The upper jaw is like balsa wood, says our expert, porous and with a good blood supply.

Many patients have teeth out before chemoradiation. Here is an explanation from a dentist member as to why the pain can be bad in some cases and WHY we sometimes need healthy teeth out in the zone of radiation.  There’s also a good explanation of why the bottom jaw can be more troublesome than the upper.

Pain relief is so important after extractions, but there are complications that make it worse such as localized osteitis (a dry socket).

In a lower jaw extraction, there is a 30 percent chance of this happening, but it doesn’t often happen in the upper jaw because it has a much better blood supply.

In dentistry we say the upper jaw is like balsa wood with huge blood supply through its porosity (the upper jaw gets its strength from being attached to the base of the skull).  “Blood helps heal”. The blood clots and then turns back into bone (very cool!).

However, the lower jaw must be stronger due to the fact it is a floating structure that is being tugged by many muscles. Its outer plate of bone is solid, so the blood supply is enough of course but not as in abundance as in the upper jaw.

When you have a tooth out, we need the blood to clot to fill the hole. If the blood clot never arrives or is washed out by over rinsing or sucking or alcohol or if infection breaks up the clot, then you have a socket with no blood, called a dry socket. The healing – instead of simply covering the blood clot – now has to grow (cell proliferation) over the exposed bone cells. These cells send messages to your brain saying this hurts like hell. Very painful!  Antibiotics and painkillers are useless. The socket needs packing every day with a clove tasting material called Alveogel. It’s the standard in treating this condition.

So, if having teeth out in the lower jaw, you must ask the dentist what to do if you get a dry socket. Ask if there is a plan for if you do get one.

Also ask for advice on pain management; it is not routine to give antibiotics unless the dentist sees exudation infection fluid in the process of surgery.

On the topic of needing teeth removed … if you have radiation, the bone around teeth becomes “almost” not alive – and with very little blood supply.

Saliva is vital and hugely important for the health of teeth. It protects teeth against decay. You will get decay in a very dry mouth caused by radiation, even though you are dedicated to perfect oral health. If (after radiation) you get to the stage of having a tooth extracted, there will be so little blood supply that there is no way a blood clot will form. That bone might never recover and heal. It will be too dry and will stay “unhealed” from that point on – a permanent dry socket.

Therefore, before radiation, teeth that are in the firing line of the radiation must be removed.

Dentists are horrified about taking out beautiful teeth before radiation. They feel a lot of emotion about having to do it but they understand the consequences if it isn’t done.

It’s very emotional to lose teeth but unfortunately so necessary.