Radiation therapy for cancer is a common approach in the treatment of cancer along with chemotherapy or by itself, depending upon the nature of the cancerous lesion. Oral care during cancer treatment becomes very important because damage to the surrounding oral tissues can lead to a number of problems like severe mouth dryness after cancer therapy, a burning sensation in the mouth, the inability to eat spicy food, rapidly spreading tooth decay, aggressive gum disease and a difficulty in chewing and swallowing .
One of the problems that people undergoing radiation therapy encounter is that their longstanding dental implants tend to fall out during or soon after the treatment . Since dental implants can be expensive and be the basis on which large functional prosthesis are based, this is a big problem for patients.
Here are some of the reasons why this may occur.
Gum Disease After Radiation Therapy
The dental implants that are placed inside the mouth function very similarly to real teeth. This means that they are anchored by the jaw bone, much like the roots of our natural teeth, and thus susceptible to some of the same problems that natural teeth are prone to .
Gum disease or periodontitis affects the supporting structures of the teeth including the supporting bone and the gums. In the case of natural teeth, there is an increased amount of mobility before the tooth eventually ‘falls out’, but in the case of dental implants, there is no such warning.
If gum disease spreads rapidly inside the mouth after radiation then the likelihood of the bone around the implants getting infected and destroyed is very high. Once this happens, the dental implant loses the support keeping it inside the mouth and will fall out.
Why Does Gum Disease Spread More Rapidly After Radiation Therapy?
One of the most common and troublesome symptom that patients report is dryness of the mouth after radiation therapy. This is something that changes the kind of bacteria that thrive inside the mouth. The population of those micro-organisms that favor the destruction of the teeth and the supporting structures becomes the majority, and this can lead to a rapid spread of tooth decay and gum disease .
Can Anything Be Done To Prevent The Implants From Falling Out After Radiation Therapy?
Yes. Since the main culprit of compromised dental implants is gum disease, the prevention of this occurrence is also aimed at that. The importance of preventive steps taken before the radiation therapy has taken place cannot be undermined.
It is highly recommended that patients undergo a thorough dental evaluation before starting radiation therapy. During this appointment, any areas where mild infection persists will be treated, any teeth which are moderately or severely compromised will be extracted and all the remaining teeth in the mouth will be cleaned to minimize the amount of plaque and tartar present in the mouth .
There is also some misconception about the idea that regular dental visits should take a backseat once radiation and chemotherapy have been started. In fact, the opposite is true. The side effects of radiation and chemotherapy, especially when targeted at the head and neck region, are so severe that patients can sometimes refuse to continue treatment altogether .
This is why most cancer treatment clinics and hospitals now recommend regular visits to the dentist during the treatment so that such side effects can be avoided.
Can Dental Implants Be Replaced After Radiation And Chemotherapy Have Been Completed?
This is another common question that does not have a straightforward answer. Since dental implants are only successful if a sufficient amount of bone forms around them, their use in patients that have undergone radiation must be undertaken with a lot of caution [7,8].
Theoretically, any patient that has received a significant amount of radiation in the region of the jaw should not undergo any elective traumatic procedure (like a dental implant surgery or a tooth extraction after cancer treatment which is not an emergency) for at least a year.
This is the approximate time after which the blood supply to the bone will start to return to normal. Unfortunately though, in some cases, this time period can be much longer and if an aggressive stance is taken, the patient can undergo something that is called osteoradionecrosis . This is an extremely painful and potentially life-threatening condition that requires a long drawn out treatment plan.
For people with dental implants that are undergoing radiation, it is important to remember that oral care during cancer treatment, as well during and after, is their best chance of preventing gum disease from setting in and their implants eventually falling out .