Results of post radiation teeth extraction, implants and HBOT

@lanig
Sorry for all you're going through. It sounds like you have good medical providers in a tough time. I thought I saw this post before....so I'm hoping if there are others who can comment on the implants you will hear from them here.

I had salivary cancer when I was 34. I had surgery and radiation because it was Stage II and they couldn't get a clear margin. Most people were much older than me in the waiting rooms and they had lost their teeth. So much has changed since then. I didn't listen to them. I was also someone who I thought took care of my teeth but after radiation I started using Phosflur mouthwash morning and night. I use a water pik and a gum stimulator.

Still, I ended up with gum disease. And wonder what's next. I hope you know that just by sharing, and then with replies, you are helping others learn about the process. I'm interested in they hyperbaric treatments (HBOT) Is the idea to oxygenate your gum tissues to boost healing? I will look again at the Head&Neck Cancer group to see if I can find other posts about implants.

Oh, when you are ready, I have found good info and support on the Osteoporosis & Bone Health group.
Thinking of you.

@lanig
I went to the home page of this group; Head&Neck Cancer Support. I searched for IMPLANTS and many post came up. No wonder I thought I saw it before!
I hope you find good help and support.

In 2003 I was diagnosed with Stage 4 tonsil cancer, a tumor in my right tonsil. Rather than surgically remove the tonsil I immediately underwent a huge dose of chemotherapy followed by 37 daily radiation treatments and weekly chemo. On my "tumor" team was an ENT surgeon, an oncologist, a radiologist, and a dentist. Before the radiation teeth guards were made and a head cage to hold my head still during the treatments. All went well until about 10 years out and jaw bone tissue started to deteriorate on the lower right side. Before any teeth could be removed or the dead tissue removed I underwent 30 hyperbaric dives. It took two dental surgeries to rid the dead tissue. I also had molars removed on upper left and lower right. This was all a result of the radiation. The reason for the dives is/was to promote healing. I have not had dental problems since all this work other than gum recession caused by dry mouth. Implants were not considered because of the chance the area would not heal properly and the difficulty of good dental hygiene afterwards. Good luck as you continue this journey to heal. I am ever so grateful to have had a dentist on my tumor team and his insistence that I not let a local dentist do anything with my teeth without first consulting him. take care!

Hyperbaric oxygen treatment as I understand will help heal live tissue and bone that was damaged by radiation. It will do nothing to bring back dead tissue however. You are relatively soon from treatment so likely oxygen treatment sounds like a good plan. Attaching implants to dead bone however is not a good idea, just a temporary solution. Dead bone or osteonecrosis will slowly be obsorbed by the body until the remaining bone fractures. At that moment it becomes critical.
My left mandible suffered from osteoradionecrosis for years after cancer treatment. Teeth cracked or exploded, roots got infected. X-rays showed progressive decay of the mandible over years. Eventually I had the mandible replaced with a section of my fibula and attached tissue. Not an easy surgery but the results are amazing. I had gold teeth installed to go with my new pirate smile and I look marvelous. Can eat anything now.
Good that you are being proactive.

@hrhwilliam
Hi Mr Olsen,
I last messaged you in Sept 2025 after my diagnosis of osteoradionecrosis. I had an initial local consultation with a recommendation for the Fibular Free Flap procedure but with lots of dire warnings about surgical complications of inability to eat well, speak well, and even the ability to cover the surgical defect due to my previously irradiated and permanently scarred neck.
As I mentioned previously, I’m a retired family doc and decided to do an extensive literature search on other approaches. By God’s grace I learned about Dr Michael Fritz at Cleveland Clinic.
He and his team of ENT and reconstructive surgeons have developed a “rescue” surgery for those with ORN. Initially I thought I would not be a candidate since I had progressed to an actual mandibular fracture but he offered me a “rescue plus” procedure which I underwent in early November. It involves a titanium spanner to stabilize the jaw, bone graft from the iliac crest (hip bone), and a skin and soft tissue free flap that gets placed over the bone and with microvascular attachment to blood vessels in the temple area—and all done from inside the mouth!!
3 days in hospital, soft foods within a week, up and moving immediately, and no need for extensive rehab.
I just got cleared for unrestricted diet. My bone graft is coming along well. The only downside is that I’m not able to get any dental implants to replace the 3 back teeth that are now gone, so chewing only on one side of my mouth. I can live with that!
This may be a good option for those with early stage ORN of the jaw. Unfortunately I don’t think it has caught on with the other medical centers yet but hopefully the numbers will bear out this approach and help avoid the Fibular Free Flap for some.
Enjoy life everyone and persevere!
Dr. Mike

@omaest

I’m guessing you had dry mouth ever since you completed your cancer treatment back in 2003?

