When we lose lots of teeth, jaw or part of the roof of our mouth during surgery, who we gonna call? The answer is usually the prosthodontist. Each hospital dentistry department dealing with head and neck cancer will need to work with a prosthodontist. Patients are not best pleased to be left toothless.

Prosthodontists are dentists who study for an three extra years to learn how to do crowns, bridges, implants and other prosthetic devices like obturators to cover holes in the mouth temporarily or permanently. Many of the treatments performed by prosthodontists are necessary for oral health and functionality.

After a big surgery on account of my third recurrence, I had teeth broken and teeth removed. I looked a sorry sight. I was able to have a partial upper denture made which gave me a respectable smile. Unfortunately, my remaining teeth bite on my insensate flaps and cause lumps so I need to use a mouthguard or stent.

Making these prostheses is very hard for the prosthodontist because I have trismus and it’s hard for him to insert the moulding material to make a good impressions.

Some of our members have had a resection of their palate and have an obturator in place until the hole can be repaired with a flap. Prosthodontic work is a crucial service to head and neck cancer patients as it can restore eating and a smile.

An obturator to fill some of mouth as well as supplying teeth.

It takes a special sort of prosthodontist to work with disfigured head and neck cancer patients. To some extent they can be called maxillofacial prosthodontists because their work is probably a lot trickier than the cosmetic work done on healthy individuals.

Another type of dentist we HNC people might need, is the endodontist. This is a practitioner who can take a tricky, decaying tooth in the radiated field and root fill it so that an extraction is not necessary. Extractions can expose post-radiotherapy patients to osteoradionecrosis or decay of the jaw bone.

Implants are much to be desired, but the patient must have healthy bone, not excessively radiated. This is a moot issue for many patients. How much radiation makes screwing implants into the bone risky? Can the patient afford implants if they are not funded or insurance won’t pay for them? They are very expensive.

An implant

And a recent innovation. “The development of titanium dental implants by Professor P.I. Brånemark in 1965 led to the refinement of bone-anchored prostheses for the face and adjacent structures. This technology has been under study at selected sites in the United States for over 40 years and is approved by the U.S. Food and Drug Administration for general use. This gives new hope for patients in need of these prostheses and has revolutionized the field.”

I’ve seen some magnificent work on other patients who have had implants or abutments onto which a denture could be fixed. If I hadn’t had radiotherapy or if my tumour had not been so unexpectedly nasty that my whole lower left gum was cut away, I could have had one implant to hold my paralysed left lip out. Having a limp, sucked in lower lip causing leaking and drooling just … sucks.

I think it’s important to ask about future dental options while the surgical planning is being done. Teeth seem to be the least important thing when you are first diagnosed but once you’re well again, you feel their absence keenly. Sometimes there are no dental options but if there are, restoring teeth contributes greatly to quality of life.