Expert: Tony Appleton BDS DPDS - 2/13/2009

Question
Dr. Appleton - I thank you for giving your professional opinion and spending your valuable time here helping others. Good things come around also. I am 42 years old and had excellent teeth up in until my late 30's. I had braces as a child/young teen and also had both a great ortho and dentist that taught me how to take care of my teeth properly. My teeth were fine until I became very ill with Non-Hodgkins Lymphoma (a form of cancer for those who are unfamiliar) and was not getting any results from standard dosage and potency chemotherapy combinations (I call them chemo cocktails). I was given different mixes at first like C.H.O.P. standard chemo but that was not stopping my tumors in fact they were growing rapidly and I was very bad off. I had a choice and it was not a easy path to do either. I could stop chemo entirely and go home with a big bottle of pain meds. Or I could endure the effects of getting high dose, high potency chemotherapy which I probably don't have to tell you can be lethal to a person when thier body is in crisis and 3rd stage advanced cancer. I had the chemo, about 50-55 times I dosings. It was given in three differnt sesssions over about 15-16 months. Obviously it was no picnic. These chemo doses were between 12 and 21 days apart. Just as I started to feel better I had another. It made me so toxic and morbidly ill. Because of bleeding out my ears and eyes 2 times, during those months, the  treatment had to be halted 2 times hence the 'three sessions' I mentioned as those were not planned. I also had bleeding from my ears and eyes and mouth (teeth) and was in and out of the emergency room not doing very well to say the least. Now, my teeth are in rapid decay. I had my last chemo dose about 7-8 months ago and literally my teeth are falling out. I also have infections. I need to get dentures but obviously after living this way for 2 years I have no money to buy more than cat food for my cat. I was told by a dentist I need to get them out asap and get a temp set of dentures in (a set of them). Then after 6 months when my gums are all healed get a permanant set and have my body thoroughly checked for infections and signs of recurring lymphoma, as I am not cured I still have thousands of cancer cells in my blood.
The infections are travelling naturally through my body when I swallow normally or drink liquids. I was given a antibiotic which helped but the infections returned to the exact same places and amounts in my mouth as soon as the antibiotic was discontinued. The dentist nor my family doctor wanted to keep me on any antibiotic for weeks, months. One thing is for sure, the family doctor, my dentist and my cancer doctor all agree the decay is definately a result of the chemo and worsened by the fact I had higher doses and higher potency. I am grateful it has only killed off my teeth and the chemo did not help the cancer weaken my immune system to the point of both having a lethal end. The cosmetic dentist and regular dentist want a combined amount of 30k to do all the pulling and fitting and finalizing of a set of dentures. I am in NC and we have very little community outreach from the state much less private schools that will do the dentistry at little or no cost. The prof dentists in the city are very busy. Most all of the offices will say they can't take on new paitients they are so booked, much less, take a new paitent who has no resources just a lot of health issues to deal with (and the risks). Therefore I am at uncertainty as to what to do, as if I have a choice. It is very difficult to eat and gain weight with a mouth of cracked teeth and infections. I am trying my best and try not to think about any of it today and the same for tomorrow. Casper my cat can eat fine, he is fat!
My question(s): Do you know of other cancer paitents who have had chemo therapy that have had thier teeth show decay or problems with their gums that was most likely a result of the chemo treatments?  Is it common? Most importantly I want to know my risks...Living the way I am now, with immune system compromised and infections in my mouth, what kind of thingscan occur to my organs, stomach, esophogus, etc.
What do you think I should be doing to stay as healthy as possible as far as my teeth, antibiotics? I am pretty much eating only foods that are (for lack of better vocabulary) 'anti-cancer' type of foods like greens and berriers, all fresh fruit, good protiens, etc.. Maybe you will have some suggestions about things I could try or medications I can discuss with my current doctor teating me.
Much respect to you for reading my delima and if you have time to reply it will be greatly appreciated and retained. Thank you..SAM

Answer
Hi Howard

Yes I'm afraid chemo etc can cause all sorts of dental problems.  The main factor is the reduction in your saliva so that the teeth don't have the normal buffering protection of the saliva.  It can absolutely ravage teeth!

It sounds to me like you really do need to get the teeth extracted - with your lowered immune response you do not want to be constantly exposed to infection and living on antibiotics is no answer!  30k is an awful lot of money for this treatment - you just need to find the right dentist (easier said than done, I know).

Regards

Tony Appleton