Dry mouth and thick saliva were pretty much the first side effects and I'm sorry to say they haven't gone away.

@omaest

Thanks, that is what I figured as dry mouth is a big reason why the dental problems come or makes things worse. I was luckily enough to been researching it back in 2015 after having the brutal dry mouth for the seven prior years but found info. on it and after my research I tried ELECTRICAL STIMULATION ACUPUNCTURE which ironically was just being offered at my cancer clinic for head & neck cancer patients. I was tested to get a baseline and retested after 8-10 appts. and had great results. Never needed to go back and has been a non-issue even with only one working salivatory gland, and I don't have to carry a water bottle with me either to this very day.

Good luck on the journey.

Hi @lanig . I had to get several teeth pulled before they would start radiation. Then about 2 years after my 33 Radiation treatments, I had a lower left molar that was bad and needed to be pulled. I already had partial plates top and bottom since so many teeth had been pulled before radiation.
My dentist knew nothing about nor ever mentioned HBOT. Hine site taught me he should have. He pulled the tooth, added a tooth to my lower plate and sent me on my way. Within 6 months, my gum where the tooth was pulled flared up and I was sent to an oral surgeon.
One of the first questions the oral surgeon asked me, was if the dentist recommended HBOT. My answer was "what is that". He knew then I was in trouble. He did dig out a lot of "mush" bone from the spot and I was better for about 6 weeks.
Then I wake up one morning and someone had stuck half of a golf ball under my skin at that same spot... Terribly swollen. Back to the oral surgeon where he confirmed my jaw had fractured.
August 2, 2025 they did mandible flap reconstruction surgery. 10 days in the hospital, 6 of them in CCU. During the surgery, they actually inserted 6 posts for prosthetic bottom teeth. The procedure was remarkable. They used measurements from my head, neck and body scans and attached the post to the bone before removing the bone from my leg to use for my jaw.
Hopefully by June, I'll have teeth again. I have a great Dental Prosthetic doctor and if all goes well, I'll have teeth by June. They've done 2 Impressions so far and I go back next week for the next step.
Financial
I'm not sure what HBOT cost, but here is what not doing it has possibly cost me, physically and financially.
The Post Implants I mentioned earlier, $10750.00. The costs over and above my medical insurance for the dental part of the surgery, $2500.00. Insurance said teeth are not a quality of life issue.
The lower prosthetic permanent teeth, $26,300.00.
I was out of work (FMLA) for about a month.
Physically
The Jaw Reconstruction left me with pretty bad neck Lymphedema. I work on it daily and wear a neck sock every night to try to control it. Hopefully it will continue to improve so when I get my teeth I can open my mouth wide enough to get some crunchy food in.
The left side of my head, from and including my ear to my chin, has no feeling whatsoever. I'm slowly relearning where my mouth is when I lift a spoon to it. I still drool sometimes however not as much as I used to.
I say all of this to say, if HBOT will keep you from total Jaw Reconstruction, go for it. I would do my homework on the HBOT and hound the doctors for answers and probabilities. I wonder every day how my journey may have changed, if I'd had that chance.

God Bless and Prayer sent

@doctrygger Hi Doc. Thanks for the feedback. I would be interested in how that works long term. It sounds like an abbreviated version of my surgery.
Now five years out, other than an occasional removal of excess growth around the prosthesis, I have had no problems.
I am glad you had this addressed and hopefully in better shape now.
I will pass this information on to the oral maxillofacial group up in Rochester as they are always interested in new and better approaches to this delicate surgery. Thanks and good healing. W.