LIFE has a way of humbling us. One day you are thriving. Your business is growing. Your children are doing well.
You have plans for the weekend, dreams for next year, feeling strong and healthy. You feel like tomorrow will always come.
Until suddenly, it does not. Cancer arrives like an unwelcome guest. It does not knock politely.
It kicks the door down, walks into your living room, sits on your couch and tells you it is staying.
One moment you were living your life and the next you are sitting in a doctor’s office hearing words that change everything.
The days after a cancer diagnosis are the worst.
Some mornings you resent opening your eyes at all because opening your eyes means facing another day of wondering.
Will the tumour grow today? Will it spread? Will today be the day everything gets worse?
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The fear is real, making it hard to breathe, hard to think, hard to hope.
When you receive your treatment plan, you want it done as soon as possible radiotherapy, chemotherapy, surgery, you name it.
All of it requires so much from you, physically, emotionally and spiritually that we tend to forget ourselves in the rush, the same with dental care, we rarely think about it, at times we completely abandon it but is it worth it?
Of course not. Dental health is not a small matter when you are facing head and neck radiation.
It can be the difference between a smooth recovery and years of suffering.
What does radiation do to your mouth?
The same radiation that saves you from that unwelcome guest called cancer can also damage your alveolar bone, the bone that supports your teeth.
It damages your salivary glands. It damages the blood vessels that your jaw needs to heal itself.
After radiation, your jawbone loses its ability to heal properly. The blood vessels narrow and scar.
If that bone gets injured, if it gets infected, if a tooth is pulled, the bone may simply die, it will never heal.
This is defined as osteoradionecrosis, which means that there is exposed dead or necrotic bone in your mouth that has weakened, prone to fractures.
To be able to resolve this, there is need for major and extensive surgery to remove the necrotic bone and replace it with new bone which can be taken preferably from the leg.
This surgery will require a lot of time and energy from both the patient and the doctor.
Hence how can you prevent osteoradionecrosis?
Before radiation therapy, there is a window that you must not miss or take for granted to take the chance to protect yourself.
This window is before treatment begins, not during and not after.
Firstly, you need to visit a dentist who understands radiation at least two to three weeks before your first session.
This is not a luxury and it is not optional; it is as important as any other part of your cancer care.
During this visit, we take special X-rays to look for problems hiding below the surface.
We check every single tooth for infection you might not even feel yet. We look for gum disease.
We examine wisdom teeth that could cause trouble later.
We search for anything that might become a problem in the months and years ahead.
Then we act accordingly, which is usually the part patients do not like, because any tooth with a questionable future must definitely be extracted, meaning that any tooth that might cause infection later, for example any periodontally compromised tooth, any tooth with extensive tooth decay that cannot be treated with a root canal or a filling.
This is being done before radiotherapy commences.
This is important because your jaw still has a healthy blood flow to heal the socket properly.
It is not easy, of course, to lose many of your teeth in one go.
Keeping them might sound like a great solution, but losing a tooth now when the bone can still heal is far much better than losing half of your jaw later when it has lost that ability to heal.
During this visit, impressions (imprints of your teeth) can also be taken, which can be used to fabricate some dental trays to be used for future flouride therapy after radiotherapy.
Flouride therapy will strengthen the healthy teeth left in your mouth and protect them form decay, which is a very crucial step for every recovering patient.
Some patients might also need special stents or spacers that push healthy tissue away from the radiation beam.
These small devices can save parts of your mouth from unnecessary damage, it is important to ask about them if you are to have radiation therapy.
What should a patient do after radiation?
Once radiation is complete, your mouth will never be the same again there are many changes that occur these include:
Mouth dryness or xerostomia
If it happens that your salivary glands were also part of the radiation field, they may stop functioning completely or produce much less saliva.
This means carrying water everyday, waking up at night feeling choked because of lack of lubrication, struggling to swallow certain foods.
This shows how saliva is not just water in your mouth, but the body’s natural protection system as it washes away sugar, neutralises acid produced by decay-causing bacteria through the fermentation of sugar from the food that we eat.
Saliva contains minerals that remineralise your teeth after eating.
Without enough saliva, your teeth become vulnerable to decay.
Cavities can start at the gum line and spread rapidly. Teeth can start crumbling and breaking.
This is where fluoride trays mentioned above become essential.
Recovering cancer patients will need to make use of flouride gel trays every evening for five to 10 minutes for the rest of their lives.
This is not optional. It is as important as any medication your doctor prescribes.
Your toothbrush must be extra soft.
Regular brushes can damage your gums, which are now more fragile.
If brushing hurts too much during treatment, use sponge swabs or soft cloths, but never stop cleaning your mouth entirely.
Avoid mouthwashes that contain alcohol.
They burn and dry your tissues further. Instead, use salt and baking soda rinses.
Mix one teaspoon of salt and one teaspoon of baking soda in a litre of water.
Here are rules you must follow forever after head and neck radiation.
No hard foods that can cut your gums because they are very fragile, this means being careful with sharp chips, crusty bread, nuts and hard candies even a small cut that heals in days for a normal person can become a wound that never closes for you.
No tooth extraction unless absolutely necessary.
If a tooth must be extracted, it requires a special hospital procedure (hyperbaric oxygen therapy), which means sitting in a chamber breathing pure oxygen under pressure.
This forces blood vessels to grow into your damaged jaw.
You need about 20 sessions before the extraction and 10 after.
It is expensive and time-consuming, but it can save your jaw from dying.
You must visit your dentist every three to four months because if there are any problems they must be caught early.
Small cavities must be filled before they reach the gum line.
Infections must be treated before they spread to bones.
Regular cleaning helps to remove buildup that your dry mouth cannot wash away.
Watch out for warning signs. Any sore that does not heal within two weeks needs immediate attention.
