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Ask the Expert: Question about mouth side effects

Question: I am 2 1/2 years out from having stage III tongue cancer. I still have a very dry mouth, very sticky & gooey saliva. In addition, most of the time I feel like there's a film on my teeth, even right after I brush. Is there anything to help this? I get my teeth cleaned every 3 months and brush every time I eat anything.

Response: Excellent dental hygiene is very important especially after radiation treatment. Most patients that have had radiation treatment carry around a water bottle to help with the dry mouth. Lots of hydration goes a long way.

Dr. Kang is an Assistant Professor in the Department of Otolaryngology – Head & Neck Surgery at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute (OSUCCC – James) , specializing in the comprehensive management of benign and malignant head and neck tumors. Click the following links to learn more about Dr. Kang and the OSUCCC– James:https://cancer.osu.edu/find-a-doctor/search-physician-directory/stephen-y-kang andhttps://cancer.osu.edu/.

The Ask the Expert Guest Moderator is not intended to be a substitute for healthcare professional medical advice, diagnosis, or treatment. Speak to your healthcare provider about any questions you may have regarding your health.

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I have rcc stage four and am starting radiation today. Ive been on novient for a week. This morning i noticed that a filling fell out. Is there any advice on getting repairs done?

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I had no cavities before radiation. Since, fillings have come out
and teeth break off at gum line. Went for consult for implants
as I'm not a canadate for dentures due to small mouth. They were
very good with exam but at the end and gave me the estimated cost
of $38,000. Yes you read it correct. $38,000. I almost fell out of chair.
No way I can afford this.

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user_ch3ded857,
I almost fell out of my chair when I saw the $38,000., too. Have you tried asking Medicare (and any supplemental health insurance plan, if you have one) to cover the cost of the dental work that is medically necessary because of cancer treatment? Your dentist can write a letter saying you need it for that reason. There are sample letters on line. You should definitely get a second opinion from a dentist, too.
My husband has little bone left on the bottom and just had a bone graft done and one implant inserted to anchor his lower denture. The cost was $4,000. He needed it because there wasn't enough to hold the denture in, which I'm guessing is the reason your dentist says you have a small mouth. It's allowed him to eat everything.
Carol

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There's no supplements that can be taken to stop this? Its not ok to wait for it to happen without trying to stop or slow down the erosion

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@carolcowan

user_ch3ded857,
I almost fell out of my chair when I saw the $38,000., too. Have you tried asking Medicare (and any supplemental health insurance plan, if you have one) to cover the cost of the dental work that is medically necessary because of cancer treatment? Your dentist can write a letter saying you need it for that reason. There are sample letters on line. You should definitely get a second opinion from a dentist, too.
My husband has little bone left on the bottom and just had a bone graft done and one implant inserted to anchor his lower denture. The cost was $4,000. He needed it because there wasn't enough to hold the denture in, which I'm guessing is the reason your dentist says you have a small mouth. It's allowed him to eat everything.
Carol

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Sorry but no Medicare or Medicaid will pay for dental implants or the structure on top of them
ALL attempts over 30 years in practice have failed they basically say it is a Dental issue and they leave it up to Dental Insurance to deal with it. If the patient has none the medical folks suggest they buy some (most Dental don't have pre-existing condition clauses)
Dr Dave (H&N surgical Oncology)

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@user_ch3ded857

I had no cavities before radiation. Since, fillings have come out
and teeth break off at gum line. Went for consult for implants
as I'm not a canadate for dentures due to small mouth. They were
very good with exam but at the end and gave me the estimated cost
of $38,000. Yes you read it correct. $38,000. I almost fell out of chair.
No way I can afford this.

Jump to this post

Actually that is not even half of the bills I have seen from some patients over the years
I have seen some as high as $70K for upper and lower implants and fixed teeth
Dr Dave (Head and Neck Surgical Oncology)

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@14forest

There's no supplements that can be taken to stop this? Its not ok to wait for it to happen without trying to stop or slow down the erosion

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It depends on where the cancer is located
If the cancer is in the head and neck and radiation was used to treat it then the mouth has lost much of its defense system to fight off decay and gum disease
That is why so much time is spent teaching H&N patients about meticulous home care and the need to see their dentist every 3 months forever
There ARE things to prevent it like customized carrier trays to have fluoride used daily and saliva replacements and even some new rinses that help in keeping up with the issues but it takes patient diligence and with the cancer reality it is just another in the long list of things to juggle
Dr Dave (Head and Neck Surgical Oncology)

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Here's a link to a legal discussion about cases where Medicare paid for dental work that was required after cancer treatment, including radiation. These cases were in Maine.
In 1965, when Medicare was begun certain kinds of medical needs were not covered because they were deemed to be not expensive ROUTINE necessities. That included eyeglasses, hearing aids, regular checkups, and ROUTINE dental work. Dental problems caused by radiation, chemo, or surgery are not routine. There is a procedure for requesting that something is or was deemed medically necessary and is not routine care. The requests are usually denied. Then there's an appeal form to fill out.
When my brother-in-law had liver cancer, the first medication that was prescribed was sorafenib (Nexavar). It had just been FDA approved for HCC (hepatocellular carcinoma which is primary liver cancer). His ghealth insurance company denied it. The price tag was $9800./mo. It was appealed, they agreed to pay. Months later, Avastin was prescribed. The price was $100,000/yr. It was denied. The doctor filled out appeal forms, denied. We asked the drug maker to reduce the price, filled out forms, it was denied, we appealed, they agreed to pay. My brother-in-law applied for Social Security disability, and he was denied. He appealed and it was approved. Near his end of life, Avastin was prescribed again. It was denied AGAIN, we appealed, it was approved.
I never say "never". There was no lawyer or expense involved. The decisions were made in a few days in all cases. Find someone persuasive who knows how to write and will put some time and effort into trying. State your case and don't give up without a fight.
Carol
http://www.medicareadvocacy.org/old-site/Projects/AdvocatesAlliance/IssueBriefs/09_02.09.DentalSvcs.pdf

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