Hi Don,

Correct, I had the bottom 3rd molar surgically extracted and stitched along with all my other teeth, including molars, last November, and did the Marx Protocol 20/10 HBOT before and after, but the 3rd molar socket opened up, had exposed bone for four months, which required another surgery in March along with bone shaving, buccal flap to close the socket, and stitched, which helped briefly, but it opened and after 4 months it still didn't fully heal, and had exposed bone, so I had to see another oral maxillofascial surgeon, who basically specializes in ORN, for possible major surgery, but he determined it was healing over, slowly, and will take a while, but I'm still not out of the woods yet, and was eventually released back to my regular oral surgeon for close follow-up, cleaning, which were weekly for quite a while.

After radiation, if you have exposed bone in the mouth longer than 3 months you're talking about possible ORN, which have different grades, and with such the doctors didn't take it lightly, and took quite seriously to the extent of treating like a cancer being the consequences can be so debilitating.

What I used to do is take a single high dose (2000mg) of amoxycillin one hour before cleaning. I don't remember where I got this idea, but the periodontist went along with it.

My new primary care physician told me not to do this. So I stopped. Now I wish I had never listened to her. Because now I cannot simply run out to the periodontist because I'm having trouble. I have other ongoing health problems which make travel very difficult, so I have to arrange for a caregiver. I also have to decide if it's worth it, because half the times the travel wipes me out and puts me into bed for days.

My periodontist wants an endodontist to have a look at this, and luckily he was able to recommend one closer to me. I'm trying to get an appointment now.

Also, I just want to add my thanks here for the information and follow-up on all my questions.

Andrew, did you have rheumatic fever at one time? I had it as a child, and for a long time some dentists required that I pre-medicate with an antibiotic before certain dental procedures, including cleanings (depending on what dentist I went to). They may have had me take the antibiotic after the procedure also, but I don't recall. I believe this was because rheumatic fever could cause heart valve problems (which you mentioned in this discussion).

Then a number of years ago (pre-OC), I was told this was not necessary. I even questioned a heart doctor about this, had some tests, and was told it wasn't necessary as they weren't any problems with my heart.

However, in recent years (post-OC) some dental professionals required pre-medication again. Manly for an extraction, but also a periodontist required it before a cleaning. This could be because of ORN danger, rheumatic fever, or both, but I was glad to use if as a precaution. Now my regular dentist does not required it for routine cleanings, but I'll use the Chlorhexidine (diluted) before and after a cleaning.

Wishing you the best!

I did not have rheumatic fever.

But I just remembered how I got started on antibiotics. The perio doc asked my primary care doc if I needed antibiotics. The primary said "no." I told the perio my doctor didn't know what he was talking about. I said that because so many doctors had given me bad information about post radiation care, and I was worried about infection. Later, a new primary doctor explained more about the reasons. I told her about post-radiation risk, and she said it didn't matter. So I stopped.

The thing is though, I have gotten lots of bad guidance from doctors. My original treatment team told me zero about post treatment follow-up. The only reason I went to see an ENT post treatment is a nurse elsewhere suggested it to me. The ENT said I didn't have to see him for another year, and this was immediately post treatment. This is not consistent with guidelines. The cancer maxillofacial doctor told me to never get a perio cleaning for the rest of my life. This turned out to be outdated information.

I could go on and on, but the net result is I have no sense of confidence with anyone involved with my post cancer care, except for the ENT I started with about a year ago.

For what it's worth, I found a chlorhexidine product that supposedly doesn't stain, or have other negative side effect normally associated with chlorhexidine. It's called Curasept. I see it available in the UK but I don't know about other countries. I live in the US.

I believe there is a non-staining brand available in the US, but don't recall the name. One of my doctors told me a number of years ago, but can't remember which doctor it was. I'm curious now, so I will ask my doctors the next time I go for a check-up.

Shortly after completing my radiation treatments I was advised to be seen by a dentist every 3 months for cleaning. I had been advised that any surgery exposing the bones in my jaw could result in osteonecrosis, even minor procedures like scaling of my teeth. The dentist prescribed Clindamycin starting several days prior, and continuing for 1 week after. I still got infections; both bacterial and fungal repeatedly.

Unfortunately within 2 years what was left of my teeth started breaking apart. At 5 years my teeth were so fragile I had to have them all totally removed. Prior to the extraction for 4 weeks I received Hyperbaric Oxygen Therapy. Then for 2 more weeks after the extraction. I was given high doses of Clindamycin and an anti microbial rinse (can't remember the name) throughout the process. Fortunately I did not develop osteonecrosis and my gums healed totally.

Since the extraction I still get both bacterial and fungal infections in my gums, mouth, tongue, throat, and nasal cavity; however perhaps only once or twice a year. They are cleared relatively easily. Although I lost my teeth, I am grateful to not be constantly burdened by the pain I had been suffering with.

I know I've probably given you more info than you requested, and it all sounds horrible but, if I got through it, anyone can. Good luck to you, I will pray you won't have to go through the same ordeal.

[quote=PaulB]
Now I just have to keep the back slowly 3rd molar open socket clean with syringe, which is going to take time due to radiation, and it's already been 10 months, with one conservative surgery failing to close it.
[/quote]

I've been thinking about this. If hyperbaric oxygen therapy encourages healing, why not give this a try to help your open socket heal over?

Hi Andrew,

I did the 20/10 HBOT before, and after, the dental extractions, and inquired about additional HBOT when it was showing early ORN after 3 months, but my Oral Maxillofacial Surgeon said it wouldn't help, it failed twice before, and needed additional surgery/flap to close the socket, and after that too seemed to have failed after several months I was sent to the Chief Oral Maxillofacial Surgeon, who is a known authority with ORN, but he said it was granualization, not showing bone at that point, so I inquired about HBOT to speed healing, and he too said it wouldn't help.

Actually, I was relieved not to do it again. After I did HBOT in 2011, for the same 3rd molar, I had a cancer recurrence about a month after I finished. Plus it really tired me out like radiation did, messed with my vision, balance, increased neuropathy, sinus, and needed a blood transfusion in 2011 midway. Wether or not some of these were related or not just doesn't make me want to do it unless necessary.

So far, so good. Went for my last follow-up visit about two weeks ago, and now on a 3 month follow-up plan. Still can't get dentures though.

I usually use warm water with salt and baking soda to rinse my mouth when my gums are bothering me it usually works for me