How do you care for teeth and dental health after H&N cancer?

Ditto

My husband had surgery, chemotherapy,and radiation in 2021. He is very restricted in how wide he can open his mouth. He has used a waterpik and an antibacterial rinse since treatments. He has not been able to have a dental cleaning. He had 20 hyperbaric treatments before having all his teeth removed in surgery. Then 10 hyperbaric treatments after tooth removal.

Now we are waiting until he is completely healed to see if he can get implants or dentures. He is limited by how little he can open his mouth.

His cancer was stage 4 so his radiation was very strong to his mouth.

As for your husband’s jaw, I too have that same problem.
My primary physician prescribed me a muscle relaxer in hopes of reducing my chronic migraine. It didn’t help my migraine however it did help my jaw! I have continued using the medication and though I can’t open my mouth wide I can open enough to eat a thin burger.
Getting the burger down my throat is another issue!

MOJO

I went to see my brother's Acupuncturist. She found a protocol developed by the VA to solve dry mouth issues. It included two sessions within 24 hours. I did that. It was quite interesting that I had forgotten the sensation of having saliva in my mouth. It worked. I was advised that it would take some time for it to reach a 'normal' state, so in the meantime use Xylitol lozenges. I was quite impressed with the Acupuncture procedure. I did not know much about it before this. It is something that I will have to learn more about.

My dental X-ray showed bone-deaths quite extesnive. One of the treatment options is to remove all the teeth and put in-plant dental which will cost more than a fancy car. scary.

Hi @darapoza,
Interesting and glad it worked in 2 sessions. I had 35 rounds (7weeks) of Photon radiation for a total of 70Gy and 3 rounds of cisplatin chemo for tonsil cancer back in 2008 but no surgery and to help with the brutal dry mouth tried Electrical Stimulation Acupuncture in 2015 which was offered at my cancer clinic for head & neck cancer patients. I was tested to get a baseline and retested after 8-10 appts. and had great results. Never needed to go back and to this day 10 yrs. later dry mouth is a non-issue and I don't have to carry a water bottle with me either.

Thank you. I have started to use fluoride toothpaste as well. My dentist had suggested that I do a total dental replacement. Other than the frightening price tag, the thought of having all the teeth removed at one time is too traumatic for me to embrace. I read about hyperbaric oxygen treatments that could help to force oxygen back into the dying bones to slow down or stop the deterioration. The dead portion probably needs to be removed. That will mean I will lose a few teeth but not all. That certainly sounds better than having all my teeth removed. I am reaching out to people that I know to learn more. Hopefully, it can be a viable option.

About your bone death or osteoradionecrosis, that section of bone will rot and of course you are right, it must be removed. However, the bone died from lack of blood supply and that is usually not limited to only the area where the teeth are anchored. Removal of the dead bone without a viable replacement of bone is like building a house on a crumbling foundation, it won’t last long.
The alternative is to have the bone section replaced with a transplant from your own body. Not just the bone but the blood supply tissue known as “free flap”, which is carefully connected to a good artery supply. Once healed, a prosthetic teeth group can be installed.
Sorry but your dentist does not get the new luxury car because health insurance usually covers a good portion of this.
This operation is performed only in limited hospitals and clinics because it requires study and set up time and is a unique surgery. You can investigate this on your own, typically limited to the mandible or lower jaw bone and is known as a mandiblectomy with fibula free flap. The bone typically is harvested from your leg fibula bone, a non-weight bearing bone. Or it can be harvested from the shoulder, collar bone, pelvis bone edge, or other places.
The upper jaw requires other options. Perhaps you should talk with someone other than your dentist.
I had this done at Mayo Clinic Rochester over four years ago. I can easily eat corn on the cob, steak, or almost anything now.
Is your issue with both upper and lower teeth? Both sides? Do you live near a large medical facility or can you travel to one?

I appreciate your response. I can understand that. I was thinking about whether the medical portion will cover this since the dental benefits are pretty limited under my dental plan. I planned to talk to my oncologist and learn more about available options.

The rot is more pervasive on the lower jaw. There are some signs on the upper teeth. One of my molars cracked and I had that removed a little while ago and had a bridge put in without knowing that was only the beginning of this journey.

I live in Honolulu, sadly far from Mayo Clinic. We do have several pretty good facilities here. I will learn more from my oncologist. Again, thank you!

My oral surgeon has recommended that I try and keep the few teeth left in my mouth. Like your husband I had stage 4 and was told they used very high radiation for my treatments. That left me with severe Trismus. Do please let us know how it goes for him. We all love hearing good news

Fluoride Mouthwash , a prescription strength every morning and every night after brushing. When I was in the ENT waiting room post op, the people who had head and neck surgeries told me I would lose my teeth! I was only 34! My radiation oncologist told me about the fluoride mouthwash. It's been 25 years and I don't miss it. My teeth are great so far.
Not missing dental cleanings is the other part of this story. My challenge is with dry mouth from the parotidectomy, radiation and autoimmune illness combined. I live with Sjogrens Syndrome. I find in time, once I have information, I learn to cope with all that chronic illness brings. Anything from my cancer treatment, only causes me to be grateful I'm alive and dealing with these things.