Q: Dear Dr. Crapo: Twenty years ago I developed a lump under my jaw. I went through the tests and it was discovered to be a lymph node cancer. I went through surgery, chemo and what seemed to me massive radiation.
Today I’m alive and healthy but over the years following the treatments I lost a lot of my saliva capacity and suffer from dry mouth. In that time, my teeth have been lost. We’ve tried to save them but the decay was so aggressive that the dentist couldn’t keep up with it. The decay got into the nerves then I needed root canals and then crowns. It was the only way to keep teeth in my mouth. But then I started having decay below the edge of the crowns and the dentist would try to fix that. No matter what was tried I’d get decay, so now I’ve got a mouth of sharp shards sticking out of my gums.
I asked about implants, in fact I’ve had an implant in the front of my mouth that has worked but he said that the bone that received all that radiation may not be strong enough or healthy enough to take the implants. He said it’s mostly the back of my jaws that were affected, so I don’t really know if something can be done with implants for the front part of both my upper and lower jaws.
A: Extensive radiation to any part of the body produces adverse effects. Large amounts of radiation to the head and neck may well produce permanent damage that results in pain, extreme dryness to the mouth, speech impairment, rampant decay and deterioration of the bone that supports teeth. It compromises the body’s capacity to heal – present and future. Can the body come back over time? In some cases, yes to a certain degree. In your case, you may have not received near the exposure in the front of your mouth. The fact that you’ve had a successful implant is a good sign.
When reconstructions are done so that your bad teeth are removed and new bridgework inserted on the same day, the implants are placed in the area just behind the eyeteeth in such a way that the attachments supporting the bridgework may be sitting two teeth back. It is designed this way because this is generally where the best bone is.
The teeth you receive on the surgical day are put in place until the bone heals to the implants. When healing is complete a very strong titanium bar is constructed to ensure the bridgework can support a full set of teeth. You may find this a very workable solution.