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We have a patient who underwent and completed a course of HBO for ORN of the jaw 3 years ago successfully. Oral surgery will need to do another tooth extraction and questioned if further HBOT would reduce his risk? Are there any thoughts or guidelines regarding this matter?
Dec 13, 2021 by Bill Khoury,
3 replies
Eugene Worth
Hi, Bill! Another great question. This has been debated for years in hyperbaric medicine meetings.

I had the opportunity to speak with Dr. Marx at several meetings. Their group had data out 5 years+ suggesting that the HBOT administered at the time of first extraction continues to be effective.

Feel free to read the article in the HBO knowledge base about ORN. That should give you some insight.

Here’s my opinion and practice habit. The answer for further treatment is, “It depends.” If the surgeon is simply taking out one or more mandibular teeth … I would not re-treat or add postoperative doses of HBOT. If the surgeon is going to do extensive debridement of the mandible, then I would strongly consider treating 10 times postoperatively. No preoperative treatment is necessary or shown beneficial.

So, that’s my opinion. This pathway served me well for many years. I can only think of a couple of cases where the mandibular tissue failed to heal using this. Most of the time, the reason is that the patient refuses to stop smoking or using chewing tobacco. We also had one woman with a weird parotid type tumor that was treated using neutron beams. This required nearly 80 HBO treatments to get her healed. Neutrons are much more destructive than the standard beam therapy.

One last item. I’m assuming that you mean further extractions of MANDIBULAR teeth. If maxillary teeth, there are plenty of alternate pathways to provide arterial flow to those teeth, no HBOT necessary at all.

Those are the caveats.

Best wishes,

Gene Worth
Dec 13, 2021
Elaine Horibe Song
Great insights, Gene!
Hi Bill, thanks for sharing this case. Here is a link to the ORN topic that Gene was referring to:

Dec 13, 2021
Thank you so much for the help!
Dec 13, 2021
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