Clinical controversies in oral and maxillofacial surgery: Part one. Management of dental extractions in irradiated jaws: a protocol with hyperbaric oxygen therapy.

Abstract

Dental management of patients who are about to receive, or who have completed a course of therapeutic radiation involving the jaws, remains a perplexing problem. The center of debate is whether to extract teeth before radiation therapy or to manage them more conservatively and preserve the dentition to the greatest extent possible. The principal concern in this debate is how to minimize the risk of developing the mosl destructive complication associated with head and neck radiation, osteoradionecrosis (ORN). Tumoricidal levels of irradiation damage all tissues exposed. The accepted cause of ORN is progressive obliterative endarteritis and fibrosis resulting in hypovascular, hypocellular, and hypoxic tissues that can necrose spontaneously or in response to trauma. The incidence of ORN after radiation is reported to be widely different in several studies, ranging between 2% and 85Y0.‘~~ The causal relationship between dental extractions and ORN has been discussed by several authors.‘-“ Beumer et al” reported that the most common factors associated with ORN were postradiation extractions (26.5%), spontaneous bone exposure associated directly with the dentition secondary to dental disease (22.8%), and preradiation extractions (20.4%). In