Stage VI Lung Cancer and Dental Work

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rebecca2015
Stage VI Lung Cancer and Dental Work

My husband has stage VI bone metastasis NSCLC since 2014.  He is currently taking Targrisso second line and Xgeva.  He recently went to the dentist about his teeth and got the approval to proceed with the root canal procedure.  It's been two weeks since the procedure and his teeth still hurts, especially when he is tired.  At night when he lies down, he gets a pain in his ear similar to when we have the cold.  When he went back to the dentist to examine what the issue may be, the X-ray does not show any issues.  Have any had a similar experience?  What type of doctor or dentist do you recommend he go see?

Any information would greatly be appropriated.

rebecca

 

JanineT Forum M...
Hi Rebecca, Welcome to Grace.

Hi Rebecca,

 

Welcome to Grace.  I know how scary this situation can be.  While my husband was on zometa something odd came up on a scan that turned out to be a wire from an old cap or crown that was causing inflammation but no ONJ.  I was surprised to find our dentist didn't know about that class of drugs outside of the low dose given for osteoporosis.  It was 10 years ago so even less was known then.  From the few studies that I just looked at, it appears they all agree more needs to be learned. 

 

It's clear that the earlier ONJ is caught the better the outcome.  All the newest info suggests there doesn't need to be exposed bone to have or find ONJ.  The underlying cause of ONJ may be related to the underlying cause of the need for dental work.  And the best way to find the extent of changes in the bone isn't 2D x-ray.  With that said I would share copies or better yet, links of studies with your husband's onc and dentist, talk to them about possibly getting more imaging.  The dentist and onc may be open to having a confab about your husband's case.  I don't know how familiar you are with med studies, I first read the abstract and conclusions then if I want more the discussion.  But the minutia of detail in a study may not be necessary to plow through to get the gist.  And the publication needs to be at least peer-reviewed to be sure it's not just hype to sell something.

 

A CBCT may give more information needed to make an early diagnosis of ONJ.  From this study of existing data, "Although conventional radiographs can demonstrate evidence of BRONJ, especially when disease is advanced, there are limitations of these imaging modalities, regarding their 2D nature and also the technical characteristics. While CBCT scans provide more information regarding the extent of bone changes, the usefulness of this imaging modality in asymptomatic individuals should be better investigated."  From what I understand you to say, your husband fits somewhere between having bone changes and being asymptomatic.  I don't know what that may mean in your husband's case but seems relevant to the conversation.

 

And a blurb here about radiographic findings, "In addition to the aforementioned plain radiographic findings, CT is more likely to demonstrate early changes"

 

My husband's experience was 10 years ago so this may be better understood, he stopped zometa because it scared us, he was doing well, and there was thought that benefit may continue after treatment stopped. 

 

I hope to hear he doesn't have ONJ but just another bump in the road.  Keep us posted.

All the best,

Janine

rebecca2015
Thank you, Janine.  This is

Thank you, Janine.  This is really helpful.  

Rebecca