Nancy, I'm happy to share and hope to hear about what others have learned.

Regarding search for a dentist, we found an experienced oral surgeon (DDS & MD) locally. He was recommended by RO & a first class endodonist that we trust. The oral surgeon had some past training at Roswell Park in Buffalo, so was well aware of ORN issues.

I still wanted a second opinion with a dentist who deals with this more often; there is no one in our area. After several attempts, a consultation was set up at Dana-Farber Cancer Center in Boston with a dentist from Brigham & Women's Hospital (several hours from our home). This is a new program. Dana-Farber's dental oncologists will only treat patients currently undergoing treatment.

This dentist sees 2-3 patients a week with post treatment problems. She was fabulous! She agreed with 20 HBOT prior & 10 post extraction. She encouraged us to have the extraction with the local oral surgeon, as he had already ordered HBOT, and was being cautious with his plan. She did say that sometimes it is better to cut the tooth down and seal it, although this approach is not problem free either. She agreed with the oral surgeon that Bob's tooth was beyond trying to save.

She gave me her email address and wanted me to keep in touch with her, which was a weight off my shoulders. She cautioned that several healing checks should follow the extraction and if not to let her know, use Peridex rinse until area is healed, and increase frequency of panorex x-rays. She said there was no way to determine ahead of time how healing would progress. Some patients heal in 2 weeks, some 2 months, and some never.

Mechanically, the extraction was not difficult due to bone loss - local anesthesia and little pain afterwards. Oral surgeon was relieved to see good blood flow, which is a critical issues. However, he still says good healing so far, but adds that it's too soon to know final outcome.