sensitive teeth

[sally]

Hello everyone, I was wondering if there is something to take that helps with deteriorating roots and gums. My teeth have gotten very sensitive and I seem to have problem roots. I take excellent care of my teeth and go to the dentist every 6 months. I went every 3 months while I was on chemo. I am on Herceptin every 3 weeks and Femara. I think I am going to go back to every 3-4 months. I can tell my teeth have taken a turn for the worse. I'm only 38 and was pushed through menopause which also caused gum problems. Thank you for any advice. Sally

[Bev]

Hi, My gums went bad on chemo as well, but they have stabilized on herceptin. I had to have a graft from the pallatte sp? to cover the gum that shrank away. I don't know of any supplements but you can ask your onc nurse for magic mouthwash to kill the pain. I guess you should alternate between a periodontist and your dentist every 3 months. The periodontist said he hadn't heard of chemo specifically causing problems but thought perhaps steroidal premeds hinder healing. Regular dentist says chemo causes drymouth and drymouth causes gum disease. OTC Biotene toothpaste helps with drymouth but there are also prescription rinses for it. I was beginning to feel like the lone crazy person with gum problems. I'm fastidious with my teeth but feel like it's been a real battle. I think it's also genetic for me as most of my relatives lost their teeth in their twenties. Good luck, BB

[rinaina]

Hi, I am a retired dental hygienist and my educated advice would be to have impecable home care consisting of brushing thoroughly for a minimum of 2 minutes 2-3x a day, flossing at least 1x a day and rinsing with a fluoride rinse for cavity protection. You should also be seen by a dentist minimally 2x a year and more if you have gum problems. If your gum problems are more involved then you should be seeing a periodontist. Professional cleaning is a must a few times a year or more. Dry mouth can lead to an increase in cavity activity as our saliva is a buffer and when dry mouth occurs we lose that protection. Extra fluoride can make a huge difference either in the form of a fluoride rinse or prescription fluoride paste. Ask your dentist about this. There are many products now on the market that can help with dry mouth including prescriptions. I have a question...has anyone suffered from increased dry eyes since starting chemo? I already have dry eye syndrome and dry mouth as well due to my autoimmune disease called Sjogren's Syndrome and worry how much worse the dryness will get.
Rina

[Lani]

used vs. Lymphoma

Herceptin can cause dry eyes (previous posts) but I ran across the following article which may interest you--all you need is the extra expense of a second monoclonal antibody, of course!

1: Arthritis Rheum. 2005 Sep;52(9):2740-50.
Related Articles, Links



Rituximab treatment in patients with primary Sjogren's syndrome: an open-label phase II study.

Pijpe J, van Imhoff GW, Spijkervet FK, Roodenburg JL, Wolbink GJ, Mansour K, Vissink A, Kallenberg CG, Bootsma H.

Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, The Netherlands. j.pijpe@kchir.umcg.nl

OBJECTIVE: To investigate the safety and efficacy of B cell depletion treatment of patients with active primary Sjogren's syndrome of short duration (early primary SS) and patients with primary SS and mucosa-associated lymphoid tissue (MALT)-type lymphoma (MALT/primary SS). METHODS: Fifteen patients with primary SS were included in this phase II trial. Inclusion criteria for the early primary SS group were B cell hyperactivity (IgG >15 gm/liter), presence of autoantibodies (IgM rheumatoid factor, anti-SSA/SSB), and short disease duration (<4 years). Inclusion criteria for the MALT/primary SS group were primary SS and an associated MALT-type lymphoma (Ann Arbor stage IE) localized in the parotid gland. Patients were treated with 4 infusions of rituximab (375 mg/m2) given weekly after pretreatment with prednisone (25 mg) and clemastine. Patients were evaluated, using immunologic, salivary/lacrimal function, and subjective parameters, at baseline and at 5 and 12 weeks after the first infusion. RESULTS: Significant improvement of subjective symptoms and an increase in salivary gland function was observed in patients with residual salivary gland function. Immunologic analysis showed a rapid decrease of peripheral B cells and stable levels of IgG. Human anti-chimeric antibodies (HACAs) developed in 4 of 15 patients (27%), all with early primary SS. Three of these patients developed a serum sickness-like disorder. Of the 7 patients with MALT/primary SS, complete remission was achieved in 3, and disease was stable in 3 and progressive in 1. CONCLUSION: Findings of this phase II study suggest that rituximab is effective in the treatment of primary SS. The high incidence of HACAs and associated side effects observed in this study needs further evaluation.



