chemo induced toothaches anyone?

[Irene546]

Has anyone experienced toothaches as a result of chemo?  I have had a generalized pain on the right side of my mouth, but dental xrays showed no cavities.  My doctor said it was highly unlikely that the toothaches are due to the chemo.  What has been your experience?

[Irene546]

Dear Dr. Roque,

I just read a scary article entitled "Optimal management for surgically Stage 1 serous cancer of the uterus.  from Gynecologic Oncology  Vol. 1 January 2004, pages 240-246.  It said:  "Recurrence rate was highest for adjuvant chemothery (66%)."  

I can't believe this!  Am I interpreting this incorrectly?  Because of chemo therapy, the recurrence rate is actually higher in stage1 patients?

What do you think of this article?

Irene

[Irene546]

Dear Dr. Roque,

Thank you so much for this information.  I will look at it.

Irene

[Fernando Roque, MD]

Hi.  I would just like to clarify that chemotherapy has no further benefit for those UPSC stage 1A patients whose cancer is confined within the polyp (referred to as Stage 1A with "no residual uterine disease" in studies).  For UPSC stage 1A patients with cancers that have extended beyond the polyp, chemoradiation improves survival.  This is the recommendation by the most recent National Comprehensive Cancer Network (NCCN) treatment guidelines for uterine cancer.  You can also check out the following journal articles:

Kelly, MG, et al. Improved survival in surgical stage I uterine papillary serous cancer (UPSC) treated with adjuvant platinum-based chemoradiation. Journal of Clinical Oncology, 2005 ASCO Annual Meeting Proceedings. Vol 23, No. 16S, Part I of II (June 1 Supplement), 2005: 5023

Lackman, FD, et al. Therapeutic dilemmas in the management of uterine papillary serous carcinoma. Current Treatment Options in Oncology. Volume 4, Number 2 / April, 2003.  pp. 99-104

[alagirl]

I spent about seven months on interferon (for hep c, not cancer) - and two of my teeth crumbled a few months afterwards.  As said above, its not just the drug's effect on the teeth, but tx drugs cause your body, for a time, to become so immunologically impaired, and they can interfere with proper blood counts, etc.  And all of these things can cause issues with the health of the mouth and gums.  Not a doctor, that's just been my experience.

[Irene546]

Dear Dr. Roque,

You mentioned that the clinical studies that have been done for UPSC 1A indicate that there is no improved survival rate with chemo therapy.  Could you possibly tell me which studies these are?

Thanking you in advance,

Irene

[Irene546]

Dear Dr. Roque,

Thank you so much for your reply,  I really appreciate it.  I will follow your advice.  
I took the last pain pill, percoset, Monday evening, and I have not had any pain since.  The pill was supposed to be taken every 3 hours, so now I suspect that the problem is gone.

If the pain is gone, it seems to indicate that it is not a permanent tooth problem, but a side effect of the chemo, or facial neuralgia.  What do you think?

Thank you again for your advice, Dr. Roque

Irne

[Fernando Roque, MD]

Hi.  For stage 1A UPSC which are confined to the polyp, the clinical studies that have  been published indicate that adding chemotherapy to the treatment regimen does not improve the patient's survival or lower recurrence risk any further.  I don't know if those experts who recommended chemotherapy to you have additional evidence which says that chemotherapy makes a difference.  Maybe you should ask them for evidence to back up their opinion.  If they can't present any additional evidence, then I don't see how continuing with another two courses of chemotherapy is advantageous to you.

Percocet is a good choice for pain control, but if your toothache is still persistent even when taking this drug, I suggest you add either Lyrica or Neurontin to it.

[Irene546]

ps.  I forgot to mention that the third prominent University also thought I did not need chemo.
Irene

[Irene546]

Dear Dr. Roque,

Thank you so much for your medical advice.

From my understanding, my cancer was confined to the polyp.  My  local surgeon  said that I only needed brachy therapy for 1A.  I went for a second opinion at a University Hospital and was told there that I should have chemo "as insurance".  Then I went to another University and was told the same thing, brachy therapy, and chemo, but they also wanted to add 5 weeks of abdominal radiation.  that university was closer by so I went there.  The first university disagreed with the abdominal radiation, and so did the third other very prominent University I consulted in Maryland.  They did their own pathology report, as had the first university and based their opinion on that.  

