I've had hyperbaric oxygen therapy (HBOT) twice in 2008 and 2013. I'm having more dental issues and may need an invasive procedure that normally would require HBOT. It's been 3.5 years since my last HBOT treatment.

When I first had HBOT in 2008, I was told it was good for "life". Then when I needed some teeth pulled in 2013, I was told it was only good for 5 years so I repeated HBOT again.

Does anyone know what the current guidelines are with regard to the time lapsed before repeating HBOT?

I would also like information on this topic ! Have an appointment with my regular dentist on Thursday and I am quite sure HBOT will be discussed.

I had 10 teeth removed before the start of chemo and radiation but due to no knowledge of dental trays I believe it is playing a big role in the shape of my remaining teeth at this point. Scared to go to the dentist, but scared not to go if that makes sense. It sure would be nice to be able to smile again without putting my hand over my mouth due to missing teeth !

My mouth being totally on fire 24 hours a day with no moisture is really getting me down. It has stopped me from being able to swallowing anything except sips of water for a long time now. Whatever I try gets stuck at the back of my throat and just stays there for hours.

I am hoping that if my dentist does not have the expertise to work with my issues that he is honest enough to refer me out to someone who does deal with post treatment problems.

Susan, I was told HBO should be repeated if its been more than 6 months post HBO. Im sorry but Im not aware of any new studies or info that sets up a clear cut guideline for when HBO is needed.


Jo have you gone to a swallowing therapist for a barium swallow test? How about seeing a SLP? They should be able to help you with exercises to help get those muscles moving correctly (if its possible) again.

Many members have gone to a prosthodontist or a dental oncologist at their CCC. After having rads, your mouth is not the same and must be treated with extra care. Most dentists do not have the training or skills in treating oral cancer post radiated patients. Proceed with caution!

Hi Susan,

I'm sorry to hear of your dental issues and need for an invasive surgery. In regards to hbot, I saw the term, "For Life" being used on some osteoradionecrosis conference slides when looking into it. The only thing related to this, and hbot, I could find was, "A study showed that the angiogenesis reaches a plateau at 80 to 85% of non irradated tissue vascularity by 20 sessions; trancutenous oxygen measures remain at that level for several years." This study was done by Dr. Marx, but the full PDF I couldn't obtain, but have other excepts that explains it.

I'm not sure "For Life" term I saw on conference is referring to radiation damage, and risk for osteoradionecrosis or HBOT, but I also saw the term mentioned on other not so trusty blogs. I would go with what Christine said, who btw has more hbot experience than all of us combined. Before I went through my last hbot in 2014, my oral surgeon asked when my last hbot treatment was (2010), so time may be a factor, and I did the 20/10 Marx Protocol. I failed that, and when asking about additional HBOT I was told that it already failed twice, and needed bone debridment with vascular closure (Sequestromy), which failed too.

As you had hbot twice, and if that helped prevent osteoradionecrosis and or improved wound healing, I can't see it not being offered again, unless your surgery is like mine, mandibularectomy with a free flap, where some, including my doctors, say hbot is not really needed being it's new vascularized bone and tissue.

I hope your surgery goes well, Susan, and I hope to ask about this with my HBOT center doctor next time I see him.

Susan, if you do find the right answer about how long HBO is good for please let us all know and what your source was.

The short answer for me is that they are recommending HBOT again for this procedure - 20 before and then 10 after.

I do want to find out more about HBOT and I guess now I will have the opportunity. I spoke with one oral surgeon a few months ago and he seemed fairly knowledgable but unfortunately I didn't take notes nor ask him if there was a study with the information. From what I recall he stated that the oxygen level was only 40-44% after RT and before HBOT. Right after HBOT it is around 90%, and then drops to around 80% - not sure of the time frame for this drop and not sure if it continues to drop. I had asked him if I would need HBOT again if I required an extraction, and he said no.

However, the procedure they are now recommending is a little more involved. I believe it is called an apicoectomy (surgical removal of the tip of the root). I've been in considerable pain since late October. I first went to my dentist (Prosthodontist), who referred me to an Endodontists for a root canal. They diagnosed me with external root resorption (not sure what caused this). The Endodontist referred me to an oral surgeon, and the first available appointment was mid-December (ARGH).

Earlier this week I went to my ENT, who had been on an extended vacation or I would have gone to see him sooner. He put me on an antibiotic and was surprised that neither doctor prescribed one for me as the area was swollen and extremely tender. He made a call to another oral surgeon, and they had a cancellation and was able to see me the next day. The task for tomorrow is to find a HBOT facility that can fit me in their schedule really soon! Fortunately there are 4 that I know of within an one hour drive.

Christine & Paul, I think it would be a great idea if we could track down some updated guidelines on HBOT. I will see what I can find out.

