Results of post radiation teeth extraction, implants and HBOT

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!

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

Hi @pauley thank you for sharing your story. It really hit me hard. I too have a dentist who I feel does not/did not understand the ramifications of pulling teeth after radiation. I really liked my oncologist however I felt like he brushed over the whole radiation and teeth issues from the beginning as I had no idea all this could happen when I began radiation. It would be nice if a dentist had to sign off to your oncologist that at the time all is well in your mouth. My oncologist just said I should see my dentist before I started radiation, which I did.
I had a dental cleaning right after completing radiation and my dentist was aware I had been through radiation. That being said a year after completing radiation I had a lower molar giving me problems she told me it needed to be pulled, so she pulled it. I saw my new oncologist just a few days after extraction (at the same practice, as my first oncologist had left) he was livid that he was not included in the decision to pull the tooth. I asked why and he told me about the possibility of it not healing and developing ORN. I asked what happened if it didn’t heal and he told me it would start with HBOT. Luckily for me it healed just fine. So now a year later I’m dealing with several other teeth my dentist says need to be removed. She sent me to the oral surgeon this time.
I am so very sorry this happened to you. It’s so discouraging to know that our medical insurance will not cover all that could and does happen to our teeth and jaw bone after radiation. I truly wish you had known about the possibility of HBOT, perhaps it could have changed your path and saved you a lot of pain and suffering. I’ve been researching HBOT and I’m hopeful that it will help to prevent any tissue or bone damage from the trauma of extracting teeth, my oral surgeon and my oncologist are strongly encouraging it. So please know that your journey lets me know that I do have to try it, so thank you for that. I wish you all the best! Take care and please let me know how it goes after getting your prosthetic teeth.
For anyone reading this HBOT dives in my area are $4500 for 30 dives, this is through a facility not linked to a hospital or wound care center.

@lanig Your story about oncologists not taking teeth issues too serious and dentists not responding well either, very common it seems. Many oncologists have limited experience if any with head and neck cancers, particularly as it pertains to mandible and teeth issues as I have observed. My oncologist, well respected and highly experienced, yet it turns out I was his first head and neck patient. When I ask patients to ask their oncologist about specific experience in head and neck, often a referral is then considered.
Dentists as well can vary. I am fortunate now to have a dentist with other experience in radiation damage as well as a keen curiosity in learning any and all he can about cancer treatment damage as it relates to dental issues.
I don't blame the dental community nor the oncologist of the world. Head and neck cancers, while common on these pages, is still a rather rare malady. Ask your personal physician how many head and neck cancer patients he/she has had over the years. Likely you are the only one. How many cancer patients inclusive? Usually less than one per year.
In our world cancer is prevalent. But in the general population, we are rather unique. Your dentist has learned from your experience, particularly if you share what you can with the dentist and dental team. Your oncologist likely learned a great deal from your treatments, which although it didn't do you much good, certainly will improve the treatments of others in the future. We can be upset. We can be angry. I certainly was. Or we can chose to help out by working not only with patients but with our healthcare team as well. We are doing that here on these discussions. You are helping others by your experience to which we are all enlightened.
I wish you well my friend. Good healing. W

@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.

@jw9 I’m so sorry I thought i replied to you but it didn’t post. Thank you for sharing your journey, 34 is so very young. Yes the HBOT is more of a preventive measure as I do not currently have ORN. It is supposed to stimulate red blood cells in the tissue and bones to help with healing as per my oral surgeon.

I did join the Osteoporosis and bone health group here at the Mayo Clinic. Lots of good information. Appreciate your response, take care!