Oral health after radiation?

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Hoping someone can answer this for me. I finished my radiation treatments (chest wall, axillary nodes, supraclavicular nodes) about six weeks ago. Started on anastrozole a couple of weeks later. I went to the dentist today because I'll be starting bisphosphonates soon. I had four new cavities, when I've never had a cavity before. I've read some places that radiation can cause oral health issues, but I don't know if that is only if it is aimed at the head? I did get some to the neck. Is it possible that this is a SE of the radiation, or is that just a coincidence? I highly doubt that a month of AI's would impact me so quickly.

Has anyone else had this problem?

Comments

  • edwards750
    edwards750 Member Posts: 3,761
    edited July 2019

    Radiation can definitely cause dental problems. It was recommended, but I didn’t know it, that you see your dentist one month before radiation. Since you had neck radiation it’s entirely plausible radiation is the cause esp since you never had dental problems before.

    In my case I had dental problems before I was DX and after so it’s hard to know who the culprit is/was.

    I still would have had the radtreatments.

    Diane

  • AliceBastable
    AliceBastable Member Posts: 3,461
    edited July 2019

    The only thing my dentist warned me about was not getting dental xrays while undergoing radiation, just to avoid piling on the radiation. I can't imagine teeth decaying that quickly since you just finished six weeks ago, unless you have some underlying dental condition that would make you exceptionally vulnerable.

  • Spookiesmom
    Spookiesmom Member Posts: 9,568
    edited July 2019

    I’ve done rads twice. First time 32 zaps. About 3 years later, had 2 cavities. I blame the Arimidex. Just finished second rads, 25 zaps, 3 weeks ago today. Not expecting any problems.

  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited July 2019

    DO NOT start a bisphosphonate until your dental problems are all taken care of and healed, and you have been cleared by a dentist knowledgeable about cancer patients and osteonecrosis of the jaw.

  • Whatjusthappened
    Whatjusthappened Member Posts: 283
    edited July 2019

    Thank you for your replies. A few cavities isn't that big a deal in the grand scheme of things, but it just strikes me odd that I would start getting them this year, of all years. I do agree that it's probably too soon to blame it on the radiation (or the Arimidex, for that matter). In any case, I do hope it's just a coincidence and not the start of more issues down the line from treatment.

    I am very nervous about starting a bisphosphonate (probably Prolia), but don't have a lot of options because I already have osteoporosis. I wanted to talk to the dentist more about it but didn't get the chance until my mouth was all numb, lol. I'll have to call them back and see if he'll talk with me some more.

    Thanks again for listening. This all sucks, but I am very appreciative of the support I get on this forum!

  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited July 2019

    You might want to read the “Combination of micronutrients for bone (COMB)” study for a possible alternative to bring up with your doctors, at least until your dental problems are resolved. I don’t think most everyday dentists possess the required expertise.

  • Whatjusthappened
    Whatjusthappened Member Posts: 283
    edited July 2019

    ShetlandPony, thank you for sharing the article. I will share it when I see my MO next week. Interestingly enough, I'm already taking all of the nutrients in that protocol except the strontium, so it wouldn't be too difficult. Both my MO and GP have said that they don't think supplements would be enough, so it will be good to have something to show.

  • gailmary
    gailmary Member Posts: 332
    edited July 2019

    YES. My sil has cancer of thyroid. Radiation beads put in for a short time i think. She is miserable. she started loosing so many of her yeeth. 7 yrs later having the rest pulled. Mouth is very dry and doesnt make saliva anymore.

  • AliceBastable
    AliceBastable Member Posts: 3,461
    edited July 2019

    I wouldn't take AIs because I already had osteoporosis, and I didn't want to go on Prolia because I might need invasive dental work. That's more complicated than it should be because I might have a metal allergy, which would rule out implants (the issue came up during a hip replacement). When I asked my PC about getting tested for the metal allergy, she got snotty and said I had other things to deal with. So, my MO said I could go with Tamoxifen since I had a hysterectomy years ago. And my BS said it helps repair bone tissue.

  • Whatjusthappened
    Whatjusthappened Member Posts: 283
    edited July 2019

    Gailmary, that's awful about your sil. I can't imagine losing my teeth! I would venture that she had a lot more radiation to the neck than I did, though they did warn me that my thyroid gland and esophagus might be affected, so who knows?

    AliceBastable, I brought up the possibility of taking Tamoxifen instead of an AI with my MO. He said that while it might be a little easier on the bones, anything that reduces estrogen is going to cause some bone loss, including Tamoxifen. I guess I'll have to read up on that a bit more before my next appt, since your doctors have told you differently. Thank you for sharing.


  • gb2115
    gb2115 Member Posts: 1,894
    edited July 2019

    I developed dry mouth and dry eyes not long after finishing radiation. Both the dentist and the eye doctor said it was the radiation.

  • Daylightdancer666
    Daylightdancer666 Member Posts: 50
    edited July 2019

    Agree here I'm. Not starting my. Treatment for bones till my. Calcium is up enough and also had get all clear from my dentist.

    I have read somewere. Make sure you keep good good dental hygiene before during and after head and neck. Radiation can't think top. My head xxx


  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited July 2019

    Cancer treatment can cause mouth dryness, which a person might not even realize is happening. It can have bad effects on oral health. My onc nurse recommended using Biotene moisturizing rinse.

  • gb2115
    gb2115 Member Posts: 1,894
    edited July 2019

    The Biotene gel is good too!

  • edj3
    edj3 Member Posts: 2,076
    edited July 2019

    This thread spurred me to call my dentist--I'll be going on Prolia in September but don't see my dentist until October. So on the off chance she's noted anything I'd need to have done, or any tooth that looks wonky, I called to check. Turns out I'm good to go.

