Extractions should be completed with as little trauma as possible, and on simple extractions of mobile teeth
Primary closure for firm teeth, by a minimal periosteal flap and alveolectomy
An experienced operator
Possibly pre-operative hyperbaric oxygen for mandibular molars in areas of high radiation
Review 5 days post-extraction and weekly review after  until healing is complete. Antibiotics
Majority of studies on ORN have recommended the use of prophylactic antibiotic where extractions are needed post-radiotherapy, although there is no universally agreed choice, timing and course duration of antibiotic regime.In one study, it was discovered that cases after 1986, the incidence of ORN after extractions post-radiotherapy was 3.6% in antibiotic prescribed cases and 2.6-3.4% in cases where there is no report on the prescription of antibiotics, showing no difference in reducing the risk of ORN and possibly reconsidering antibiotic regime in preventing ORN. Hyperbaric oxygen therapy
Results since 1986 have shown of far lower rates of ORN incidence, even without HBO (3.1-3.5%) and even a slightly higher rate for HBO patients (4.0%). Prophylactic use of HBO has been recommended in some studies  with a Cochrane review suggesting evidence for some reduction in ORN. However, the use of HBO prophylaxis is not agreed by others due to the insufficient evidence. Majority of British maxillofacial surgeons who participated in a survey recommended prophylactic HBO but protocols are varied. Management
Conservative
Antiseptic mouthwashes: Mouthrinses such as 0.02% aqueous chlorhexidine and saline can be used in acute ORN together with analgesics and anti-inflammatory drugs.
However, it was during World War II that the subject first received serious attention and the pathogenesis of the disease was understood to be due to exposure to high altitude flights. Rapid altitude changes with accompanying changes in ambient pressure exposed the aircrews to an increasing number of episodes of sinus barotrauma. Referred pain from barosinusitis to the maxilla consists about one-fifth of in-flight barodontalgia (i.e., pain in the oral cavity caused by barometric pressure change) cases. Although the environment of fighter pilots produces the most stressful barometric changes, commercial flying has changed the picture of the disease. See also
Barodontalgia – Tooth pain caused by ambient pressure change
Barotrauma – Injury caused by pressure

References


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