Head and neck cancers are often treated with radiotherapy. Radiotherapy can lead to faster rates of tooth decay and poor healing in the mouth.

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1 DENTAL EXTRACTION This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu and yur cancer care team. AN OVERVIEW TO DENTAL EXTRACTIONS Head and neck cancers are ften treated with raditherapy. Raditherapy can lead t faster rates f tth decay and pr healing in the muth. A dental examinatin will be arranged befre raditherapy starts, usually by the special dentist wh is part f yur cancer care team. It is likely that the dentist will recmmend that any brken, infected r decayed teeth are remved befre raditherapy starts. This is called a dental extractin. 1

2 WHY IS A DENTAL EXTRACTION NEEDED If yur teeth and gums are nt healthy, yu culd have prblems during yur cancer treatment with side effects such as pain and infectin, which culd be severe. These side effects culd lead t a delay r interruptin in yur radiatin therapy which can affect yur utcme r recvery after treatment. T reduce the risk f these side effects, teeth that are nt healthy are taken ut. Smetimes healthy teeth may als be taken ut t reduce side effects f radiatin therapy. Remving teeth befre radiatin therapy als reduces the risk f less cmmn side effects such as breakdwn f the jawbne (steradinecrsis) which can ccur if any dental injury r infectin ccurs even mnths and years after radiatin therapy. It will be imprtant fr yu t see a dentist r ral specialist befre yur cancer treatment s that yu can have a thrugh examinatin f yur muth. The dentist r ral specialist can then advise n an ral health care plan and decide if any teeth shuld be extracted. The teeth t be extracted will depend n where yur cancer is and what treatment yu will be having fr yur cancer. 2

3 HOW TO PREPARE FOR THE OPERATION Befre the dental extractin: Yu will visit the dentist fr a dental check-up. During this appintment, the dentist will put tgether a plan fr any dental wrk that yu may need. They will ften arrange an x-ray f yur teeth befre r during the appintment. Yur dentist r ral specialist will explain the details f yur extractin. Be sure t bring up any questins r cncerns, and share yur needs and wishes with the team. Yu shuld speak t yur dentist r ral specialist abut hw t manage aspects f yur lifestyle such as smking, drinking alchl and chrnic cnditins (e.g. diabetes and besity) that may increase the risk f cmplicatins. If yu take bld thinning medicatin fr a heart cnditin r bld clts (such as warfarin, Plavix, aspirin r Pradaxa), make sure yur surgen is aware. Sme f these medicatins need t be stpped mre than a week befre the peratin. Smetimes a shrt-acting bld thinner (such as Clexane) is used befre and after the surgery Dental extractins can be dne with a lcal r general anaesthetic: Mst dental extractins are dne with lcal anaesthetic (a needle t numb the gum and teeth). Smetimes sme ther medicatins are used t make yu sleepy r less anxius. A general anaesthetic (yu will be asleep) may be used if yu are having several teeth remved r the teeth are difficult t remve. If this is the case, yu will need t fast (have nthing t eat r drink) fr six hurs befre yur peratin (unless advised differently by yur surgen r anaesthetist). If a dental extractin is needed after radiatin therapy there may be sme extra things t d befre the prcedure t reduce the risk f steradinecrsis. These may include: Lking at the raditherapy plans t decide hw likely a healing prblem will be. Hyperbaric xygen: sme dentists will refer yu t a specialist wh uses high pressure xygen t help the gum heal. This is given in a decmpressin chamber like what is used t treat divers with the bends. Often there will be abut 30 sessins, sme befre and sme after the extractin. Special medicatins: sme dentists use a cmbinatin f medicatins t help with healing. This ften includes antibitics, Vitamin E, pentxifylline (Trental ) and medicatin used fr steprsis. 3

