Can anyone speak to the issue of ORN risk dropping over time. As other oral structures slowly regain some function after radio, does this indicate a reducing risk of osteoradionecrosis?? I hope some of you can address this. Tom

Tom, it is my understanding that once the blood supply to the bone has been diminished by radiation, it will be forever more vulnerable. Temporary revascularization can be achieved by a series of hyperbaric oxygen treatments, without which any traumatic occurrences may not heal normally due to lack of blood supply.

I had hyperbaric treatments prior to the placement of lower titanium implants. If I elect to have upper ones placed at this later date, I will have to return to the hyperbaric chamber.

Probably not what you wanted to hear and I am sorry for that.

Tom, I was told very clearly by my oral surgeon that the risk of ORN never goes down after radiation. Anytime the bone is exposed, there is a risk, whether it is two years or twenty years later. He also told me the same thing Joanna said about hyperbaric oxygen --it temporarily protects (usually) against ORN if you need oral surgery but probably doesn't change the longer term risk--you'd need it again for it to help again.

Nelie

What is ORN?

Thanks, Vickie

Tom,

I was also under the impression that the risk doesn't lessen over time. I've had a couple of fairly standard procedures in the last two years with my oral surgeon and periodontist, and I know they both were very careful to assess the ORN risk before going ahead with them.

Vickie,

ORN is osteoradionecrosis (you can find quite a bit about it if you search this site). It is basically "bone death" that can occur post-radiation in areas such as the jaw if the bone is exposed during major dental procedures.

Cathy

Vickie, ORN is Osteoradionecrosis, which means bone death due to lack of blood supply, caused by exposure to radiation. This is a very serious business that is difficult to treat - by cutting out the affected bone. Docs never joke about it, and OC patients need to be aware of the risk.

Vickie,

The following may help you:

Osteoradionecrosis...bone that has received doses of radiation may lack the ability to repair itself after trauma. Radiation destroys the blood vessels in the area causing a reduction of circulation to the area of oxygen and other nutrients. This then will prevent normal healing in that area if the bone is injured.

Hyperbaric oxygen to the area will stimulate new blood vessel growth and therefore stimulate bone healing.

Without hyperbaric oxygen, removal of a tooth or placement of an implant will probably result in bone that won't heal.

This is a good article: http://www.virginiamason.org/dbHyperbaricOxygen/sec181033.htm

Hope this has been helpful.

Jerry

Thank you Joanna, Nelie, Cathy and Vickie. I really appreciate the information. Tom

Tom,

I've had 20 dives so far and then had dental work done. I just had four of my lower teeth (front) and one molar removed on Friday. Now I start back up with HBO tomorrow to finish with 10 more dives. All is well except for some swelling. Not much pain. I was really worried about the ORN, and I guess I still should be. Having the HBO really eases my mind to a degree. One good thing that came about because of the HBO is that the fistula that I have is almost all the way healed.

John

John, Thanks for the HBO info. I have not had that treatment and know very little about it. Is there a limited number of dives you can take? Will you be able to go in for more after some time has passed? Its very cool that you got some real healing from the time you spent, PLUS got some dental work done. I'm thinking about implanted hooks for dentures, but I'm fearful of the ORN. Be strong. Tom

Tom, it was explained to me that the schedule of 20 dives prior to whatever treatment, followed by 10 more provides the optimum benefit. Fewer are not enough, more will not give more benefit. Also, there is no limit on the number of times one can have a course of treatments. People who believe it provides a cosmetic benefit pay big bucks to have repeated courses of treatment. I expected to come out looking 20 years younger, but it was not to be (grin).

Tom,

I concur with Joanna, from what the director of Hyperbaric Oxygen told me, 30 dives is the recommended treatment length. They do 20 prior to any type of procedure and then 10 afterwards to promote healing. As far as going in for more, I think that would always be an option. The drawback would be the expense and approval from the insurance company. I've been told that these treatments are quite expensive. I've not seen any bills yet, but from what the nurse at the site told me, they are expnesive.

I like you am fearful of the ORN. I know that somewhere along my treatment path, it was explained to me. But I really did not consider it happening to me until I got on this site and began conversing with you guys.

I was almost embarrased to bring up the topic the few times on this forum that I did. I mean, shouldn't someone in my condition be more versed on something like that?

