Mark,

As a point of information, if in fact local anesthetics with vasoconstrictors can cause a problem, there are many locals that don't have vasoconstrictors. Most oral surgeons use local, even when the patient is asleep for surgery, but they can use one without the vasoconstrictor. They do this so that the patient doesn't wake up in pain and there is time for the pain meds to kick in.

That was a very informative article, but not for anyone with a weak stomach.

Hi Mark, Jerry et al,

I'm having pain with one of my front lower teeth, (throbbing, caries). And I don't really have much bite left because of shrinking teeth

When I recently visited my H & N Clinic for the usual nose scope, I mentioned my teeth, HBO, ORN etc. This Radio registrar (not my own ENT/ONC/Surgeon) said that because my cancer was tonsillar with met to the neck, judging by the 3 fields of radio (not IMRT), losing a tooth at the lower front should not be a problem, or a root canal (who can afford one of those now?), as that was not in the radio beams sites. Anyone else had similar opinions?

I thought that any radio in the H & N area would affect the whole mouth and neck, reduce the capillary blood flow in the jaw for quite a long time. Correct me if I have been misguided, but that as been most of my journey from the beginning since diagnosis...(except when I found OCF)

HBO is difficult to get here, because of insurance companies, and there is only one in Sydney! In this doctor's opinion, HBO shouldn't be necessary for most patients, a rare occurrence...(not from what I have read elsewhere )

I haven't been brave enough to visit my dentist yet (will do soon, because of the ache/pain), as I think I may have to lose that tooth, perhaps a bit far gone methinks...

Cheers!

Tizz

Thanks Jerry,
I would believe that we could tell our dentists not to use local anesthetics with vasoconstrictors If they are doing work on the lower teeth. (in most cases the upper teeth and above are not radiated directly).

My apologies for the graphic photos, I did not scroll past the text to see them the first time.

Curious that the risk of ORN increases fo all of us as we get older.

Can anyone address the issue of long-term bone/soft tissue health after radio? Do we recover any additional blood flow, regenerate any new circulation as we travel past Tx? Is all that radiated tissue completely static, or does it slowly regenerate into 'healthier' tissue?

Jerry - Thanks. Tom

I'm no expert but from my own questioning about this, I'm fairly sure the bone does not recover at all, at least not without HBO. At first I was under the impression that over many years, it would heal soemwhat and ORN would be less of a risk but my oral surgeon who has a good amount of experience with this said no, the risk never gets to be less. Bone that has been radiated is permanently damaged. (And then I imagine that as we age, it could get worse as bones get more brittle with age anyway). I don't know about after HBO--does it stay permanently better?

I also don't know about soft tissue healing. I know that I have read here of patients who were sent for HBO to heal soft tissue damage from radiation because they were told it wouldn't heal otherwise. But then so many people here have stories of regaining function and having less swelling, etc. up to a couple of years out from treatment that it seems soft tissue must heal on its own sometimes.

I do know that if my throat does not appear to be much more healed the next time my ENT scopes me, and especially if I'm still having major swallowing problems after a few months of swallowing exercises, I'm going to ask about HBO treatment. If my insurance covers it, I want to try it.

Mark, Thanks for that info. about novocaine shots. I was wondering about that.

Tizz, the impression my oral surgeon gave me ws that sites that are not directly in the field of radiation are not as risky for ORN. He said he woudl want to see the exact raidiation plan before making a decision about any kind of oral surgery and whether I needed HBO.

Nelie

Jerry,

I live about 50 miles south of Pittsburgh. Washington Co. Go Steelers!....... Yeah right!

Thanks for all of the information guys. There is a lot to digest. I'll keep you guys updated as this thing prgoresses. I'm wondering if the HBO therapy would expedite the healing of this fistula that I have? Something that I'm going to take a serious look at.

John