IT WITH PROPER SUPPLEMENTATION AND NUTRITION AND IT IS IDEAL TO HAVE SOMEONE KNOWLEDGEABLE TO GUIDE YOU THROUGH THE NUTRITIONAL PROCESS PROPERLY.

EACH CASE IS SO INDIVIDUALIZED. YOU REALLY NEED A VERY QUALIFIED ORAL SURGEON TO HANDLE YOUR SITUATION.

<<Dental extractions in irradiated patients can lead to ORN if the extraction sites don't heal properly and far more horrifying scenarios then simply some missing teeth.>>

DENTAL EXTRACTIONS DONE IMPROPERLY OR NOT THOROUGHLY IN ANY PERSON (MORE SO IN YOUR CASE) CAN LEAD TO ORN. BUT CHRONICALLY INFECTED TEETH CAN ALSO LEAD TO OSTEOMYELITIS AND OSTEONECROSIS OF THE JAW BONE. SO THERE NEEDS TO BE A TEAM EFFORT INVOLVED TO REDUCE THE CHANCES OF THAT OCCURRING.

**A RESTORATIVE DENTIST AND ORAL SURGEON WHO IS NOT NEGLECTFUL OR LACKADAISICAL IN DIAGNOSING THE ONSET OF INFECTION AND BOTH WHO WORK WELL WITH THEIR PEERS AS A COLLABORATIVE EFFORT.
**A PHYSICIAN WHO IS WELL VERSED ON HBO AND WANTS TO BE PART OF THIS TEAM.
**A CLINICAL HOLISTIC NUTRITIONIST WHO CAN GUIDE YOU THROUGH THE PROCESS OF SUPERB EATING HABITS TO RESTORE THE IMMUNE CELLS TO BUILD HEALTHY NEW BONE, ENCOURAGE HEALING AND POSSIBLY ALTER THE DNA THAT FEEDS INTO THIS CANCER THING. A WHOLE FRESH FOODS ORGANIC DIET THAT REFRAINS FROM PROCESSED AND CHEMICAL LADEN FOODS HAS THE ABILITY TO ALTER DNA.

<<I know I will have to undergo HBO treatments prior to and following any extractions. And these extractions may just be the first of many as the endodontist noted that because of my past cancer treatments all my roots along the bottom are decaying despite my good oral hygiene habits (the visible teeth above the gumline look mostly healthy even compared to a non-radiated patient).>>

THE DECAYING ROOTS NEED TO BE CLINICALLY EVALUATED AND ADDRESSED. TO WATCH THEM CONTINUE TO DECAY MAY NOT BE IN YOUR BEST INTEREST. TO ROOT CANAL THEM MEANS TO RETAIN DEAD AND INFECTED TEETH. WITHOUT QUESTION, THIS IS NOT THE IDEAL SCENARIO FOR YOU.

ENDODONTISTS ARE DENTISTS WHO BELIEVE IN "RETAINING" TEETH EVEN THOUGH THAT MEANS "RETAINING" UNHEALTHY TEETH. THEY GIVE LITTLE REGARD IF ANY TO THE SYSTEMIC HEALTH OF THE PATIENT. I KNOW THAT SOUND AWFUL BUT THE FACT IS ENDODONTISTS ARE JUST DOING WHAT THEY HAVE BEEN TAUGHT TO DO... RETAIN TEETH AND THEY LEAVE THE AFTERMATH UP TO SOMEBODY ELSE TO FIGURE OUT.

<< Additionally my trismus condition allows my mouth only to open not even half so wide as a "normal" person, making extraction all the more difficult for the surgeon.>>

YOU WOULD MOST LIKELY NEED TO HAVE IV SEDATION FOR EXTRACTIONS AS THEN YOUR MOUTH WOULD BE ABLE TO BE PROPPED OPENED WIDER WITHOUT INJURY OR DISCOMFORT TO YOU. THIS IS ANOTHER REASON I ENCOURAGE YOU TO FIND OUT THE "WHOLE" PICTURE OF WHAT TEETH ARE IN HOPELESS CONDITION AS IT DOES NOT BEHOOVE YOU TO KEEP GOING UNDER SEDATION FOR ONE TOOTH AT A TIME NOR GO THROUGH THE HEALING OVER AND OVER AGAIN. HAVE I EXPLAINED THAT OKAY?

<<So I wonder if there's any other options I should consider?>>
YES, CONSIDER HAVING AN IN DEPTH COMPREHENSIVE EXAMINATION AND XRAYS TO DETERMINE WHAT TEETH ARE HOPELESS AND/OR INFECTED. THEN GET THE OPINION OF YOUR "TEAM" AND GET A PLAN TOGETHER. THAT WOULD BE MY HONEST MOST SINCERE SUGGESTION FOR YOU.