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What is the best at home fluoride to give a patient undergoing head/neck radiation with rampant decay?

We recently started treating a new patient who has undergone serious head/neck radiation for throat cancer and he’s got severe xerostomia. All of his fillings/crowns are failing, he’s got rampant recurrent decay and there is different views in our office how to send this patient home with a home treament. What do you find works best? Giving the patient varnish to apply monthly? Custom trays with a gel? What gel would you recommend if this is your choice? Any other thoughts or recommendations for us to give this patient? THANK YOU!!



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8 Answers

He can be prescribed a rx medication that can help the salivary glands produce more saliva. One is called pilocarpine (sp?) However I don’t have first hand knowledge of well this works. Other than that definitely get him some trays made for fluoride gel. Have him brush 3-4 times a day and floss daily. Avoid anything with alcohol that can further dry out the tissue. Avoid spicy foods. A humidifier at night can put some extra moisture in the air.

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Without doing any research my first thought is trays with gel…how much would be to much though? I don’t know. I would also give him a product like biotene, but that only works for short periods of time from what my patients have told me. For Severe xerostomia, it probably would not have much effect. I am interested in other feed back you get.

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If he has mouth ulcers I know SockItGel works wonders.

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Trays, used twice a day for 30 min. each. This will be for the remainder of his life.

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We make custom trays like bleach trays with a reservoir on each tooth and recommend Clinpro 5000 ppm fluoride paste. Recommended use is 5 min per day plus brushing with the paste 2 x per day. Wait 30 min to rinse off.

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Salivary gland Rx’s dont tend to work as salivary glands are often damaged…Varnish at appointments and def gel for home use daily (simple boil and bite tray works)…Prevident…Biotene for sure, the gel form helps…but also ACT lozenges have been found to really help those with terrible dry mouth…

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Do you just have the patient put the prevident/clinpro into the tray to wear? I’m wondering if that gets a little pricey for them? Is there a different gel better suited for trays and then just use the prevident or clinpro for brushing? His cancer team have him a bunch of fluoride things too but it’s obvious he isn’t using them and he “can’t remember” what the names of them are.

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So as stated above about the salivary gland damaged is different and RX wouldn’t work the same…. I’m sure that’s true but I’d try it anyway and see if he noticed a change, we give Salagen (spelling) pill form they take. Varnishes r the best uptake and can cost office like $1-2 maybe the office can make an exception on costs for him! I’d ask my rep which fl2 for the trays, tell the why… stannous or what?

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