Why is dental care so important in cancer treatment?
There’s a lot to think about when undergoing cancer treatment and, for many patients with cancer, dental care is relatively low on the list of concerns. But for Michael Shannon, D.D.S. it’s a top priority.
“I’m a prosthodontist,” he laughed, “but no one knows what that is.”
Prosthodontists are dentists with additional years of specialty training. They work with patients to replace missing teeth with crowns and bridges, and they help restore jaw function after trauma, birth defects, or cancer treatment.
At Mary Bird Perkins Cancer Center, Dr. Shannon sees patients before and after radiation therapy to safeguard their dental health in the short and long term. Many patients are surprised to hear how much treatment can affect their oral health.
“Patients come to see me, and they say, ‘What do my teeth have to do with cancer treatment?’”
For cancers of the head and neck, many patients will get radiation therapy as part of their treatment. Radiation passes through the oral cavity and in some cases can damage tissues, making the teeth brittle and causing dry mouth.
Too little saliva can mean more cavities, because saliva helps protect teeth from decay. But Dr. Shannon can help. Using a mold of the patient’s teeth, he produces a custom-fit tray. Patients wear this tray, with fluoride inside, for a few minutes each day to help counteract the effects of dry mouth after treatment.
But the biggest concerns in the mouth after radiation center around the jawbone.
How does radiation treatment damage the jaw?
When the jawbone has been exposed to a high dose of radiation, blood vessels inside can be damaged, resulting in decreased blood supply. If the jawbone is injured after radiation therapy it might have a harder time healing, which can lead to a serious complication called osteonecrosis, or bone death.
“The most common injury to the jawbone is tooth extraction,” Dr. Shannon explained. “So, if you have a tooth extracted from a part of the jaw that’s been exposed to high dose radiation, it might not heal. Osteonecrosis can be extreme and very painful.”
To help patients avoid this outcome, Dr. Shannon removes any teeth that might need to be pulled soon before radiation therapy begins. This way, patients won’t need to risk having tooth extraction surgery in the months following treatment.
Long-term dental impacts of radiation therapy
Dr. Shannon works with his patients to discuss the importance of proper tooth care, especially after radiation therapy.
“The effect of the radiation passing through the jawbone is for life,” he explained. “So, any time someone needs a tooth extraction in a high-dose radiation zone, there’s a risk of the bone not healing.”
After radiation therapy, patients are encouraged to see their regular dentist more frequently at first. Visits every three to four months can help the dentist keep an eye out and assist with tooth care before cavities take hold. If patients have not been visiting the dentist regularly before cancer treatment, Dr. Shannon encourages them to find a dentist and establish regular care.
Dr. Shannon communicates with each patient’s regular dentist about their prosthodontic care, and outlines restrictions that follow cancer treatment. These are intended to avoid injury to the jaw, and include:
- No tooth extractions
- No tissue surgery
- No deep periodontal cleanings
- No dental implants without first checking with Mary Bird Perkins
In the event an implant or extraction is necessary, Dr. Shannon works with the radiation therapy department to determine whether the tooth is in a danger zone for slow jaw healing. If so, they can help determine an alternative treatment plan, such as a root canal, which can effectively treat a tooth without injuring the jaw.
In cases when tooth extraction is necessary, such as a fracture or a failed root canal, hyperbaric oxygen therapy can help infuse more oxygen in the blood to promote healing.
Comprehensive cancer care
There’s so much to think about when cancer treatment is on the horizon. Dr. Shannon helps patients build healthy dental habits so they can avoid serious problems such as osteonecrosis before they even start.
“Decay is the most common reason to need a tooth extraction after radiation therapy,” he said. “Patients need to understand how important it is to take care of their teeth.”
As Louisiana’s leading cancer care organization, Mary Bird Perkins cares for more patients each year than anywhere else in the region. Our state-of-the-art treatments are supported by collaborative, comprehensive cancer services that keep patients at the center of everything we do—teeth included.
To learn how you can help support vital patient services, visit marybird.org/giving.