This condition is caused due to bone death happening due to radiation. Osteoradionecrosis happens generally as a symptom of radiation treatment. Bone death happens when radiation treatment harms veins. A rare secondary effect grows after the radiation treatment has finished. This condition generally happens in the lower jaw or the mandible. The risk of the condition speculated in the lower jaw is very high on account of the restricted blood supply. In extremely rare cases does the condition affect the upper jaw or the maxilla?
Osteoradionecrosis is classified based on the type of tissue it affects, whether the treatment provided is of some use because of the limited blood supply in the area, and whether it has caused the fracture. The seriousness of the condition is reviewed from 1-3 typically as a Roman numeral. The treatment plans are based on what grade the condition is at.
| GRADE | DESCRIPTION |
| I | Destruction of the soft tissue which has exposed the bone underneath it |
| II | Osteoradionecrosis that does not respond to treatment |
| III | Osteoradionecrosis affects the entire thickness of the bone. Has caused a fracture in either one or both the bones. |
What are the causes of Osteoradionecrosis?
The essential explanation for the reason for the Osteoradionecrosis condition is giving radiation treatment deep down. It doesn’t occur right away and may happen solely after years in the wake of getting radiation therapy for head and neck cancers.
The higher the radiation dosage, the higher the risks of getting osteoradionecrosis. If the patient has received greater than 60 grays, there are high chances of having bone conditions.
The risk of Osteoradionecrosis is additionally more prominent assuming the fundamental dental tests and cavity fixes are not done previously or after the radiation treatment. Keeping up with great oral hygiene is significant. Patients having dry mouth conditions because of oral treatment are likewise powerless.
In the event that the patient has gone through any harm or injury to the jaw after radiation treatment inside the main year in the wake of getting therapy, the possibilities of getting Osteoradionecrosis are very high. The harm of injury can be caused due to,
- dental replacement irritation
- tooth extraction
- Mishaps
- Cancer medical procedure, or biopsy
The development of Osteoradionecrosis can occur even if there isn’t any damage or trauma to the mouth, jaw, or teeth. This is a rare condition, and the side effects might shift relying upon the grade and the degree.
- Pain
- trouble opening the jaw, or lockjaw
- a sore, or ulcer, in the mouth or on the jawless inclination in the mouth or jaw, or even a total loss of sensation nearby
- teeth that aren’t adjusted as expected, which is called malocclusion
- an unusual opening, or fistula, between the jaw and the outer layer of the body
- contamination
- enlarging
- the uncovered bone inside the mouth
- jaw break not connected with a mishap or other injury
- bone standing out through the skin, which is known as a sequestrum
- The uncovered bones are most frequently found under the jaw and these side effects ought to be accounted for to your PCP right away.
Diagnosis:
Once you tell your doctor that you are experiencing such a condition. Your doctor will first run a few tests to understand the underlying cause. To do such, different tests will incorporate an actual test, and a total head and neck test. The previous medical records will be reviewed carefully to find the amount of dosage that has been administered to you during the treatment and the area where you have received the treatment.
In addition to the aforementioned tests, you might also need to take an
- X-ray of the whole jaw
- MRI
- CT scan
- Biopsy of the area to check for the presence of cancer cells or on the other hand in the event that subsequent cancer has been created nearby.
Prevention:
The prevention methods to avoid the occupancy of osteoradionecrosis will be done by your healthcare team. The flowing measure should be undertaken on completion of the radiation therapy.
Before radiation therapy:
Visit your dental specialist and go through a dental test and get your teeth cleaned before you go in for radiation treatment. On the off chance that the expulsion of any teeth ought to be finished, or the holes to be filled do as such before the radiation treatment begins. Begin by utilizing everyday fluoride medicines. Any treants options that you consider doing should be discussed with your dentist or your healthcare team
During and after radiation therapy:
- Ensure that you practice great oral cleanliness and take great consideration of your mouth when treatment. The teeth and gums should be kept healthy so that it will speed up the healing process.
- Devour a sound eating regimen, for example, food sources and refreshments that are low in sugar.
- Go in for standard dental tests and make a point to fill any pits and the contaminations in the mouth ought to be treated at the earliest opportunity. If you want a tooth to be removed, do so after the treatment has been completed.
- For the prevention of any cavities from occurring, your dentist will recommend fluorine fluids. In case you have dry mouth conditions, ways to keep your mouth moist and replace saliva will be suggested to you.
Managing osteoradionecrosis:
When the seriousness of your not entirely set in stone, your kid’s medical services group will recommend ways and strategies to treat it proficiently. The child will be prescribed antibiotics in case any infection is found in the bone. One other option is to go in for surgery.
Surgery
A surgical debridement will be considered for the patient. This interaction includes the expulsion of the dead or contaminated tissue from around the injury. On the off chance that there is any dead or necrotic bone, it could likewise be eliminated. This is called sequestrectomy.
Contingent upon the area of the osteoradionecrosis and how far it has advanced, your PCP should perform a medical procedure in a manner to reestablish the impacted region. The medical procedure for the most part is a microvascular reconstructive medical procedure that further develops the bloodstream to the area. In the area where the jawbone is removed, it needs to be replaced with a bone graft. In places where infected tissues have been removed, soft tissue grafts will be used to replace them. Dental implants are also necessary in cases where teeth are removed.
Hyperbaric oxygen therapy
This treatment is done by causing the patient to breathe in and inhale unadulterated oxygen in a compressed room. The treatment takes place in a closed chamber where the pressure inside the cabin is higher than the one outside. Making one inhale such high-pressure oxygen is to make sure that the oxygen gets into your blood and teaches and heals every damaged and infected tissue in the body.
This therapy is utilized in blend with wound care and treatment and the therapy plan frequently incorporates 20 spitting before the beginning of radiation treatment and 10 sittings after the treatment. The plans of this treatment can be changed in view of the singular’s decision and how eel they answer Hyperbaric oxygen treatment. Endless supply of this treatment, your kid’s medical services group will conclude whether Hyperbaric oxygen treatment is required from you and on the off chance that there ought to be any teeth eliminated. One drawback is that this treatment is not available in all the centers.
Preventive regime:
Rather than going in for treatment after the condition has occurred, it is best to ensure that you maintain a high standard of brushing and that the brushing techniques are good. Those undergoing radiotherapy to the head and mouth might experience sore mouth, so it is recommended that one might use a soft bristle toothbrush. Use chlorhexidine mouthwash in addition to bruising your teeth and if it is too sore on the mucosa, you can dilute it with equal amounts of water.
The most common and much-preferred regime is either a fluoride toothpaste (Duraphat 5000), applying fluoride gel for 10 mins per day, or using alcohol-free mouthwashes. The oral hygiene and the real health of the patient should be taken into consideration and tailored accordingly. The back of the mouth should not be allowed access to the fluoride splints or trays. Due to the altered mucosal ulceration, some may even find it difficult to tolerate toothpaste and mouthwashes due to altered taste.
The patient should also be highly motivated to maintain their oral health and hygiene and be regular in attending dental appointments. Dental appointments are mandatory where the patient’s dental health will be monitored before, after, and during radiotherapy. The patient should have a clear understanding of the medications that have been recommended for their oral health to avoid further damage to their mouth and teeth. Saliva substitutes provided should always be pH neutral.
Antibiotics:
Recent studies on the condition have recommended the use of prophylactic antibiotics in cases where extractions were needed after receiving the treatment. The course of treatment duration and timing of the antibiotic has not been finalized yet.