Oncology Dentist: Is it recommended to see a specialist?

My husband was being evaluated for a heart and kidney transplant when the lymph nodes in his neck swelled. We went to the ER who set up an appointment with an ENT who in turn did a fine needle biopsy identifying it as back of throat HPV +16(luckily Stage 1) which was confirmed by his ENT surgeon with a biopsy performed in an operating room with a cardiology team on standby. He had 6 teeth removed by an oncology oral surgeon prior to the start of radiation and monoclonal antibody therapy(in lieu of chemo). His regular dentist was excellent regarding coordinating his aftercare with the oral surgeon, his oncology team and his heart failure team. He was told to use a high fluoride oncology toothpaste, floss and brush 3x/day to preserve the rest of his teeth and more importantly his jawbone(radiation is hard on it).Also fluoride treatment when seeing his regular dentist 2x/year. He swishes many times a day with Prevention mouth rinse for oncology patients(Amazon)which “soothes & protects oral mucosa…” (permanently affected by radiation to head & neck. I’m probably missing some of the other dental recommendations. Sorry so long!

It's evident that you prioritize your oral health and have developed a personalized routine to maintain your excellent teeth. Here's a summary of the key points from your statement:

Emphasis on Oral Care for Tooth Preservation:

The primary advice you received was to take care of your teeth if you want to keep them. This underscores the importance of preventive measures for oral health.
Focus on Oral Sores Treatment:

The information you received was predominantly about the treatment of oral sores, indicating awareness of potential issues and their management.
Maintaining Oral Health with Personal Routine:

You describe your personal oral care routine, which involves using a toothbrush without toothpaste, brushing and massaging gums while watching television.
Use of Hydrogen Peroxide as Mouthwash:

You dilute 3% hydrogen peroxide with water as a mouthwash. This serves the purposes of debridement, whitening, and disinfection simultaneously.
Delaying Cleaning Due to Infection Concerns:

You've been putting off a dental cleaning, possibly due to concerns about creating opportunities for infection. However, you've had a semi-annual inspection with X-rays, and everything was fine.
Reminder to Brush the Tongue:

A reminder to brush the tongue is included, emphasizing comprehensive oral care.
It's important to note that personal oral care routines can vary, and what works for one person may not be suitable for another. Your proactive approach to oral health and regular check-ups contribute to the overall well-being of your teeth. If you have specific concerns or questions, consulting with a dental professional for personalized advice is always a good practice.

My husband had oral cancer in his cheek. After surgery, radiation and chemotherapy, he can not open his wide enough for a full cleaning by a dentist. After he was finished with treatment, Imsearched for a dentist who had some knowledge about treating a patient after oral cancer.
We finally took him to see an oral surgeon who did panoramic X-ray. He then sat down and explained everything he saw. My husband’s teeth have shifted and the radiation did cause damage to his teeth and gums.

The oral surgeon recommended 4 dentists that he knew that were familiar with oral cancer patients. My husband uses a watepik, has higher fluoride toothpaste and a special mouthwash. His new dentist is wonderful and also explained the issues and treatment plan.

Hello,
I hear you on the worried about the teeth!
I’m 7 years out of stage IV treatments and still worry about my teeth.
I brush several times a day with prescription fluoride as well as whitening paste and get my 2 cleanings and checkups per year. I also get fluoride treatments during my 2 cleaning, my insurance covers one and I pay for one($45.00).
Wishing you the best

MOJO

That might maintain the water pic as well. My wife uses one of those. I have to run peroxide through it sometimes because scum grows in the pump and tubing.

My dentist always checks around my neck and underneath my tongue, looking for lumps or swelling. Unfortunately, dentists and other health care providers can only act on their own training and experience, the same as all of us. They may hesitate to refer a patient to a specialist unless they are really sure its outside their own expertise. When I went to see my GP about the lump on my neck, he put me on antibiotics for 10 days instead of immediately referring me to a specialist. I had to call his office twice to remind him that he was supposed to make the call if the lump had not gone away after the antibiotic treatment. By then the lump had grown from the size of a pea to the size of a walnut. A specialist generally won't see a patient unless they have a referral from another doctor. Those referrals can be hard to get. It may be an insurance issue, I don't know.

Thank you. I’ve been thinking about getting a water pic as I’ve read many people use them.

At my last dental exam, dentist said gums were getting to be an issue. Try a water pic. Did it for six months while learning not to spray the mirror or myself so much. Got a "good gums" during my pre-radiation exam. Start off low pressure and may want to talk to doc before considering it.
P.S. talked to a guy just finishing rad/Chem. He said the salt/baking soda gargle was effective for throat care. Don't see why it wouldn't help with tooth care as well.
I'm planning to use the pic during my treatment and may consider dissolving saltbaking soda in the pic water. I'll see what doc says. Good luck.

From what I understand is that generally if you have teeth issues, this should be addressed prior to radiation treatments. If you have no issues then normal dental care should be fine. Your dentist should be able to understand and explain any abnormal issues with the teeth and gums as well as the mouth. Most dentists and many oral hygienists are excellent at discovery of issues. A surprising number of oral cancers are discovered by dentists. You can certainly ask your dentist if he/she understands what to look for with oral cancer and tooth care. Any professional would not be offended and it will open the conversation.

I forgot to mention that I also floss.