4 Visit the Beynd Five website fr further infrmatin n the health prfessinals wh may be part f yur cancer care team WHAT TO EXPECT DURING THE OPERATION Befre the peratin, yu will be given a lcal r a general anaesthetic s that yu cannt feel anything during the prcedure. A lcal anaesthetic numbs the muth and prevents pain during the prcedure. With a general anaesthetic yu are asleep fr the peratin. When the area arund the tth is numb, the tth is lsened and then remved. Smetimes cnsiderable pressure is needed t lsen the tth. If the tth is under the gum r brken, the gum may need t be cut and the bne drilled away arund the rt(s). Any sharp edges n yur teeth r false teeth may be remved t reduce the risk f them hurting yur muth during yur cancer treatment. Once the tth has been pulled, the dentist/ral surgen will fill the hle with gauze and ask yu t bite dwn t help stp any bleeding. Yu may be given stitches t clse up the hle left by the tth. These will disslve ver time. The gum nrmally heals in tw weeks. WHAT TO EXPECT AFTER THE OPERATION After the peratin, yur lip and muth may feel numb if yu have had a lcal anaesthetic. It is imprtant t avid eating anything ht at this time. Yu may experience sme pain r swelling in the days after the peratin. Yur dentist r ral specialist will give yu medicine t help manage this. Regular paracetaml may be sufficient but many patients will need strnger pain medicatins, particularly at night time t help yu sleep. An antiseptic muth rinse will help keep the wund clean, this shuld be used after every meal t clear any fd away and befre yu sleep. Usually yu can g hme after the peratin, but yu cannt drive if yu have had a general anaesthetic r sedatin. Yur dentist r ral specialist will advise n whether yu will need t stay in hspital after a general anaesthetic and fr the duratin. 4

5 POSSIBLE RISKS OF DENTAL EXTRACTION All peratins carry sme risks such as wund infectins, bleeding, adverse reactins t anaesthetic, and ther cmplicatins. These risks will be explained by yur dentist and anaesthetist, if yu have a general anaesthetic. Yur dctr will explain details f the peratin, general risks and side effects f the peratin, they may recmmend: stpping bld thinners (e.g. aspirin) befre surgery t reduce the risk f bleeding antibitics t reduce t risk f wund infectin Althugh dental extractin is nt a majr peratin, there are sme specific risks. These include: Dry scket: ccurs when the bne where the tth was extracted is expsed t air and fd. This may happen if a bld clt des nt frm in the hle r the bld clt is disrupted. This can be very painful and can cause a bad taste and dur in yur muth. If this ccurs yu need t cntact yur dentist. Numbness, tingling r pain: can affect the lip, tngue, cheek, gums and teeth. This ccurs due t the irritatin f r damage t the nerves during the extractin. It is usually temprary and nly lasts a few days. Prlnged r permanent nerve damage is uncmmn but can ccur. Rt fragments: a piece f rt may break ff during the extractin due t the length r weakness f the rts. The fragment can ften be remved withut any further cmplicatins. Hwever, if it lies clse t a nerve r a sinus cavity the dentist may decide t leave the fragment in place. Fracture: there is a small chance f the jaw bne breaking due t the frce needed t remve the tth. This is mre likely if the bne is already weak. Damage t lips and cheeks: yu may bite r rub the numbed area withut realizing because the tissue is still numb. Bruising r bleeding: if yu take medicatin t thin yur bld, yu are mre likely t get a bruise. Applying a cld pack t the area will help t minimise the bruising. If there is delayed bleeding, direct pressure with a gauze will usually stp this. 5

6 FOLLOW-UP CARE Yu will have nging care f yur muth during yur cancer treatment frm yur cancer care team. They will advise n hw t deal with sme f the effects f cancer treatment n yur muth (such as dry r sre muth, ulcers, lss f taste r difficulty chewing), and n any difficulty with dentures. It will be imprtant fr yu t fllw-up with yur dentist r ral care specialist after yur cancer treatment finishes. This fllw-up will check the prgress f healing in the muth after the dental extractin and give yu advice abut hw t keep yur remaining teeth in gd cnditin. Yu shuld cntinue t have regular check-ups with yur dentist thereafter. 6

7 QUESTIONS TO ASK YOUR DOCTOR Which teeth are being extracted? Will this affect my ther teeth? What will happen if I dn't have the dental extractin? Hw lng d I need t wait in between my dental extractin and cancer treatment? What are the pssible side effects f treatment? Hw can they be prevented r cntrlled? What lifestyle changes (diet, exercise) d yu recmmend I make? Hw much will the surgery cst? Will my health insurance cver it? Wh are the health prfessinals that I need t see as part f my fllw up care? Yu may want t write additinal questins here t ask yur dctr r cancer care team Beynd Five disclaimer: Yu acknwledge and accept that the infrmatin in this factsheet is fr general infrmatin purpses nly. It is nt intended, nr shuld it be relied n, as medical r legal advice, r as a substitute fr cnsultatin with a physician r ther licensed healthcare prvider. Yu agree that if yu have individual healthcare-related questins yu shuld cntact yur dctr prmptly and shuld nt disregard prfessinal medical advice, r delay seeking it, because f infrmatin cntained here. Yu als agree that Beynd Five is nt liable fr any injury r damage t persns r prperty (hwsever caused, including by negligence) arising ut f r related t any use f Beynd Five s patient educatin materials, r fr any errrs r missins. Last updated: 19 Octber