Susan, yes I agree updated HBO info would be great to have and share with everyone. Thanks for sharing whatever you dig up and where it comes from. I will check a couple avenues over the next few business days as time permits.

The answer may be just as difficult to find as an elusive tree frog. I'm no authority for sure, but have read many, well more than many, abstracts and studies on osteoradionecrosis and HBOT, including having and reading the book, "Handbook on Hyperbaric Medicine" by Dr David Mathier, 2006 edition, and others, and never saw for life mentioned, although it's over 700 pages lol, and could have missed it. The only times were as I previously mentioned. I looked again, and it actually said, "Effects of Hyperbaric Oxygen are permanent." That's it, no footnotes or anything to work on.

I did find that HBOT is just as complex as radiation treatment. There are many indications for it, exclusions also, and has many biological and physiological effects on the patient. HBOT for Osteoradionecrosis management, basically helps the radiation damage by partial reversal of Hypocellularity, Hypovascularity, and Hypoxia, known as the three H's, Angiogenetic and Fibroblastic, and inhibits inflammation. These are just some, and it gets complex.

This morning I contacted the "Undersea and Hyperbaric Medical Society" , which seems to be one of the authorities on HBOT in the U.S., and spoke with the Executive Director, who is not a medical doctor. Much of it was as I thought, that HBOT is very complex, has many indications. and they don't know all the effects about it. He had said that one treatment often works, but each incident is different, as there are different areas that may need treatment, and some may need it twice, and is difficult to say if it's for life or not, through angiogenesis, and is really based on the individual. When I asked about where the Life idea or part of that came from and was told from Dr. Marx's studies, but he couldn't find the study when we were on the phone, but believe it may be the one I mentioned.

Next step is to look further into Dr. Robert Marx's studies, if not, maybe contact his office for direction. I was wanting to inquire about the stem cell treatment that's he's doing at the University of Miami for Osteoradionecrosis anyway.

I hope this helps anyone in their search.

Thank you Paul!!!

I had planned on trying to call Dr Marx next week. He is the expert so hopefully he can shed some light on this subject or at least send us in the right direction. Im sorry I couldnt call today. I have my 2 year old granddaughter with me today and phone calls dont always happen when shes here.

That's ok, Christine, and enjoy your time with your granddaughter! I have a 3yr old great niece, and don't see her often either, except on holidays. Maybe I can leave calling Dr Marx or whomever in your hands when you get a chance.

There certainly doesn't seem to be one simple or consistent answer. Today I spoke with the HBO tech in the Wound Care Center at one local hospital. He has been in this group since at least 2008, and I had my last round of HBOT at this facility in 2013.

He discussed my case with the doctor who heads the department, and this doctor said I would only need 10 dives after I have the procedure done. Since I already had at least 20 dives, this causes a permanent change and I would not need to repeat the 20 dives before the procedure. I will be going for a consult with this doctor next week, and I asked Bob (the tech) if he and the doctor could gather some information on this topic that I could take and share.

I also stopped by the oral surgeons office to pick up the referral. This doctor reiterated his position that I should have the 20/10 protocol as recommended by the radiation oncology department where I had my RT in 2006. The tooth that I am having a problem with was in the radiation field, but it was at the edge of the field and I don't believe it received as much as some other parts of my jaw. I would rather err on the side of caution and do the 20/10 HBOT rather than be faced with ORN.

Thanks Paul and Christine! I'm anxious to learn what Dr. Marx has to say on this topic. If there are studies or recommendations and guidelines perhaps these can be added to OCF main pages.

I've been told that radiation causes compromised blood flow in the radiation field, and the compromised blood flow does not allow as much oxygen to that area which is one of the reason healing is so difficult. Prior to going through HBOT the first time, my RO put me on a treatment of Trental (pentoxifylline) 400 mg + vitamin E. My understanding is that this treatment reshaped the red blood cells to allow them through the damaged and narrowed capillaries thus delivering more oxygenated blood to that area and helping with healing. I did see some improvement with this treatment, which I was on for nearly 2 years, but it wasn't until I did the HBOT that I saw the greatest change.

One question I have is there a way to measure the blood flow or the oxygen levels in the blood. I'm not a medical professional, but it seems this would be very helpful to know this to determine if HBOT is really necessary. If you have good blood flow that is already rich in oxygen, then it would seem that HBOT wouldn't have that much of an impact.

The other question would be what medical speciality would be the most knowledgeable of this? In my case, one oral surgeon contacted the raditaton oncology department at a large local hospital. Second opinion was by the doctor in charge of the wound healing department at a different local hospital. I also had a discussion with a different oral surgeon a few months ago regarding an extraction and he didn't think I would need any more HBOT if an extraction was necessary.

To be honest, I would value the expert opinion of the doctors at the large, teaching cancer centers over the local hospitals and doctors.