    So thanks, you guys, for this thread.

  • Whatjusthappened
    Whatjusthappened Member Posts: 283
    edited July 2019

    I talked to my dentist today and he said that he saw no forseeable oral surgeries in my future and that my x-rays looked good. So I will be taking scrupulous care of my teeth from here on out and hoping for the best. Got some biotene rinse today, and the gel for when I'm at work. Thanks everyone for the suggestions.

  • Calli0p3
    Calli0p3 Member Posts: 21
    edited July 2019

    I wish I had known about this dental stuff sooner. I was going through the process of getting invisaligns just when I was diagnosed. Was told by the surgeon that it shouldn't be a problem, so went ahead. While wearing my first aligners (changing weekly right now), during a cleaning, was told that a root canal I got almost a year ago still hasn't quite healed and I have a periodontal pocket. I also have some fillings I have to get replaced, and some tooth pain from one of them in the back. I was told the invisaligns aren't going to be a problem with fixing my perio/root canal issue, and to keep going. 

    But, I am having radiation right now, and because I am small, the darned field for the machine (made for a man), goes from my collar bone, down the middle of my chest, to the bottom of my rib cage, and just about around to my back along my side, and up into the top part of my arm pit. That is A LOT of my upper body irradiated, and into a bit of my neck/esophagus. They are supposed to *only* be irradiating my breast. I even have a form in my file saying I explicitly do not give them permission to treat my lymph nodes with radiation, since they do not need it. But, I think, and they definitely won't tell me, their machine cannot work in a space that small. THAT worries me because I am supposed to get a partial breast "boost" at the end of my treatment.

    So now I guess I have to go back to my orthodontist/dentist/endodontist/periodontist and make plans for expensive, painful, and time consuming work on my dental health very soon. Anyone have any orthodontic issues after radiation/hormone treatment?

  • Calli0p3
    Calli0p3 Member Posts: 21
    edited July 2019

    gb2115, I've been using xylimints with my invisaligns (which can also cause mouth dryness, especially at night). They work really well for me. I like the lightly mint ones.

  • Calli0p3
    Calli0p3 Member Posts: 21
    edited July 2019

    Whatjusthappened-- Just wanted to let you know that I too had been told that tamoxifen hardens bones. I've got braces (at 51, I know, I know...), and I was told by the orthodontist that they would do the braces with me *if* I was on tamoxifen, BUT the changes had to be extremely slow to compensate for the hardening, otherwise it might damage the tooth roots. They would *not* give me braces or manage my care if I were on AIs, especially if I were to go on any of those drugs that combat osteoporosis. Tamoxifen blocks estrogen receptors on most cells, but seems to increase it in the uterus (thus increasing the chance of uterine cancer by a lot, I am going to have to be watched for endometerial lining increases and polyps), and in the bones. Thus the hardening. And it seems that the effect accumulates over time, so it lasts past the five years or how ever long you take it. I'm not going to be able to afford to take it for very long, essentially until I finish my invisaligns, and then get all my dental issues sorted after. I dread the idea of radiation making my teeth that much more vulnerable to decay on top of the invisaligns themselves. It just doesn't seem to get easier as we get older, does it?

  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited July 2019

    My understanding is that tamoxifen can be detrimental to bones for a premenopausal woman, and helpful to bones for a postmenopausal woman. I do not know about its effect on men’s bones. (Sorry, I’m too tired to find a scientific reference to cite rightnow.)

  • Calli0p3
    Calli0p3 Member Posts: 21
    edited August 2019

    ShetlandPony, thanks for the reply. I didn't really consider the premenopausal aspect because I am at the end of perimenopause. I appreciate the detail. That would be important for someone younger.

  • Kimmh012
    Kimmh012 Member Posts: 87
    edited December 2019

    thanks for this thread. Has anyone found an at home solution. My teeth are so sensative i cannot eat hot or cold food or drink, mostly room temperature stuff.

    My tooth decay is from Chemotherapy. I start Rads next week. I had good teeth before chemo. I have cleanings every 3 months. 3 months ago i had super sensative teeth and gums, 4 cavities, lost 2 fillings, and now i have 2 more cavities, gums receeding and the start of gingervities/periodontal disease. I am from a small town so I am looking for a Peridontel Dentist, I think.

  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited December 2019

    Wow Kimm - Mostly I was warned about dry mouth. When that happens, the saliva can't 'wash' out the germs that are always there & accumulate. Hopefully someone else know more.

    Did you tell you dentist you were in chemo? What did he recommend? What did your oncologist say? They should have been monitoring this all along.

  • Cowgirl13
    Cowgirl13 Member Posts: 1,936
    edited December 2019

    Whatjusthappened, I am 10 years out and just heard for the first time about how chemo can affect our teeth. About 6 months after my last chemo I went to the dentist and found out I had to have a crown or two and some fillings. It was really surprising because I had had regular dental care for years. So just this year I switched from my regular dentist to a dental school which is much cheaper. The care I get at the school is terrific and they told me part of it is because of the lack of saliva from the effects of chemo.

  • MinusTwo
    MinusTwo Member Posts: 16,634
    edited December 2019

    BTW - what I used for dry mouth was Biotene. I kept the spray by my bed and if I remember there are also a mouth wash and toothpaste and also lozenges.

  • mamacure
    mamacure Member Posts: 236
    edited October 2021

    anyone else having dental issues lately? I need a crown but not sure best to do it before or after radiation. Also do you have to wait 6 months after chemo to do dental work

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