IT'S BEEN 13 yrs now and now my tooth needs to be removed but the Oral surgeon "won't touch it". He is afraid of the complications that could happen?.He mentioned the hypobaric machine at USC but Pacificare Dental insurance will not cover. I am in extreme pain right now and I don't like to show my son's the agony i'm dealing with. I live in Fountain Valley area of Ca. Does anyone know of someone I can contact? Please, Thank You......

Will your medical insurance cover the cost of the HBO treatments? The need for it is a direct result of your medical treatment, after all.

Dave,

The HBO treatments take time and are costly. They often recommend 20 treatments before oral surgery, and an additional 10 afterwards at a minimum. I had RT in 2006 and they determined that my jaw bone has already deteriorated, and I was having some problems, so my doctors recommended that I undergo HBO treatments. I completed 45 treatments just recently. The cost was covered by my medical insurance, not dental.

These are daily treatments, typically Mon-Fri, so you would need a minimum of 4 weeks before any type of oral surgery. If possible, find an oral surgeon who has treated OC patients who have had radiation. I�m from the east coast, so I don�t have a recommendation for you, but there are a number of OCF members you are from CA so they may be able to give you a reference.

Good luck � and don�t take no for an answer.

Hello,
I do not know anything about the HBO treatments. If you have not checked with your medical insurance company yet call them to see if your tooth issue will be covered under your medical insurance. I know in my husbands case everything we have related to dental due to cancer/radiation damage is covered through medical insurance. Although, it's not been 13 years.
As for finding a dentist or oral surgeon check out Loma Linda University. You could also check out the University of California,Irvine. I have the number for the Head and Neck Dr. we got our 2nd opinion from(he was great)there. You could call his office and explain your situation. I'm sure they have a dental group there they use for all these type of side effects their patients have. We saw a Dr. Armstrong and his number is 714-456-7017.
Good luck.
Sincerely,
Tamara
Caregiver to husband with oral cancer

Dave,

The damage to the bone from radiation is called osteoradionecrosis (ORN for short). My doctors needed to provide this diagnosis to my medical insurance company in order for them to approve treatment and payment.

Minor correction: ORN is not typical damage and is not normally a side effect of radiation. It is a potential problem due to decreased blood circulation in the bone due to radiation. Major dental work like extractions can have several side effects which are minimized with HBO "dives". Hyperbaric Oxygen therapy works by temporarily causing an increase (through vascular improvements) in blood flow to radiated tissues.

Dave,

Hyperbaric Oxygen Treatments are in fact covered by medical carriers as opposed to dental. Some carriers still consider the treatment to be "experimental" and balk at covering. You quite possibly would need a "letter of necessity" from your doc which should be no problem. It is my information that there is an approximate 25% chance of ORN occurrence to the mandible if you have undergone radiation treatment. The ORN can come about if the mandible suffers any form of trauma to include a tooth extraction. I fell into that percentage but also fell into the "less than 5%" chance of ORN even with a total of 30 HBO treatments.

Bill D.

Dave,

I too am having a tooth pulled that was in direct line of my radiation treatments. My Oral Surgeon has set me up for the 30 HBO treatments. His statistics show that death can occur in up to 5% of patients that do get ORN. You fought for your life once, no need to do it again.

All the best,
Rob J.

As long as we're on the subject, after radiation, ORN can be caused by the vasoconstricter effects of novocain (makes the novocain stay in the local tissues longer) For this reason we all should ask for local anesthetic that does not cause vasoconstriction. Carbocain I think is the name of one such local anesthetic. Perhaps Jerry the Dentist could elaborate.

Speaking from my own experience of someone who has had ORN and am still going through treatments 16 months after being diagnosed with it, I would do anything and everything where possible to prevent it from happening.

During my extensive surgery in April 2007 to remove a tumour from my tongue (ulcer underneath my tongue) the surgeon accessed my mouth to remove the tumour by cutting my jaw (mandible) down the centre -opened my jaw up like a door, closed it and then they put it back together with some metal clips. It is my belief that the reason that I then got ORN is because of the area around the jaw split and the teeth on either side of the jaw split which probably had not healed properly before radiation was started.

Finding out that I had ORN after having to deal with surgery, radiotherapy and chemo was just unbelievable, I thought I had been through it all and it was time to start the recovery process, WOW was I wrong.

Karen