Osteoradionecrosis (ORN) of the jaws is most commonly defined clinically as an area of previously irradiated, devitalized, exposed bone that fails to heal over a period of three to six months, in the absence of local neoplastic disease. It is thought to be caused by radiation-induced firbo-atrophic tissue injury.1 ORN is associated with considerable morbidity and has important ramifications for the qualityof life of cancer survivors.2,3 Principal manifestations include pain, and, more rarely, dysesthesia and anesthesia.4 These may be further complicated by secondary infection and fistula formation, as well as dysgeusia, dysphagia, dyspnea, xerostomia, pathologic fracture and mechanical impairment of speech.4 Many classification systems have been devised in order to stratify the wide spectrum of clinical presentations of ORN; however, their adoption has been far from universal and none has been validated with large-scale clinical trials,5 posing difficulties for the comparison of controlled interventions and potential disparities in reporting rates.
The reported incidence of ORN in head and neck cancer patients with an absorbed radiation dose to the mandible or maxilla is highly variable.6, 7 Clayman 1997 found the overall incidence (not stratified by risk) before 1968 reached 11.8%, while it dropped to 5.4% between 1968 and 1992, presumably with the widespread adoption of more directed, high-energy supervoltage/megavoltage therapy.6 More recently, an incidence of 3% was reported in a sample of patients treated between 1997 and 2006.7 The true incidence may in fact be higher due to under-reporting of this condition secondary to inadequate or variable follow-up periods in published studies.8, 9
Original Author: Daniel E. Jolly, DDS, FAAHD, FACD, DABSCD, is in private practice in Columbus, Ohio. He is retired as Professor and Director of the General Practice Residency program at The Ohio State University College of Dentistry and University Medical Center. He has actively practiced dental care for people with cancer for over 30 years and educated the dental team over those same three decades. Dr. Jolly is a Fellow in the American Association of Hospital Dentists and the American College of Dentists. He also is a Diplomate of the American Board of Special Care Dentistry and has served as President of the American Association of Hospital Dentists and the Special Care Dentistry Association.
This course has been reviewed and revised by Christina (Christy) L. Ross, CDA, EFDA, MS
Christy Ross is an Associate Professor and Dean of Health Sciences at Ivy Tech Community College, in Columbus, IN. Ms. Ross has been a certified dental assistant for over 30 years. She worked in private practice in general dentistry, orthodontics, and pediatrics before switching to academia. She became the academic program director and clinical coordinator for Ivy Tech Community College, and progressed to becoming the Program Director for the Dental Assisting program and Dean of the Health Sciences at the Columbus, IN campus.
She serves as a Commission on Dental Assisting (CODA) Site Visitor, a member of the ADAA Council on Education and Professional Development and is an integral part of the Course Review Committee of the ADAA. Ms. Ross was instrumental in assisting the Sellersburg Campus of Ivy Tech establish a dental assisting program and complete the initial Commission on Dental Accreditation (CODA) self-study and the hiring of the Dental Assisting Program Chair.
Ms. Ross is currently completing her doctoral degree from Walden University in Baltimore, MD, and has her Master’s
and Baccalaureate degrees.
Upon completion of this course, the dental professional should be able to:
• Define Osteoradionecrosis (ORN).
• Explain the development of Osteoradionecrosis (ORN).
• Identify the signs and symptoms of Osteoradionecrosis (ORN).
• Describe how radiation affects the vascularity of the bone.
• List five preventive measures taken to prevent Osteoradionecrosis (ORN).
• Explain what role Hyperbaric Oxygen plays as both a prevention and treatment modality.
• Explain what Hyperbaric Oxygen is and how it benefits patients with Osteoradionecrosis (ORN).
CONTINUING EDUCATION CREDIT
The ADAA has an obligation to disseminate knowledge in the field of dentistry. Sponsorship of a continuing education program by the ADAA does not necessarily imply endorsement of a particular philosophy, product or technique.
The ADAA cautions participants taking this course on the hazards of using limited knowledge when integrating new techniques into their practices.
Credits earned upon completion of the course may be used to meet DANB’s Recertification Requirements.
CONCERNS OR HELP
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