Hi everyone,

My husband was diagnosed with BOT cancer seven years ago. He has been cancer-free but two years ago he had an infection in the jaw/gum area where the radiation was done, and it caused a sore in the gum that did not heal. He has had two dentists monitoring his treatment as well as the Tampa Bay Moffitt Cancer Center ENT surgeon/oncologist. The primary dentist thought it would heal on its own and the only treatment given was to remove some of the dead bone tissue that was easily accessible.

Recently, he was referred to an oral surgeon who recommended surgery for osteoradionecrosis based on CAT scan results. He told him he would go through approximately 20 HBO dives first. The oral surgeon said there would be the possibility of losing 2 or more teeth on one side. At an appointment yesterday, the dentist told him that under the worst case scenario, no tooth replacement of any kind including a partial could result. My husband did not need to have any teeth removed during his original O.C. treatment and has all his teeth.

Has anyone else encountered this situation? Is it unusual to not be able to have some kind of tooth replacement? Under what circumstances would this scenario occur and what are the alternatives?

Thanks very much,

Connie (and Jerry)

I faced a similar situation with a molar in the radiation field. They ended up performing a root canal and decapitating the tooth. It now is just a stump with a cap over it. An extraction could have been very serious and result in possible loss of the jawbone. Implants are dicey in irradiated areas and actually cause more problems. The worst case scenario is removal of the jaw bone. Keeping your medical team in the loop is a must. Perhaps a consult with a dental oncologist is in order.

Just finished a consultation with a well-respected specialist in Miami, Dr. Marx, who said that my presumed ORN may, instead, be radiation-induced osteosarcoma of the mandible. I have a biopsy scheduled for tomorrow to find out. I too had two molars removed followed by 30 HBO dives back in December 2010. About 8 months later I discovered a lump on the side of my jaw that has gotten progressively bigger. Tooth extractions can, indeed bring on ORN of the mandible but radiation can also cause some issues far down the road. Either way, I think I was facing a mandibulectomy anyway. If its osteosarcoma, we just add chemotherapy.

Thanks for the responses. Gary - my husband is seeing the dental oncologist who works with Moffitt Cancer Center patients in Tampa, FL. He apparently is not familiar with the Marx protocol for ORN that I found posted on another thread on this site by ChristineB and Art2Go. Or, isn't using it for some reason. Unfortunately neither was my husband nor I until I read that thread. We were familiar with HBO since the Moffit oncologist prescribed 30-40 dives a few months after his initial radiation therapy when his treated BOT area wouldn't completely heal. It worked great for that. I have wondered over the past 2 years why they couldn't use HBO for this ORN issue. I guess we trusted too much that the three people monitoring him were doing everything that could be done and didn't do due diligence on our own research.

The oral surgeon he was finally referred to a week ago is also the person that Moffitt CC uses for H&N patient issues like this. It appears from the oral surgeon's cat scan results and remarks and after reading other posts on ORN on this site that his oncologist and dentists have let this go to the point of it becoming a Stage II or even Stage III ORN issue. Very disappointing and scary.

The issue isn't that his tooth is problematic but that the underlying jawbone tissue around the socket area has dead tissue from 2-4 infections in that area over the past two years. The oral surgeon wants to give him HBO now and remove the dead jawbone tissue and is saying that he will have to remove at least 1 tooth in that area and possibly up to 4-5 teeth. He said if he finds that the jaw area is 'crumbly' when he does the surgery, he may have to insert a metal plate. Afterwards at another appt, my husband's regular dentist said that it probably wouldn't be the case, but it was possible that they would not be able to do anything to replace the teeth (i.e. bridge, implants, etc.)

Anyone else encounter anything like this?

Thanks very much!

Connie (and Jerry)

Hi Connie! I am very familiar with HBO, ORN and the Marx Protocol. Any time a tooth needs to be pulled after having radiation for head and neck cancer, the dentist should be using 20 HBO prior to the removal and minimum of 10 after. If you are running into professionals who do not follow this then it should tell you they are not the right person to treat your husband. If I were you, I would be looking for a prosthodontist. That type of dentist is usually most familiar with oral cancer patients special needs.

It is a good possibility that there is damage to your husbands jawbone. Several members including myself have been thru a mandibulectomy. It also could be possible to not be able to get dental implants or dentures to replace teeth that have been removed. Ive lost all my teeth due to radiation damage. At this time, I am without teeth for over 2 years with no date planned to get dentures or implants. With the damage that has been done to my mouth, I am not a candidate for either. Of course, this is the worst case scenario. Most patients are able to get dentures or a bridge to replace what they lose.

Any other questions, please let me know. I will be happy to help you.

Christine, Thanks very much for the information. We're going to be making some calls over the next few days to find out the oral surgeon's experience with doing this kind of thing and find out whether there are any other oral surgeons with experience with H/N cancer patients in the area. Moffitt Cancer Center is ranked the #18 comprehensive cancer center in the country by US News, so we had been relying on their expertise in managing and treating his condition. I've lost confidence with what has happened and what we've learned recently. So, time to do some research on doctors!

Thanks again for the fast response,

Connie (and Jerry)