Publication Types:
Clinical Trial
Clinical Trial, Phase II
PMID: 16142737 [PubMed - indexed for MEDLINE]

PS as far as I can tell HACAs are antibodies which tend to develop to the antibodies when monoclonal antibodies which are not purely human are used(there is a tiny bit of mouse antibody in Herceptin). There have been reports of antibodies to a monoclonal antibody used for rheumatoid arthritis (and those patients developing that antibody experience ineffectiveness of the monoclonal antibody) Perhaps it is something inherent in the immune system of rheumatoid arthritis patients, and maybe there is something similar in SOME sjoegren's patients.

[R.B.]

Fairly vague I 'm afraid and you will have to check for yourself but I have a recollection of reading that CoQ10 benifitedpersons with periodontal problems.

PGE2 is linked to periodontal problems. Cox 2 is a percussor of PGE 2.


RB


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15780952&query_hl=4&itool=pubmed_docsum





There is limited suggestion DHA may help


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8720373&query_hl=8&itool=pubmed_docsum

1: Bull Group Int Rech Sci Stomatol Odontol. 1996 Feb-Mar;39(1-2):25-31. Related Articles, Links

[Polyunsaturated omega-3 fatty acids in the treatment of experimental human gingivitis]

[Article in French]

Campan P, Planchand PO, Duran D.

Departement de Chirurgie Buccale, U.F.R. d'Odontologie, Toulouse, France.

The anti-inflammatory effect of omega-3 polyunsaturated fatty acids (n-3 PUFA) has already been demonstrated in an animal model. The aim of this randomized, double-blind, versus placebo study is to assess this action on experimental gingivitis in humans. Over a 14-day period (day 0-day 14), 37 healthy volunteers undertook intensive oral hygiene, and then did not brush their teeth for 21 days (day 14-day 35) so that gingivitis could then develop. On day 28, the subjects were randomized in two groups: 18 in the treatment group (fish oil: 1.8 g of n-3 PUFA), 19 in the placebo group (olive oil), at a daily dose of 6 g over days (day 28-day 35). The Plaque Index (PI), the Gingival Index (GI) and the Papilla Bleeding Index (PBI), as inflammation markers, were measured on day 14, day 28 and day 35. On day 28 and day 35, five volunteers of each group underwent removal of an interdental papilla to carry out the n-3 PUFA composition of cell membranes: arachidonic acid (AA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA). The results show the integration of EPA, DHA and DPA in the membranes of the cells removed and particularly a significant increase of EPA in the treatment group (p = 0.04 S). GI in the treatment group decreased significantly (p = 0.008 S). The level of AA decrease, but no significantly. It would therefore seem that the n-3 PUFA have an effect on the reduction of gingival inflammation in this experimental gingival model in humans.

Publication Types:

* Clinical Trial
* Randomized Controlled Trial


PMID: 8720373 [PubMed - indexed for MEDLINE]

[chrislmelb]

As someone who used to work with teeth, I suggest gentle brushing using a desensitising toothpaste like Sensodyne. Sometimes you can even smear it around the teeth with out actually brushing. Make sure you keep up your oral hygiene GENTLY or it will worsen. I am horrified by some brushing actions i see. Keep you toothbrush at a 45degree angle and gentle jiggle the brush at the spot where the tooth meets the gum. Of course don't forget all the other areas as well.

Good luck
Christine

[Susan]

I'm a practicing hygienist, and we suggust to have fluoride trays made at the dentist, when patients are going through chemo, and use them daily at home. I did this myself, and I didn't have any teeth decay problems, just the mouth sores. I havent' noticed any problems while on herceptin, at least with my mouth!

[jhandley]

There is quite a bit of info. in the literature about Q10 and gum disease. I know that when I had a surgical op. for a bothersome root canal.. the gum healed in 10 days..I took either 100 or 200 mg a day of Q 10 during this 10 days, knowing its benefits. Anyway the endodentist said he had never seen anyone heal so quick in 40 years of endodentistry. If you take it take it with food as it is fat soluble...and of course it has anticancer/immune boosting effects as well particularly in the 200-400m g range.
Jackie