Hi my dentist recommends a tooth extraction. I know that we survivors need to have hyperbaric treatments before and after extraction, and am wondering if anyone here has gone through this process and can let me know what it entails and how successful it was. Did you have any problems with healing after the extraction. Thank you.

It's important to work with a dentist, periodontist, and/or dental surgeon who is knowledgeable with post treatment dental care. To begin with, the decision is based, in part, by whether the tooth is on the top or the bottom, the bottom usually being the greater risk. And depending on the case, a cancer-literate dental specialist might order a root canal or cut the tooth off at the gum line. And with removal, where normally there might be an extraction, instead it will be surgical removal. And as for chambers, I've heard variations of how this goes.

What I wrote above are just examples of possibilities. I am not saying this is right for your case. But what I can say is you need to work with someone who is knowledgeable and experienced with post cancer dental issues. There is no way i would work with a regular dentist on this.

I agree with the first answer. Extractions post radiation can be problematic. This is a function of the number of gy's of radiation the bone surrounding the tooth received. With very mappable IMRT radiation used today, each individual and each area in an individual's oral environment is unique and mapped for radiation exposure in varying levels of intensity, duration, and spread of the beam. As stated in the answer above, the mandible is more of a problem area than the maxilla is also correct.

I would want to work with an oral surgeon that has some experience with radiated patients. It would be nice for him to communicate with the radiologist that handled your treatment to get some idea of the level of exposure around the tooth in question. Your radiation map is a permanent part of your medical records and this information can be known.

The whole idea of hyperbaric oxygen treatments before and after extraction has a lot of grey areas in it, and the science isn't in total agreement on the benefits. I had 02 treatments before and after an extraction, and osteoradionecrosis was still a problem that has caused years of more bone issues and damaging surgery to try and deal with it. It's very expensive (about 1400 dollars a session times 30) and not always proven to work. I also had an extraction in the maxilla prior to all this and there were no issues with healing and no 02 treatments. So very much a function of where the tooth in question was in the radiated field, and the level of radiation the bone was subjected to.

I was thinking of some of the other ides that I explored before my extraction that caused many more problems. One of them was the use of a drug called Pentoxifillyne which increases micro vascularization and blood flow. The data on this is pretty good. But like O2 dives it's results in everyone is variable. It has few down sides, and If you want to understand more about it please ask. It is taken (400 mg) with vitamin E a couple times a day to improve the vascular quality of your bone. Your average oral surgeon may not be familiar with it, but there is a large body of peer reviewed publish articles on it.

Thank you Brian for the information. I am interested in the Pentoxifillyne. Is this taken only before and after extraction or is it something you would take long term. Also I assume it’s a prescription only drug? I’m in the final week of hyperbaric sessions. I’ve gone to an endodontist about a root canal but he said the tooth is not salvageable. The tooth is causing quite a bit of pain and inflammation otherwise I would just put off getting it removed. Also it’s a molar on the bottom so I know I have more risk.

Thank you Andrew for your reply and advice on this. I’ve been blessed with pretty good health following my treatment 12 years ago, so I really hate that I’m faced with this now.

I'm in Los Angeles, so if you need to know who my oral surgeon/pario is I'll post the info.

I needed a molar extracted and university medical center oral surgeon is only one that would do it due to radiation damage. Did Pentoxifylline treatment prior to extraction. Surgeon extracted and couldn’t get roots out. A month later, roots removed and debrided. Soft diet after both but two weeks after second surgery, jaw broke. Last week got a 3d printed titanium plate put in with cadaver bone added. Have been on Pentoxifylline and Vit E plus an antibacterial mouthwash for 3 months and plan on being on it for over a year. This was not the recommended treatment for repair but felt worth a shot before full flap.

If you get it removed, I would do a liquid diet using a substance like Huel primarily and graduate to a very soft diet for several months until the extraction site bone reheals. Trust me, you don’t want a fracture. Learn from my lesson.

Thank you Andrew. Yes could you give me that information on your doctor?

My doctor is Mark Handelsman. I've never had surgery from him but he helped me with post--treatment pario.

But just now I decided to see what his google reviews are. They are mixed. So I'm giving you the link to that