Dose and delivery of radiation; generally speaking, higher doses of radiation are more likely to result in ORN, especially when doses exceed 65 Gy. While minimizing radiation doses and avoiding excess radiation to bone can reduce ORN, there does not appear to much evidence that different radiation strategies (i.e. conventional radiotherapy, IMRT, brachytherapy) reduce risk. Smoking; tobacco use is associated with significant increases in risk of developing ORN. This increased risk is attributed to the vasoconstrictive properties of nicotine, which coupled with damage to endothelium by radiation, exacerbate the decreased perfusion of affected tissues. Diabetes mellitus; diabetes is a known cause of microvascular disease, which similar to smoking, can worsen the blood supply and perfusion to tissues affected by radiation. Dental disease and extractions; patients with poor oral hygiene and dental disease prior to radiation, including edentulous patients and those with dentures, are more susceptible to developing ORN. Diseased teeth near the radiation field may need to be extracted, and should be evaluated prior to radiation treatment. Staging
The staging system can be useful as a baseline reference for management after a definitive diagnosis of ORN has been established. Prevention and management
There is currently no universally accepted prevention and management of ORN and in many cases depends on how severe the condition presents. Currently, there are many preventive approaches for ORN proposed, but yet to be justified by high quality evidence. Studies have been conducted to measure effectiveness of current interventions. However, there lacks evidence to conclude that one approach is more effective than others.
It equally affects men, women, and all races. PKD occurs in some animals as well as humans. See also
Autosomal recessive polycystic kidney disease

References
Further reading


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