Are there dental impacts of hormone therapy ?

Romla

Hi all , I take Letrozole/ Femara daily and 6 monthly Prolia injections and seem to be in bother with teeth chipping/ splitting or breaking.

Is anyone else in the same boat ?Also am on a week off from Prolia to get some dental work done - a filling done.Am worried about the safety of extractions in my circumstance.Any thoughts gratefully accepted - seeing dentist in the morning and just made an appointment to see my gp afterwards.

wendy55

Hi, yes I too have to be very careful about dental work, I am on Xeloda a oral chermo, but more importantly I have Xgeva{prolia} every 6weeks and to have any dental work done I have to have a blood test prior to see what the level of Xgeva is in my blood, to determine whether the bone will grow back or not, as you are having a filling thats fine I have never had to have anything special done for that, a extraction is where the problem lies, its all about getting the bone to re grow under neath the gum, I was told that I have to tell my local dentist that I was on Oral chemo and Xgeva{prolia} I also have to get my teeth completely cleaned every so often by the hygenist, unfortunately chemo like most toxic drugs also affects your teeth as well as everything else, and apparently if the extraction is on the top part of your mouth,m that heals better than if you have to have a extraction on the bottom teeth, go figure! the bone apparently grows back better on your top teeth, a bit of useless information really! any way good luck, I dislike the dentist anytime, @Romla

wendy55

Romla

Thanks @wendy55 I snapped an upper tooth this afternoon and am 1 week past the 6 months Prolia injection life.I too am not keen on the dentist even though mine is very gentle.

JanineG

Hi Romla. I'm on Arimidex and about to start yearly Zoledronic acid infusions ,(Due to osteoporosis).I was advised to get all dental up to date before I started. My dentist said its really important for me to keep up the 6 monthly check ups. Dentists worry about major work that involves the jaw ie implants. And extractions are a concern for healing.( he said this was rare but possible). But if you are diligent and have an experienced dentist you shouldn't have any drama. 
Goodluck. Janine

Romla

Thanks @JanineG 4 years ago I was on bisphosphonate tablets for about 3/4 months for osteoporosis and needed an extraction .No dentist would help me until Professor Goss head of dentistry at Adelaide Uni stepped in and did it after a blood test involving “ cross laps” to see that bone was turning over which it was. Now I have had breast cancer - lumpectomy and radiation - followed by Letrozole -as am er+ - with Prolia injections to help protect my bones which were already osteoporotic as Letrozole thins bones.Am worried esp as my teeth seem to be falling apart - I had 8 implants last year but now am wishing I had the lot out and dentures as it feels like playing Russian roulette.

Romla

Am starting to be fearful eating esp any thing crisp , flossing and brushing

JanineG

Gosh that Sounds awful @Romla. Can you contact Professor Goss again? I hope your 'gentle dentist can provide some solution going forward. Xo Janine

Afraser

For the record , I am close to five years on letrozole ( Femara)  and appear not to have a problem. I have lost one tooth, but the internal, and for ages invisible, crack probably precedes both Femara and chemo. So maybe the Prolia is the problem? Good for one thing, and not so good for something else. Hard, hard choices. 

wendy55

Hi thats exactly what I had to have done a cross laps blood test 5 days before the extraction,Prof.Goss was the man in charge,I also saw Dr.Kardachi for my dental clean, they have been fantastic there, with out putting a dampener on things, if the extraction had gone wrong it would have meant many many visits back to the dental hospital for treatment, having said that I have every faith in the team in Oral Surgery and Restorative Surgery At the Dental Hospital, everything was explained by the dentist as was by the local dentist,its a matter of them having all the information, also my oncologist stopped my Xgeva injections for 12 weeks as well,I hope all goes well for you,
wendy55

Jane_Elizabeth

I had ac and taxol chemo in 2016 and now on Letrozole, and I wish I had been told to have a dental check up before starting all this. I felt like my teeth became very delicate during chemo, and during and after chemo 2 of them broke, and I feel they are not as strong as they once were. Have just been to the dentist this week to have a filling replaced, and was told I will need 2 of them capped some time within the next year. I think it should be standard advice to have a dental check and clean before starting cancer treatment.

wendy55

Very good advice, I know a friend with metastatic breast cancer who went through a root canal procedure and was in constant pain before and after the procedure, she was sent to various specialists and in a conversation with her I explained the side effects of Xgeva and the effect on our teeth, and was so surprised that no one had told her, and no dentist she visited asked the question about what drugs she was on!!! so she had a root canal for nothing because as soon as she stopped the xgeva the pain pain subsided and then disappeared.
Yes it should be standard procedure but sometimes you are just given the drug and not everyone reads all the side effects, but I was very upset to think my friend had gone through all of this simply because her dentists werent up with what xgeva can do, of course it doesnt affect everyone but it is a possibility that jaw necrosis can occur, I was fortunate that this was all explained to me and the fact my dentist is very much aware of all the things that xgeva can do, having said that its doing an amazing job on my bone mets and I have gone from having osteoporosis to only having osteopenia!!
Yes I agree, everyone starting the cancer road should have all the information, such a little thing about having a dental check up but could save a lot of grief in the future, 

Romla

Firstly the good news I have broken the crown on a dental implant - no need for extraction.Yes  agree all should have dental review before treatment - I only knew because of a kerfuffle years ago when I was briefly on bisphosphonates and needed an extraction.I think we are drowned with paperwork during treatment when most of us are numb and hence maybe do not read all we should.Interestingly I know 2 elderly ladies on Prolia with their own teeth who have not been told to advise their dentist about their Prolia injections nor are aware of the risks  of Osteonecrosis of the Jaw with extractions , root canals or implants.

Brenda5

I did crack a tooth from gritting my teeth with anxiety and depression. My dentist repaired it and made sure that particular tooth is filed down now so I cannot grind it. The rest of my teeth are still hanging in there although on and off my root canal tooth aches but it comes good. I get tongue ulcers on and off which I never had before. 

Romla

Hi @Brenda5 apart from avoiding hard things like the delicious Vegemite Bagel Bites I am getting a mouth guard as I think I might have been grinding my teeth at night for the same reasons.

jennyss

This is all very interesting (and no fun, like a lot of other things). I must have missed any warnings about dental work, and problems linked to chemo. Five months after chemo and two months into anastrozole and alendronate osteoporosis tablets, my teeth  have gone all  super sensitive. I'll have to be very careful and avoid  eating almonds or toffee.

wendy55

@romla, Hi, I was not sure where to put this, its regarding the south australian governments medical heating and cooling concession, I rang them this morning as I had not received my letter advising the money had been put in my bank account - just a cost cutting measure, the $54 is put into my account every three months, I know that it is not a lot considering the power prices here in south australia, but every little helps, especially as I do suffer with the heat and the xeloda oral chemo that I am on, our airconditioners are running almost 24/7 when the temp goes over 30 as I cannot tolerate the heat at all, so if anyone from sa sees this just go to the concessions sa website -heating and cooling, and download the paperwork for your gp.