Crowns or implants after chemotherapy

The likelihood is high that aggressive cancer treatment will have toxic effects on normal cells as well as on cancer cells. The gastrointestinal tract, including the mouth, is particularly prone to damage.

The risk of oral toxic effects is real and conditioned by a range of factors: the cellular turnover rate of the lining of the mouth, the complexity and diversity of the oral micro-organisms, as well as trauma to the soft tissues during normal oral functioning.

The main oral complications include inflammation of the lining of the mouth (mucositis), altered sensations, susceptibility to infections, salivary and taste alterations often resulting in a dry mouth which further predisposes one to dental decay.

It is of critical importance to add the development of jaw bone pathology to this list as well.  In order for an implant to integrate into the jaw bone, a series of metabolic changes take place around the implant, leading to the formation of bone, intimately bound to the implant surface.

Drugs often given with chemotherapy, known as bisphosphonates, are known to cause the breakdown of cells involved with bone formation which limits or impedes the bone reabsorption processes required for integration of dental implants.

The toxic effects of chemotherapy thus hold significant implications for dental crowns, as well as dental implant tooth replacements.

Reduction in salivary flow due to chemotherapy will mean existing crowns are prone to decay of the root portion of the tooth.

Prevention is key

However, patients can do much to keep the mouth healthy and plaque-free during chemotherapy.  To minimise or prevent compromise to existing crowns, the mouth must be kept moist using saliva substitutes; the intake of food and drink with high sugar content must be reduced drastically and oral hygiene measures must be intensified. Dental visits are mandatory both during and after chemotherapy.

Furthermore, continued liaison between your dentist and oncologist in order to determine immune competence is critical before any treatment is prescribed.  Elective dental treatment such as replacing defective crowns, or implanting new crowns should be done before chemotherapy, with the emphasis on the elimination of potential infection. If you plan to get crowns, it is best to wait for complete recovery of your mouth after chemotherapy. Should your require more than the recementation of a displaced crown, such as root canal treatment or extraction of the root, it should be completed before chemotherapy.  If it is necessary to extract dental roots following completion of chemotherapy, special measures need to be taken. Exposure to hyperbaric oxygen improve bone healing and the integration of implants in patients.

Suitable discussions involving your dentist, doctor and the Centre for Hyperbaric Oxygen Therapy and Health Care Fund will explore and plan your ongoing treatment and maintenance.

Written by Dr Yvette Solomons

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