Dental problems after radiation therapy?

[Mrs.Milo]

My DH has had 2 unusual dental problems in the last year, after having 42 radiation treatments for prostate cancer. He hit the 2 year mark this summer since start of treatment, and now is NED, No Evidence of Disease. Yay!

One year ago, he had a toothache in a tooth that had never had a cavity, went to the dentist and was told it could not be saved. It was a reabsorption, no idea why it happened, but it would eventually have to be pulled. It was bottom left. When he could stand it no longer, he had it pulled.

Now top front tooth hurts, X-ray shows he is losing the tooth due to bone loss, it’s shifting the tooth, and again cannot be saved. He is planning on an implant, but will need a bone graft first, then surgery. Trying to figure out when to start the process around our Disney trip and the holidays. Any idea how long this process will take overall? And is this to be expected after having radiation?
Thanks for any replies.

 

[mumto3girls]

Congratulations on the NED—sounds like fantastic news.

I don’t know anything about how radiation may have contributed, but I can help a little with a timeline. I had an implant and crown following extraction and the whole process took a few weeks short of a year. I think I could have hurried it along a bit and maybe shaved a month or two off the process, but a few times I put off appointments a little longer than I had to. I did not require a bone graft though and I think that may add some time for that to heal.

As far as traveling and holidays, I probably wouldn’t schedule anything for a week or so after the extraction and after the surgery to place the implant. There was some discomfort and I was rinsing with warm salt water multiple times a day to keep it clean. I worked (even went back to work the same day as the extraction) but wouldn’t have wanted to deal with all that on a trip.

 

[Pea-n-Me]

Congratulations to him on NED.

I had radiation therapy and never heard of anything like this. I did a little research and this is what I found:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420702/

I’ve also had a tooth implant. If I recall it took about 12 weeks to seed after the screw was put in right after extraction, then the crown had to be built on top of that, which took a couple of months, also. I did not have a bone graft. I think they can be somewhat flexible for appointments. It will be nice to get away after all he’s been through!

I think I would probably try to find a dental specialist who works with this type of thing a lot, if possible, since this could continue to be an issue and it would be nice to see if there were any strategies to deal with it long term. But if not, it sounds like his dentist is on top of it. Not sure where you live but you could do a search or consult with a major dental school near you for referral if you decide to go that route. He should also talk to his radiation oncologist about it if he hasn’t already to see what they say about it.

I wish him good luck with this!

 

[lanejudy]

Sorry to hear he's have new dental issues -- I have no experience as to whether that is common with radiation or not.

A standard implant process will likely take 4-6 months, maybe longer with the bone graft. Chances are your insurance (if you have dental insurance) will only cover maybe 50%, and then likely will max out annual coverage well below the full cost. If you can get the work split across coverage years you'll get more. Good luck!

 

[Skippyboo]

I had 6 weeks of radiation on my head. My radiation oncologist stress to get regular dental cleanings. Not I probably for me I do 2 regular cleaning at my dentist and 2 with my periodontist. I had gum issues prior to radiation. I had no issues with bone loss post radiation (almost 4 1/2 years later) with radiation on my head. The hair never came back though.

 

[DLgal]

Did your husband have braces at any point? That is the main cause of root reabsorption. It can happen spontaneously in adulthood.

Bone loss is usually caused by peridontitis. Had he been seeing a dentist every 6 months prior to these issues? Periodontal disease is sneaky and if you don't stay on top of it, can cause all kinds of problems. I have it and had to go in for a deep cleaning every 4 months for a couple years to get it under control. Unfortunately, a lot of dentists overlook gum issues unless the problem is causing symptoms.

 

[LuvOrlando]

Talk to your Dr general practitioner and Oncologist, pretty sure bone loss happens if your body is running low on calcium, which is a salt. Electrolytes are a delicate thing and our bodies are designed to exploit reserves, you can lose too much salt by just drinking too much fluid because when we eliminate excess fluids we lose salts so your body goes to bone to replace it. This is what our bodies are supposed to do but I'd ask a Dr if this is happening out of concern for other bones too, too much loss and bones get weak but too much calcium and you get kidney stones so you want to stay in the middle so don't swing too far out on the other side. If it was me, in the meantime some fortified cereal with milk wouldn't hurt, I think there is also fortified OJ if he doesn't like milk.

