Mouth and Teeth (M&T) Routine

To avoid my teeth rotting during radiation therapy, part of my regular routine during treatment is to wash my mouth out after each main meal with a solution combining a glass of hot water with a small amount of bi-carb soda and salt. Then I brush my teeth with high fluoride toothpaste and, instead of rinsing my mouth afterwards, leaving the toothpaste residue on my teeth. This routine is required to protect the health of my teeth and gums.

With neck and head cancers like mine, special attention must be paid to teeth, gums and jaw, particularly on the side of the face/neck to which the radiation dose is administered. Should any teeth be in a weakened state at the onset of radiotherapy, it is highly likely they will rot due to the treatment. I was advised that once a single tooth is damaged like this, often beyond repair and certainly irreparable during treatment, that there is a very high likelihood of damage to other teeth as they too will become weakened, and more susceptible to normal mouth-based bacteria.

This is because radiation therapy patients consistently report the disfunctioning of salivary glands during and after treatment. Without saliva to protect against it, bacteria in your mouth and on your teeth and gums can multiply rapidly and attack weakened teeth.

One of the tests I underwent in preparation for my treatment was a Dental X-Ray known as an “OPG”, being an acronym for Orthopantomogram. It is a panoramic or wide view x-ray of the lower face, which displays all the teeth of the upper and lower jaw on a single film. It demonstrates the number, position and condition of all the teeth.

I was advised to undertake this test to ascertain if any of my teeth would be affected by the radiation therapy. It turned out that the OPG identified a minor indent in my lower right molar. Something confirmed by viewing the tooth and something I knew about. It was a dent caused by the misalignment of my Wisdom teeth, which I had removed in my early 20s. The dentist who inspected the OPG and the tooth said this was a weak point and therefore the tooth needed to come out. It also meant that my opposing upper right molar should also be removed because it wasn’t going to be doing anything now the lower molar was not there to grind food against. This sucked because apart from that small dent, there was nothing wrong with either tooth.

Nevertheless, I deferred to the experience of the two Dentists who conferred on my case, and agreed to have both removed in the chair rather than risk what sounded like a difficult process if my teeth were adversely affected during the treatment.

You can see an extreme example of what radiotherapy can do to teeth here. Obviously, this is what I'm trying to avoid by adhering to this mouth and teeth routine.

The extraction of my two otherwise healthy teeth wasn't a pleasant experience. It involved a bit of pain from the anaesthetic needles, but was mostly uncomfortable due to my jaw frequently dislocating as the Dentist levered my good teeth out of the bone. I required quite a few needles because, the Dentist said, the tumour had pushed blood vessels to the surface and she had to search for areas to inject without causing my gums to bleed unnecessarily. This was hard to do, so in the end, the Dentist used stronger and stronger anaesthetic in order to dull the pain of the extractions. In addition, because the blood vessels were so close to the surface, the hole in my gum resulting from the removal of the lower molar took about a day and half to stop bleeding. Vicki had to stop by the Pharmacy to get more gauze. The hole from the removal of my upper molar stopped bleeding after around 5 hours. I used standard Woolworth’s variety Panadol and Nurafen, when needed, to manage the post-extraction pain, which eventually subsided entirely after 8 days.

I commenced the bi-carb and salt solution mouth wash immediately the wounds stopped bleeding and commenced using the high fluoride toothpaste just after Christmas.

I'm getting used to chewing on my left side. So the muscles on the left side of my face will look like Schwarzenegger, and my right like Pee-Wee Herman.