@Uptown - you just caught my nonsensical wordsmithing. For me that's lunch time. lol

ORN is actually fairly elusive topic. Like all these posts there seems to be a variety of perceptions and not a lot of hard science or trials or studies.

My interpretation from the research I have done is ORN is caused primarily by radiation in proximity to the jawbones (upper and lower). Depending on the location of the tumors the amount of radiation striking the jawbone and teeth can vary a lot.

Not only direct rads to the bone but the "overspray" and rads bouncing off metal crowns and such all are sources of rads to the bones.

ORN does not happen in a week or a month and usually appears years post tx. My own thinking is the damage is done at the time of the radiation and over time the damaged bone and tissue are not able to sustain a healthy situation. The damage can grow to a point where bone and teeth are now unfit and some sort of treatment is necessary.

@Lottie,

My advice came from 4 dentists. One is both an oral surgeon and medical doctor, pretty smart fellow. Two are primary care dentists, and one does root canals. The two primary dentists are the most clueless, the root canal guy is pretty alert and cautious, and the oral surgeon/doctor is most informed.

As far as I am concerned I am on my own to stay on top of degrading oral structures. Any recommended procedure that seems invasive will be held until a group hug is complete to understand the full impact. At any regular checkup if anything seems at all not right, I will head over to the oral surgeon to get his input and if there is any question I will then seek a specialist who just deals with cancer/orn/HNC cases. Hope that never happens. Good luck, Don