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November 10, 2009
by Wound Healing & Hyperbaric Center at St. Cloud Regional
Articles
You would think that after surviving cancer, having a tooth extracted would be as easy as a walk in the park. Yet people who undergo radiation therapy of the head or neck are more likely to be at risk for osteoradionecrosis (ORN), delayed bone damage caused by radiation, which is most commonly found in the mouth.
"The extraction of teeth in a previously radiated jaw accounts for nearly nine out of 10 cases of trauma induced mandibular radionecrosis," explains Dr. Robert Bartlett, senior medical advisor for National Healing Corporation whose Wound Healing Centers around the nation treat the condition. "It seems counterintuitive when cancer survivors gauge success in the passage of time, yet there is greater risk of ORN five years after radiation versus one year later since the degenerative process is progressing beneath the surface without any outward sign."
The Wound Healing & Hyperbaric Center at St. Cloud Regional, a National Healing Corporation Wound Healing Center, uses leading edge hyperbaric oxygen therapy (HBOT) to treat ORN. Unlike the tedium of sitting in a dentist's chair, patients watch movies during treatment while relaxing on a bed incased in a large see-through plastic shell as they are surrounded by 100 percent oxygen at higher-than-normal atmospheric pressure. The therapy enables oxygen molecules to pass through the plasma to the tissue more easily and speed healing.
"Microorganisms begin to impact the surface of irradiated bone in the mouth," Bartlett says. "This makes ORN a matter of wound healing rather than infection and these problematic wounds do not require the same type of topical management."
Complications from ORN can result in intractable pain, difficulty opening the mouth, bone fractures, nutritional deficiencies caused by difficulty eating, chronic wounds and the loss of large areas of soft bone and tissue.
The local experts at The Wound Healing & Hyperbaric Center at St. Cloud Regional recommend the following for preventing, identifying and treating ORN:
- ORN is often not visible and may be diagnosed by x-ray, CT scans, MRI or biopsy. The doctor may ask for your radiation therapy records to determine exact location and dose of radiation you received.
- Patients considering radiation therapy of the head or neck should consider a pre-radiation dental consultation to optimize oral health.
- ORN risk factors include inadequate healing time between undergoing oral surgery and starting radiation therapy, extractions within irradiated bone, alcohol and tobacco use and nutritional factors.
- Quit smoking. Radiation is successfully used to treat many types of head and neck cancer caused by tobacco use and the jawbone is the most common site of ORN because the bone receives poor blood flow due to its density and also because teeth are present.
- The most common symptom of ORN is bone pain. Hyperbaric oxygen therapy can help in pain management if the pain is due to ORN and not recurring cancer or other causes.
- Patients who are currently receiving chemotherapy must have a thorough review by a hyperbaric physician before being treated for injuries since some drugs may have adverse affects.
For more information about ORN and treating and preventing chronic wounds, contact The Wound Healing & Hyperbaric Center at St. Cloud Regional at (407) 892-2388, visit www.woundcare.stcloudregional.com, or stop by 2912 17th Street, St. Cloud, Florida.
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