Now that I'm having, what most likely are neuropathy problems, I am reconsidering the 5th and 6th chemo treatments. I am also reconsidering the abdominal radiation, since only one radiologist recommended this out of three.   I wanted to play it safe, originially, and agreed to do chemo for that reason,  thinking though inconvenient, it couldn't hurt the outcome ,
but it does hurt, and causes a new set of problems. Now I don't know anymore.  I never saw a "Medical Oncologist", only oncology radiologists, and  gynocologic oncologists,  because I only have 2 more treatments of chemo, I was considering finishing them if possible....unless the pain persists.  I consulted my doctor and showed him your suggestions.  He precribed percocet instead, and told me to take a week's break from the chemo which was scheduled this coming Thursday, and see a neurologist.  He did not think my oral pain symptoms were caused by the chemo.

Thank you so much for your interest,

Irene

[Fernando Roque, MD]

Hi.  Stage 1A uterine papillary serous cancer (UPSC) usually presents as a polyp, which is a fleshy growth along the inner lining of the uterus.  The treatment of Stage 1A UPSC will depend on whether the cancer is just confined within the polyp or has already spread outside of it..  If you have the type of disease where the cancer is still confined to the polyp, then you do not need chemotherapy.  Brachytherapy will suffice.  However, if you have the type of stage 1A disease where the cancer has spread outside the polyp, then the risk of recurrence is higher, and you stand to benefit from having chemotherapy.  Now, if the type of disease you have is the one where the cancer has spread outside the polyp, I think it would be best for you to complete all six cycles of chemotherapy to maximize the benefit you will get from the treatment.  

[Irene546]

Dear Dr. Roque,

Thank you so much for your advise.  I will suggest the drugs Tramadol or Paracetamol to my doctor as a substitute for Ibuprofen.

I am also wondering if I should even continue with the last two chemo treatments since there has been disagreement on whether I even needed the chemo.  Just recently a prominent doctor from Johns Hopkins suggested to me that at stage IA "UPSC", I don't need chemo, just brachy therapy.  My original doctor at Inova thought that as well, but two other doctors at U. of Virginia and  Georgetown U. thought I needed chemo as "insurance",  so I went with those opinions, having been scared by the statistics of UPSC.  But now I hear these old  statistics are not reliable.

I have finished four rounds of chemo of six.  Do you think I could stop, and not risk further dental complications?  I don't want to loose my teeth, but I don't want to loose my life either....  I would then do vaginal brachy only, and be done with all this.

Thank you so much for your attention to this matter.  

Irene

[Fernando Roque, MD]

Hi.  Docetaxel is one of the chemotherapy drugs which cause a lot of neuropathy, so I have a hunch that what you're experiencing is not toothache (since no cavities were seen on dental x-rays) but a side effect of the chemotherapy.  I really suggest that you try either Neurontin or Lyrica.  If that pain is due to neuropathy, you will feel a marked decrease in pain after taking these drugs for a few days.

You can take Ibuprofen intermittently, but it could damage your kidneys or cause gastritis (damage to the stomach lining) if taken regularly for a long period of time (e.g. more than 7-10 days) at that dose.  You can try substituting Tramadol or Paracetamol for Ibuprofen.

I'm not a dentist, but I think the dental x-rays are enough to show you if you have a tooth problem.  Since the results are negative, I'm entertaining the possibility that the cause of the pain is the chemotherapy.

[Irene546]

Dear Dr. Roque,

Thank you very much for your reply to my question about toothaches during chemo.  I am on the 4th carboplatin and taxotere (docetaxel generic) treatment.  This morning I am seeing an endodontist.  I had already asked my oncologists whether this pain could be a side effect of the chemo, he thought it highly unlikely, but couldn't rule it out.  He suggested I see my general practitioner or go to the emergency room.

I am presently taking 800 milligrams of ibuprofin to ease the pain, and I take only one a day.  This seems to take care of the pain, but could it be detrimental to my general health if taken longer then a week?

I also wonder how I can tell if it is indeed a bad tooth, or the temporary result of chemo.  I certainly want to avoid unnecessary oral surgery, and loosing my teeth!

I greatly appreciate your input.

Thank you so much

[Fernando Roque, MD]

Hi.  I would just like to know what specific chemotherapy drugs are you receiving?  Most chemotherapy drugs will not directly damage the teeth, but some of these medications cause neuropathy (dysfunction of the nerves) or neuritis (inflammation of the nerves).  Often, chemotherapy-induced neuropathy manifests as tingling or painful sensations at the tips of the hands and feet, but if the nerves of the face are affected, it is possible to experience facial pain which can be interpreted by the patient as toothaches.  You can try some medications which can ease neuropathic pain, such as Gabapentin (Neurontin) or Pregabalin (Lyrica).  Discuss this with your doctor to see if these medications are suitable for you.