Tooth Extraction For H&N Patients Is Always A Major Risk Event

wbcgaruss Member Posts: 2,367 Member
edited February 2023 in Head and Neck Cancer #1

Anyone who has had head and Neck cancer and had radiation treatment in the head and neck area could be at risk for osteoradionecrosis (ORN), or bone death depending on where the radiation fields were and how strong the radiation was.

Please be extremely aware of oral and dental care moving forward after treatment. It is extremely important, especially with reduced saliva which has a big impact on overall oral health in the years moving forward after H&N treatment. And the less saliva you have the more impact it can have.

This is very important because the end result of osteoradionecrosis if they can't cure it with antibiotics or debriding and antibiotics is many times the major operation of removing a part of your jawbone and taking a piece of bone from another part of your body and grafting it in.

So whatever you do be vigilant with your oral care.

This is one of the after-effects of treatment specifically radiation treatment that hangs over us Head and Neck people and is a very real possible threat every time we need a tooth extraction.

Be sure to make your dentist aware if you were treated for H&N cancer with radiation and he can work with your radiation doctor to know the fields of radiation, the strength of radiation, and your personal level of risk for getting osteoradionecrosis.

Up to this point, the way this situation was dealt with was to get Hyperbaric Oxygen Treatments (HBOT) before the extraction, usually 20 to 30 treatments or dives as they are sometimes called, and follow-up treatments after the extraction approximately 10 in number. This aids in the healing process by increasing the oxygen content in the body--

The healing power of Oxygen through HBOT involves a number of repeated sessions to stimulate the growth of new blood vessels. With time, these sessions strengthen bones through the increase of blood circulation and flow of plasma, which carries red and white blood cells to fight infections.

This is still the standard treatment before extraction and from what I have read about it is proven to help and give you an edge so you don't have problems. It is not guaranteed that HBOT will totally eliminate the chance for ORN but it definitely puts the odds in your favor.

Recently I have seen my oral surgeon for a follow-up check and he tells me there is a new approach also for dealing with extractions for H&N people. So now we have another tool to use to help us pre-extraction of teeth and in the case of ORN.

New approach for the treatment of osteoradionecrosis with pentoxifylline and tocopherol

Background: Treatment of osteoradionecrosis (ORN) is not a straightforward task, and it is unpredictable. However, a combination of pentoxifylline; an antioxidant drug, and tocopherol (vitamin E) works as a potent antifibrotic agent and have shown recently both significant and impressive results.

Pentoxifylline improves the flow of blood through blood vessels.

Tocopherol also known as Vitamin E

Vitamin E (also known as tocopherol or alpha-tocopherol) is a nutrient that is found in every cell of your body. It helps your nerves and muscles work well, prevents blood clots, and boosts your immune system so it can fight off infections from germs.

From what I have researched this approach may not be widely used right now as opposed to the older technology of HBOT but it is certainly welcome to have another option. I feel that this is certainly worth sharing with our group. The oral surgeon group I go to is well-known and established with 7 doctors and 3 locations and has been established for 38 years. Each visit has been very positive and professional so I have confidence in them. I do want to contact them and get more information on this to share in the future.

My dentist and oral surgeon are very aware of my situation and work with my radiation oncologist. They are both knowledgeable of what effects radiation has on H&N patients. If I need an extraction I mostly go to my oral surgeon anymore unless my dentist decides he wants to handle it. If your dentist doesn't feel comfortable dealing with your situation you may want to look for a dentist schooled in H&N radiation effects and is comfortable helping you deal with it. This is very important for H&N patients.

I hope this information helps.

Take care, God Bless-Russ


  • Nancy24
    Nancy24 Member Posts: 72 Member

    Thanks for sharing this - I will pass it on to my husband. 6 years post treatment, he had a molar pulled. At the time we didn't know about HBOT. Very long story short: 11 months after the tooth was extracted, it still had not healed. Found an oral surgeon knowledgeable about H&N radiation effects and he immediately prescribed 30 HBOT sessions. They worked like a charm. At the point the oral surgeon was able to clean out dead tissue, etc., send my husband back for 10 more HBOT sessions. Everything has healed. So happy to hear there's another alternative.

  • wbcgaruss
    wbcgaruss Member Posts: 2,367 Member

    Nancy Thanks for telling us your husbands story.

    He is living proof this can happen and it is a serious issue. Thank God that he got the HBOT treatments and he has healed up perfectly I am so glad for you folks.

    Wishing You the Best

    Take Care God Bless-Russ

  • OregonGreen
    OregonGreen Member Posts: 7 Member

    Thanks for this information Russ, I'd never heard about this HBOT prior to finding this web site and dental care is a great concern of mine specifically since with severe trismus I am unable to even have my teeth cleaned. I wonder if it would help us to take vitamin E supplements daily? Sounds like it might be a good idea but will ask my dentist to be sure.

    Again really appreciate your sharing such great information.

  • wbcgaruss
    wbcgaruss Member Posts: 2,367 Member

    Thank you much OregonGreen I am so glad this information was helpful to you. It is fulfilling to me to know my efforts are not in vain and the information I share is helping others in some way.

    Your situation is certainly conpromised if you can't have your teeth cleaned and possibly low saliva flow due to treatment. How is it handled if you need a tooth extracted?

    Take Care God Bless-Russ