Everyone always asks me if I have increased energy from taking the 100% oxygen. I have not noticed any changes. Other than clearing your ears, the treatment is pretty simple. It's my two hour mid morning nap time now.

Happy St. Patty's Day to all,

John

Almost forgot to mention that I have to go back to the dentist /oral surgeon tomorrow because today the temporary work that they did came loose from the teeth they had it cemented to. Sometimes it never ends!

Oh well, just another speed bump on the highway of life!

John

Another up date.

I met with the oral surgeon today for a check up. Everything looks great ,no sign of any infection. the sutures are healed and I have very litttle pain.

I have one more "dive" to go with the HBO therapy. I may have it extended as this pesky fistula is not quite healed yet. The doctor with the HBO threapy says that 30 dives is just a base number. They will go as many as they have to in order to get a wound to heal. I guess I'll have to wait and see what my insurance company says about it.

My partial plate should be done sometime next week. I go back to the oral surgeon in the middle of April to have a wisdom tooth extracted and another molar.

Regards,

John

Thank you all for your posts. I've learned a bunch already. Can anyone advise me how to be a 'smart consumer' when discussing risks with the oral surgeon? What do I want to know? Are there certain implanted devices that heal more easily than others? Is there any good counsel on how to approach the insurance company? or what to have the surgeon approach them with??

Is the ORN risk as high on the upper jaw? I can't really swallow, so the teeth are mostly for appearance. I miss my teeth! (I think the doc who pulled them has an insider deal with the tooth fairy...) Any additional info would be greatly appreciated. Be strong. Tom

I too have a number of questions about ORN and HBO treatment I hope one here can help me. I have to have two maybe three teeth pulled both upper and lower molars on the side where I was radiated. My Ent told me yesterday that maybe after the teeth are pulled that i might need HBO, although there is not a site for this treatment in the city in which I live, This whole ORN thing has gotten me scared shitless and I do not know how to procede however I do know that i sit here intears and agony my teeth hurt so bad, I am running dangerously low on pain meds, I need good advice fast. I hope someone can please offer me some advice and or suggestions.
Once again thanks so much lenny

My husband (BOT SCC--finished treatment June 04) has had HBO treatments and after that a round of CIPRO (antibiotic)& finally acheived healing of exposed jawbone after 18 months of waiting. (Bone was exposed due to tooth extraction done just 5 days prior to start of radiation.) We had just about given up on healing and were very concerned about his pain and narcotic use. Things were looking great for several weeks after the eventual healing, but several weeks ago, a strange looking area has appeared in his mouth. Looks like a raw place and has a white cover/"skin" over it until washed away with syringe (no needle)and water. Goes to doctor on June 12 and may have to have another biopsy to check it out. Afraid they may decide this is bone death/ORN and procede w/ jaw replacement OR that it might be recurrance of cancer. Anyone had this problem?

I am currently doing HBO treatments, I had much tooth pain along with a small piece of exposed bone on my inner gum. They have increased my HBO treatments to 40 from 30 , that is 30 before 10 after, I have, as of yesterday completed 21 treatments. I was told by the nurse at the HBO center at Millard Fillmore Hospital in Buffalo that the benefits are permanent(so many conflicting views). This much I do know, the pain in my teeth is gone, the bone is still exposed (but they said that this may take some time and I now have temporary Myopia (eye sight is a mess) and my wallet is much thinner after having to drive 150 miles round trip daily. I now question if I should have those 2/3 molars pulled after 30 treatments since my teeth feel fine. As far as cost it is expensive , about $2000.00 a treatment and insurance companies can be assholes about this especially if it is out of their "service area". I told those morons that if it was available here why would I want to drive 75 miles each way and have to be there by 8am. One angry call from my GP as well as a well crafted pissed off letter by her worked wonders. The next day three different people from my insurance company called to give me the approval news.
lenny

I met with my radiation oncologist at Mass General this week and she said that the risk of ORN is greatest when the radiation treatment plan calls for more than 70 Gy's of radiation. She also said that since the risk of ORN is ongoing, that it is important to be followed long term. - Sheldon

i am 4 weeks into radiation and wound up having all 4 of my wisdom teeth removed and radiation pushed back one week to allow for healing all to prevent any future ORN issues in chance these teeth needed to come out one day. after reading this chain i better appreciate why it was recommended