When Radiation Damages the Jaw
Patients who undergo radiation therapy for head and neck cancers often face a devastating long-term complication called osteoradionecrosis, or ORN. Radiation damages the blood vessels that supply the jawbone, creating tissue that is hypovascular, hypoxic, and hypocellular. This means reduced blood flow, reduced oxygen, and reduced ability to produce new cells for repair. The jawbone becomes fragile and unable to heal normally.
Osteoradionecrosis can develop spontaneously or be triggered by dental procedures such as tooth extractions, implant placement, or even routine dental work in previously irradiated tissue. The bone fails to heal, leading to exposed bone, chronic pain, infection, pathologic fracture, and in severe cases, loss of significant portions of the jaw. Hyperbaric oxygen therapy is the most effective treatment for ORN and the standard of care for preventing it before dental procedures in irradiated patients.
How HBOT Restores Irradiated Tissue
HBOT reverses the radiation damage in jaw tissue through a process called neovascularization. By cycling between high-pressure oxygen in the chamber and normal atmospheric conditions between sessions, HBOT triggers the body to grow new blood vessels into the irradiated tissue. Over a course of 20 to 30 treatments, the vascular density in irradiated bone can approach 75 to 80 percent of normal tissue levels.
This revascularization restores oxygen delivery, bringing immune cells and nutrients back to tissue that has been deprived for years. HBOT also mobilizes stem cells that differentiate into osteoblasts, the cells that build new bone. The result is tissue that can once again support healing, whether from a dental extraction, implant procedure, or the ORN itself. For patients with existing ORN, HBOT combined with surgical debridement can halt the progression and promote healing of exposed bone. Learn more about HBOT for radiation injury recovery.
The Marx Protocol
The most widely used protocol for preventing ORN before dental procedures in irradiated patients was developed by Dr. Robert Marx. It involves 20 HBOT sessions before the dental procedure to rebuild the vascular supply, followed by the dental extraction or surgery, then 10 additional HBOT sessions after the procedure to support healing. This protocol has dramatically reduced the incidence of ORN following dental extractions in irradiated patients. Explore the evidence on our HBOT research library.
Treatment Protocol
Sessions are conducted at 2.0 to 2.4 ATA for 90 minutes each in a medical-grade chamber, typically delivered daily five days per week. Our physicians coordinate closely with your oral surgeon, dentist, and oncologist to ensure optimal timing of HBOT relative to your dental procedure. Read about what to expect at your first session.
Treatment at National Hyperbaric
Osteoradionecrosis and prevention of ORN before dental procedures are FDA-approved indications for HBOT and are covered by most insurance plans including Medicare. Our team, led by Dr. Allan Spiegel and Dr. Montana, has extensive experience managing these cases. Learn about choosing the right provider.
Contact us for a free consultation if you need dental work in a previously irradiated area or have been diagnosed with osteoradionecrosis. Visit our cost and insurance page and explore all conditions we treat. We offer travel for treatment support. Check our FAQ.