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Hyperbaric oxygen therapy saves patient’s jawbone

February 22, 2019

Hugh Christie’s diagnosis of tonsil cancer didn’t surprise the former chewing tobacco user. Nor was he surprised that side effects from the 35 radiation treatments used to cure the cancer would threaten the loss of his jawbone three years later in his dentist’s office.

“I work in a nuclear facility so I know what radiation does to you,” said Christie, a 61-yearold maintenance supervisor at Oak Ridge National Lab. “So I’m not surprised by any side effects that happen.”

David Stanley, MD, a vascular surgeon and director of the Wound Treatment Center at Methodist Medical Center of Oak Ridge, wasn’t surprised either. He said osteoradionecrosis or “bone death” due to radiation treatments, occurs in about 75 percent of patients who have a tooth extraction or jaw surgery without having first undergone hyperbaric oxygen therapy (HBOT).

“The jaw has less oxygen than any other organ, and once it’s radiated, it has marginal circulation,” said Dr. Stanley. “As long as it’s not injured or operated on, or a tooth is pulled, it gets by for a while – usually indefinitely – but if you break your jaw or pull your tooth, the repair itself takes more oxygen than the bone has available.”

That’s why HBOT works so well at healing the radiated bone and soft tissue. It stimulates the formation of new blood vessels, improves the flow of oxygen into tissues and increases the formation of fibrous tissues. In short, HBOT allows for an increase of 10 times in plasma oxygen concentration, thereby accelerating the healing process.

“Hyperbaric oxygen is probably the oldest protocol in the United States – maybe the world – for people who’ve had radiation, particularly on their jaws,” said Dr. Stanley, adding that the dental field has relied on HBOT since the 1950s. But if the dentist doesn’t know a patient has had radiation and extracts a tooth, Dr. Stanley said almost half of those patients will have “significant complications” up to and including the loss of their jawbone.
Dr. Stanley said he has personally seen a couple of patients over the years who lost their mandible after tooth extractions.

“That’s why it’s very important to let your dentist know in advance if you have had any radiation of the head and neck area,” he said. Christie had already been declared cancer-free last year when he bit into a piece of bread and broke a capped tooth. When his dentist tried to remove the crown, he saw Christie’s jawbone was exposed and sent him to Lindsey Nagy, DDS, an oral surgeon on staff at Methodist Medical Center, who referred him to the Wound Treatment Center.

“She didn’t want to do anything to it until I came here first,” Christie said. “It was not healing over the exposed bone. . . and she wanted to get that bone covered.”

It took 20 HBOT visits – five visits per week for four weeks – before the rest of the broken tooth could be safely removed. Christie then returned to Dr. Stanley for 30 more visits over six weeks to ensure his jaw was completely healed.

“On my first visit, I said, ‘everyone ought to do this at least once a week,”’ said Christie, who found the twohour sessions inside the clear, pressurized chamber incredibly relaxing. “In fact, I’ve never felt so good in my life. It did wonders not only for my jaw to heal, but also my blood pressure and my sense of humor. “You couldn’t ask for better folks,” Christie continued.

“I was 17 when I first met Dr. Stanley. He was a great doctor the day I met him, and I still have the same opinion of him and his staff today. They’re professionals. They took absolutely great care of me. I’ve never had anything but great care at Covenant. I trust the doctors and nurses in this facility [Wound Treatment Center], the hospital [Methodist Medical Center] and all of Covenant’s associated facilities.”

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