Gerald S. Fine, D.D.S.
Oral and Maxillofacial Surgery
Last month a general dentist called me to discuss a new patient. The dentist had noted at the initial examination an area of exposed bone on the lingual aspect of the mandible. The site was painless and the patient told the dentist that it had appeared a few months after dental treatment by her former dentist. The dentist wanted a second opinion and asked me to examine his patient.
The patient's medical history revealed that the patient had previously been treated for both breast cancer as well as a malignant salivary gland tumor. The lymphatic system of the head and neck had been treated with radiation therapy, included the mandible. My examination revealed a breakdown of overlying tissue and a symptomatic destruction of bone. My diagnosis was osteoradionecrosis(ORN) of the mandible, a condition of nonvital bone at a site of radiation injury.
ETIOLOGY: Osteoradionecrosis can either be spontaneous (39%) or the result of insult (61%). Bone insult can result through direct trauma such as tooth extraction [84%], biopsy [12%], denture irritation [1%], periodontal procedures or to the exposure of the oral cavity secondary to soft tissue necrosis.
CLINICAL SYMPTOMS: Pain, Swelling, Trismus, and Exposed Bone
TREATMENT: The current treatment protocol of osteoradionecrosis is:
Hyperbaric Oxygen (HBO) treatment is the process of breathing 100% oxygen in a pressurized environment resulting in increased oxygen delivery to the tissues. The patient was referred to the Norman Knight Hyperbaric medicine center at the Massachusetts General Hospital and is currently receiving hyperbaric oxygen. She is expected to have a complete and uneventful recovery. Since seeing this patient, a second patient with the diagnosis of osteoradionecrosis has been referred to our office. The treatment of many head and neck tumors by radiation therapy that may involve the mandible with-in the field of radiation is common.
It is very important that every patient receiving dental care should have a complete medical history taken and/or updated in addition to a thorough dental examination. If there is any history of tumor/radiation treatment as part of the patient's history, the portals of radiation therapy must be obtained prior to any treatment and appropriate action determined.
Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery