Stage VI Lung Cancer and Dental Work

Tue, 08/25/2020 - 00:38

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.



JanineT Forum …

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,


In reply to by rebecca2015


I want to thank the cancer community for the incredible source of information on cancer, Xgeva, and dental work. I’d like to share my husband's recent experience hoping it will be useful to someone.

My husband is a stage 4 lung cancer with bone metastasis. To treat osteoporosis, his oncologist prescribed Xgeva, a medication that is known to cause ONJ. 

Last September, my husband had an excruciating toothache requiring tooth extraction and implant for a regular person. Since my husband is taking Xgeva, a tooth implant is not an option, and tooth extraction can only be a last resort. He went to see two oral surgeons; one told him to file his teeth down until it drops off by itself, and the other surgeon told him to pull it out before the infection got worse immediately. He tried the first surgeon’s recommendation with no success and decided not to continue due to a large amount of pain killer intake per day. The second oral surgeon extracted the tooth and gave my husband a regular amount of pain killer and antibiotics. After a month, pain slowly subsided, but the infection in the bone was still there. In light of this new situation and the MRI result, his oncologist referred him to a neck, ears and throat surgeon. The neck, ears and throat surgeon immediately told him he needed to get rid of the infection immediately to stop the growth of dead bone. He prescribed a different antibiotic and a very high dose of vitamin E. After one week of taking the recommended antibiotic and vitamin, the smell of a tooth infection disappeared. He has an appointment with the neck, ears and throat surgeon for further checkup, but we believe his tooth is no longer an issue. I’m sharing my husband’s story in hope it will be helpful to someone.

JanineT Forum …

That last part is great to hear Rebecca!  What a relief you both must be feeling right now.  Stay in touch with that surgeon and keep your husband's onc team in the loop or better yet in contact with the ear nose throat doc.  As you know, this can be a devastating problem with little understanding of how to get rid of the bone infection in the jaw.  We know that before starting the kind of dose needed all dental work should be done.  But that doesn't help if you don't have dental insurance or time or you don't have a problem going in.  The point is, oncologists need a helping hand here and someone having success with treating ONJ should be shared with others. 


Thank you so much for sharing your experience with us and YAY for your husband and his care team!

Best of luck and keep us posted,