When we are diagnosed with cancer, we think of all the treatments we will have to have, radiation, chemotherapy, surgery and many other procedures. Initially we are worried about getting rid of the cancer and not worried about the side effects of all those treatments. Prolonged dental problems are some of the least discussed side effects and can be some of the worst.
Osteoradionecrosis, or ORN, is the most serious possible complication facing the oral cancer patient. A condition of the non vital bone in a site of radiotherapy (RT), Osteoradionecrosis is bone that has died as a complication of radiotherapy. Because radiation works to destroy cancerous cells through the deprivation of oxygen and vital nutrients, it inevitably destroys normal cells as well, damaging small arteries and reducing circulation to the area of the mandible. Not an infection itself, it is the bone’s reduced ability to heal and the resulting lesions, pain and fragility. Insufficient blood supply to the irradiated areas decreases the ability to heal, and any subsequent infections to the jaw can pose a huge risk to the patient. Though it is possible to develop spontaneously, ORN most frequently occurs when an insult to the bone is sustained in the irradiated area, such as related subsequent surgery or biopsy, tooth extractions or denture irritations.
So what do you do about it? Years ago it wasn't even talked about, now several head & neck cancer treatment centers will refer you to their Oral Surgery department on the same day you see your Oncologist for the first time to set up a plan. Depending on your dental condition and your extent of radiation that is going to be given on your jaw, mouth, head area, you will either be directed to go to your regular Dentist and set up monthly meetings for cleanings and fluoride treatments or it will be suggested that you have all of your teeth removed before you start treatment to avoid the possibility of the problems later.
The issue is that when you get radiation to the head and neck area, the blood vessels are damaged, the bone is weakened and your saliva glands are damaged or sometimes killed out completely. With the lack of saliva in your mouth the bacteria that damages your teeth runs rampant. Saliva includes helpful enzymes to help clean your teeth and keep the mouth healthy, without it the slightest of dental problem turns into a cavity. If you develop one or more cavities when you haven't had them before it is likely you will develop more problems, and shows that you will have a difficult time keeping your teeth healthy. Once you have teeth that have decayed to the point of needing pulled, you are at a risk of developing the ORN if you do not heal quickly. Some Oral Surgeons will not pull teeth on a patient after they have had radiation therapy to the mouth/head/neck. In stead they will refer you to a Prosthodontist who will develop a radical plan to save your teeth that can be saved and seal those off that cannot be saved, but still not pull them. A prosthetic dental device is installed that is basically a permanent denture. Extractions are the last resort. If you do have to have extractions the Oral Surgeon will order Hyperbaric Oxygen treatments. This is a treatment that infuses oxygen into your body under pressure to encourage tissue to heal. These treatments can be very expensive and do not always prevent the ORN from setting in.
Hyperbaric Oxygen Chamber In Use
The dental side effects of radiation to the jaw/neck area can take years to surface. If you are going into head and neck cancer treatment ask your Oncologists about their plan for the care of your teeth and mouth and address it before it's too late. Many times pulling the teeth before treatment ever starts is the best approach. The expense of having dental work done is not covered under many insurance plans, even though it was a result of your having cancer and the subsequent treatment. So the expense of the problem alone is good enough motivation to address the situation before hand. More information is available now than ever before on this side efffect, but still it continues to be the least talked about of the head and neck problems.
Get informed, and ask your treatment team to put the dental issues into the plan. You will save lots of expense and trouble for yourself and your teeth later.