 

[DLgal]

Talk to your Dr general practitioner and Oncologist, pretty sure bone loss happens if your body is running low on calcium, which is a salt. Electrolytes are a delicate thing and our bodies are designed to exploit reserves, you can lose too much salt by just drinking too much fluid because when we eliminate excess fluids we lose salts so your body goes to bone to replace it. This is what our bodies are supposed to do but I'd ask a Dr if this is happening out of concern for other bones too, too much loss and bones get weak but too much calcium and you get kidney stones so you want to stay in the middle so don't swing too far out on the other side. If it was me, in the meantime some fortified cereal with milk wouldn't hurt, I think there is also fortified OJ if he doesn't like milk.

Dental bone loss is only caused by disease or infection. It's not the same as osteoporosis, which is a loss of bone density. Dental bone loss has nothing to do with calcium levels.

 

[LuvOrlando]

Dental bone loss is only caused by disease or infection. It's not the same as osteoporosis, which is a loss of bone density. Dental bone loss has nothing to do with calcium levels.

You may be right but a Dr would be best to ask since radiation is a wild card

 

[DLgal]

You may be right but a Dr would be best to ask since radiation is a wild card

Radiation for prostate cancer would not affect the bones in a person's head. They use targeted radiation for that, which means it will NOT affect other areas of the body besides the area receiving the radiation.

 

[princesscinderella]

Definitely go see a specialist (periodontist since you are also having bone issues vs an oral surgeon) for the implant as a front tooth is a much harder implant to place as the jaw bone is thinner there. It takes about 3 months on average for an implant to integrate into the bone. There’s a 95% success rate with implants but sometimes they do fail and need to be replaced usually with a bone graft again to the area which would need to heal before another can be placed. They specialist will work with your dentist who will make a temporary tooth to fit over the implant while it heals so he won’t have a missing tooth in his smile. There are certain medications given after cancer treatments that can as a side effect cause issues in the jaw bone.

 

[EricLaurie]

I’m just finishing up a bone graft and implant process. The bone graft procedure was surprisingly easy. There was some swelling for a week or so and the stitches were always in the way. I was happy to get them removed. The bone graft has to heal for 6 months before they can do the implants. I got the implants put in at the 6 month mark ( I was replacing 2 baby teeth that just never had adult teeth underneath). The implants had to heal for 3 months. At my 3 month check, the oral surgeon measured the healing and said I was close, but not done. At the 4 month point, I was approved for the crowns. I was at the dentist two weeks ago to get those made and will finally get them out in on Oct 12. In all, this has been an 11 month process for me. Best case scenario would have been 10 months.

Good luck with your husband’s bone graft and implants. It’s a long process but it’s good to know it is permanent.

 

[Mrs.Milo]

Thank you for all the information, a lot we did not know. We have been flossing daily forever so no gum disease, and yes to braces on just the bottom teeth. Princesscinderella, thanks for the suggestion to see a periodontist, that sounds like the way to start as our dentist office is a one-stop Does it all so maybe not enough experience for this procedure.

 

[DLgal]

Thank you for all the information, a lot we did not know. We have been flossing daily forever so no gum disease, and yes to braces on just the bottom teeth. Princesscinderella, thanks for the suggestion to see a periodontist, that sounds like the way to start as our dentist office is a one-stop Does it all so maybe not enough experience for this procedure.

Flossing daily doesn't mean you don't have gum disease. I floss daily too, always have, but have chronic gum inflammation. It doesn't bother me, I have no indication that I have this, but when I go to the dentist, she tells me and shows me on the xray where DEEP DOWN, there are periodontal pockets near the roots.

Seeing a periodontist is a great plan.