Author: Courtney Misher, MPH, BS R.T.(T)
Last Reviewed: November 03, 2023

What is osteoradionecrosis?

Osteoradionecrosis (ORN) is bone death caused by radiation. It is a side effect that can happen if you have had radiation to your head and neck area. ORN commonly affects your jaw bones. Radiation harms the healthy gums that cover your jawbone. The bone becomes exposed. Because the bone isn’t covered it is more likely to become infected or not able to heal.

What are the symptoms of ORN?

Some of the most common symptoms of ORN include:

  • Pain.
  • Swelling.
  • Sores or ulcers.
  • Trouble opening your mouth (trismus).

What causes ORN?

Radiation exposure can cause hypovascularization. This means that radiation can harm and sometimes destroy small blood vessels. These vessels supply the jawbone and nearby tissues with oxygen and nutrients to stay alive and to heal after injury. The more radiation you get, the more likely you are to get ORN.

Can I prevent ORN?

You can’t prevent ORN, but there are some ways to reduce your risk. Before you have radiation to your head and neck area, see your dentist for your routine cleaning, have any teeth that could be a problem in the future removed, and start daily fluoride treatments.

During and after radiation to your mouth area, practice good mouth care, continue daily fluoride treatments, eat fewer sugary drinks and foods, visit your dentist for regular cleanings, and take care of any new dental issues right away.

When should I contact my provider?

If you have gotten radiation to your head and neck area and have new symptoms including swelling, pain, or sores you should contact your provider right away. ORN can happen months or even years after your radiation treatments. If you need dental work done, you should talk with your radiation oncologist first. Having a tooth removed could cause trauma to your jawbone which can worsen ORN and cause infection.

How is ORN treated?

Treatment depends on how bad your ORN is. They include:

  • Antibiotics: At the first sign of infection, most providers will order you an antibiotic. This will control and treat the infection.
  • Surgery: Surgery can be used to remove the dead bone. How bad your case of ORN is will help decide what type of surgery you need. You may need to have bone and tissue taken from another part of your body to rebuild what was removed. In some cases, hyperbaric oxygen therapy is given before or after the surgery is done.
  • Hyperbaric Oxygen Therapy (HBO): HBO is the use of pure oxygen to help the healing of blood vessels and tissues. This treatment allows you to breathe in higher levels of oxygen to help speed up your body’s healing process.

ORN is a serious side effect that can happen after radiation treatment for head and neck cancers, but the symptoms can be managed. You and your care team will work together to decide the best way to prevent or treat your ORN.

Blanchaert DDS MD, RH et al. Osteoradionecrosis of the Mandible Treatment & Management. August 2017. Updated June 2019. Found at: https://emedicine.medscape.com/article/851539-treatment#d11

Fan H et al. New approach for the treatment of osteoradionecrosis with pentoxyifylline and tocopherol. Biomaterials Research. 2015; 18:13. Found at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552457/

Osteoradionecrosis. Oral Cancer Foundation Information and Resources about Oral Head and Neck Cancer. (n.d.). https://oralcancerfoundation.org/complications/osteoradionecrosis/

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