Yesterday one of patients in my Dental Clinic handed over to me a slip written in Hindi. I am reproducing here the translated text in English –
Doctor, Radiotherapy (R.T) has destroyed my all teeth. At times i develop sensitivity to hot and cold. But you just take care of my upper teeth on left side. Gums have become empty which leads to food impaction. Sir, I am afraid that some Cancer type disease might develop in these teeth – I had seen one patient whose tooth was involved with cancer.
This gentleman had earlier came to me 2-3 years ago for dental problem. However, he never returned during all this period.
I want to tell you that this patient can’t speak normally-so he always comes with written notes. And when I want to have some additional information from him, he writes on the paper.
This gentleman who is around 44 years old have developed cancer of throat about 7-8 years ago for which he was operated upon – his total larynx alongwith partial pharynx was removed. And later on he was given Radiotherapy. He was a bidi smoker for many years which he has left ever since his illness. Otherwise he enjoys robust health.
Coming to the dental problem, you can see in this picture in which some of his upper teeth are visible – I didn’t wanted to trouble him by attempting to picture his back teeth also. Otherwise, his all the teeth are hopelessly decayed.
Even look at his lower teeth in this picture. All the lower teeth are badly damaged. His molars are so badly decayed that just root stumps are left.
Radiation Caries –
He is suffering from Radiation Caries.
Radiotherapy destroys the cancerous tissues but alongwith it some of the healthy tissues also get affected. In this case, salivary glands get affected leading to gradual reduction of salivary secretions which ultimately leads to Dry mouth.
In Radiation Caries, the dental decay is aggravated by dry mouth. When the mouth is dry, it promotes dental caries and it spreads very fast. Overall because of radiotherapy oral mucosal tissues and dental structures get damaged and end result is for the patient to suffer.
Now, a million dollar question ! — if Radiotherapy is so injurious to surrounding tissues and organs, they why do they advise Radiotherapy? . Radiotherapy decision is based on saving a person’s life — little damage here and there in the surrounding areas is inevitable.
How lightly I have added little damage here and there – I am reminded of a saying ‘a wearer knows where the shoe pinches’. The best remedy for this man is getting all the teeth extracted and then go in for full dentures.
But decision about the extraction of his all teeth or a single tooth can only be taken with the permission of his oncologist –cancer specialist. That’s a vital decision because jaws in which teeth are seated have also received some radiation from the radiotherapy doses.
Let me finish it with a happy note—while leaving my room, he opened his shirt’s collar button, put his fisted hand on the throat opening and happily announced in his own voice that he regularly goes for check-ups and that the doctors have told him that there would be no recurrence of cancer in his case. I wish him long and happy life. Yes, he said some machine has been fitted in place of his larynx.
May he live a very long disease-free life!