When I went to the dentist after my bone marrow transplant, he shocked me by saying I would need four teeth pulled. They were decayed beyond repair, and root canal would create a risk for infection.
"You’re lucky you have any teeth left at all," he said. Well, that put it in perspective.
Several oral problems can occur during high-dose chemotherapy. First, while the chemotherapy knocks out cancer cells, it also knocks down all your blood counts What's pertinent to your teeth and mouth is a condition called neutropenia, an abnormally low count of neutrophils, a type of white blood cell that helps fight off infections, particularly those caused by bacteria and fungi.
The lower your neutrophil count, the more vulnerable you are to infectious diseases. If you have severe neutropenia — fewer than about 500 cells per microliter of blood — bacteria normally present in your mouth and digestive tract can cause infections, according to the Mayo Clinic.
As my neutrophil dropped, I developed mouth sores so severe that I needed morphine and a feeding tube. A doctor came in once and said something so simple yet so remarkable to me at the time that he gave me hope. "You will eat again," he said.
The dental problems became clear later.
Before undergoing high-dose chemotherapy, you need to visit your dentist to make sure you are not entering treatment with any pre-existing problems. During treatment, you use a spongy brush with mild toothpaste. You also apply a gel to protect the enamel on your teeth. You really need to do this religiously, which is hard when you are in so much pain.
Another problem during high dose chemotherapy is decreased production of saliva. Because saliva helps protect the teeth from decay, transplant patients are at greater risk for tooth decay.
You can see your dentist a year after transplant, and that’s when I learned about the four teeth that needed extraction. I had it done two at a time, and, although no fun, each visit definitely had its light moments.
My friend Barry took me the first time. The oral surgeon had said to take two milligrams of Ativan, a course preferable to undergoing anesthesia. The most I had ever taken was one, so I got pretty relaxed. Afterwards, I kept insisting to Barry that we go out for coffee – something we usually did. He said he'd take me home and bring me coffee, but by the time I got settled in I didn’t want it anymore.
The second time I went into Dana-Farber because my platelets – which produce clotting – had dropped too low for safety, so I would need a transfusion first. I take Benadryl before platelets to prevent the allergic reaction I have without it. Benadryl, as people who take it know, makes you sleepy.
Before heading to the adjoining Brigham and Women’s Hospital to see the dental surgeon, I popped my two Ativan. I was so loopy that my sister had to hold me up on the way to the hospital. During the procedure the surgeon kept reminding me to keep my mouth open. Later, he said I was a hoot.
They don’t want to give me dental implants because of the risk of infection. I can manage now by chewing only on one side. If I need more teeth pulled, I might be in trouble. But in the meantime, at least I have fewer teeth to floss.
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