My 18 month follow up scans...........except for the jaw infection and subsequent redo of a failed root canal, which is painful, not bad.

[katartizo61]

CT no new mets

Impression

1. Interval improvement in patient known widespread osseous

metastatic disease as describe above.

2. New focal uptake in left mandible could be related to recent

dental procedure versus periodontal disease, however as patient is

reportedly on Zometa, biphosphonate induced osteonecrosis of the jaw

is also in differential. Clinical correlation and further evaluation

with dental exam is recommended.

A notice that an imaging finding is present on this exam which may

require follow up will be sent to the patient.

Narrative

CLINICAL HISTORY:

71-year-old male with medical history significant for stage IV

hormone sensitive prostate cancer with bony metastatic disease,

Gleason 5+4 equals 9, diagnosed in May 2021. Currently being treated

with Lupron, coupled with Zytiga and prednisone as well as every

3-month Zometa, which has been ongoing for a year. PSA is increased

from 0.05 obtained on 06/01/2020 to 0.09 on 08/24/2022. Restaging

bone scan.

COMPARISON:

Bone scan 05/20/2021.

CORRELATED STUDY:

CT scan of the chest and abdomen 10/27/2022.

RADIOPHARMACEUTICAL ADMINISTERED:

27.3 mCi of technetium 99 MDP intravenously.

TECHNIQUE:

Approximately 3 hours following radiotracer administration delayed

whole-body images were acquired in anterior and posterior

projections. Planer dedicated images of the head/neck, chest, pelvis,

tibia and upper extremities were also obtained.

FINDINGS:

Compared to 05/20/2021 whole-body bone scan new focal increased

tracer uptake is noted in left mandible. No other new focal area of

increased tracer uptake is identified.

Previously noted posterior skull lesions are resolved and vertex

lesion appear decrease in uptake. Also noted interval improvement in

multiple bilateral rib lesions, spinous metastatic disease involving

cervical, thoracic and lumbar spine, bilateral proximal femur,

bilateral proximal humerus, bilateral scapula and pelvis. Sternum

lesion not appear significantly changed in uptake.

Degenerative changes are noted throughout cervical, thoracic and

lumbar spine, bilateral shoulders, hips, knees and feet.

Physiological activity is noted in kidneys and urinary bladder.

IMPRESSION

Wide spread osseous metastatic disease involving axial and

appendicular skeleton as describe above.

Component Results

[Kaliber]

were you on Zometa when you had the dental work done ?

[katartizo61 in reply to Kaliber]

yes began zometa last year in June, what's ur thoughts of the best manner to kick this? saw dental surgeon and she redid the root canal. your thoughts on where to go? she prescribed antibiotics

[rsgdmd in reply to katartizo61]

I'm a retired dentist. Did a surgeon redo the root canal or an endodontist? Usually surgeons will do a surgical procedure called an apicoectomy, while an endodontist will redo the root canal. Either way can take time to heal & feel better. Also possible could have root fracture, which would make tooth hopeless.

[katartizo61 in reply to rsgdmd]

Endodontist. Redid root canal. Step one last Friday step 2 the 11th. Feels some better slowly. Cold laser from me. Just got antibiotics filled today

[katartizo61 in reply to rsgdmd]

Thank you for your response

[CAMPSOUPS in reply to rsgdmd]

Brother Kal and now I too lol have concern that katartizo61 had a root canal while on Zometa it appears and states he has a jaw infection.

[katartizo61 in reply to CAMPSOUPS]

Just to be clear for any help I need, the original root canal was pre Zometa by a few years. This last Friday was due to jaw bone involvement

[Kaliber in reply to katartizo61]

just exactly what brother campsoups alluded to , having Zometa present and doing anything to a mandible, upper jaw or nasal passages. You should never let anyone in your mouth, even a tooth cleaning because one of the instruments may slip accidentally. My friend Mark ( Urang on this group, now deceased, ) accidentally had, a root canal preformed while having Zometa treatments and he got a real nasty necrosis in his mandible that required several surgeries and a metal plate installed. It starts off like a tooth ache or soreness in the mandible joint or face near the mandible. If you think that might be it, alert someone on your medical team immediately before it spreads. I hope it’s not the case.

❤️❤️❤️

[Kaliber in reply to Kaliber]

I just had my 48th Zometa infusion this Thursday past. Even after 48 of them , my infusion crew questions me for 5 minutes about anything that did or may have happened in / to my mouth , before I can even get the infusion.

[CAMPSOUPS in reply to katartizo61]

I have had 3 Medical Oncologists over the past 3 years. Each of them questions heavily whether or not I have or need dental work of any kind when they see my records show I am on Zometa.

They even take a look at my teeth. Not to alarm you but no one wants the possibility of jaw infection (which is a mild way to put it) actually medically described as jaw necrosis. You don't need that.

If your Dental team was not aware of your Zometa and your Medical Oncologist not aware of your dental work Please make them aware.

[katartizo61 in reply to CAMPSOUPS]

the 3 week increasingly difficult pain was felt to be an abscess forming around a root. All information was shared with the endodontist and MO. Feels a little better and in not increasing pain wise currently. I was ok w extraction. Thanks for all your help.

[rsgdmd]

Root canals have a high success rate but not 100%. Zometa shouldn't affect healing. If, however, it doesn't heal & you need an extraction.....

[katartizo61 in reply to rsgdmd]

my thoughts as well. She said years to pain free, and chewing on it, go figure