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.
Surgery: The procedures involved in the surgical management of ORN are as listed: Removal of small sequestra, sequestrectomy, alveolectomy with primary closure, closure of orocutaneous fistula and large resections. Surgical management is usually required in cases of advanced disease, or if conservative measures fail to work. Methods used to reconstruct anatomical structures involve plates, autogenous bone grafts, regional flaps and free tissue transfer. Vascularised bone flaps are known to be the most effective mode of reconstruction. Therapeutic approach
Research to treat ORN at a molecular level has increased with progress in the field of medicine. The pharmacological methods to treat ORN listed below were developed to treat the etiologic factors. Pentoxifylline is methylxanthine derivative that drives vascular dilation and increased erythrocyte flexibility, resulting in enhanced blood flow. It also contains anti-tumour necrosis factor α activity, and reduces the cytokine cascade that facilitates the process of ORN. However, pentoxifylline is not meant for the long-term treatment of ORN. Tocopherols can occur in various forms. Its alpha form, also known as vitamin E, has antioxidant properties which results in the inhibition of platelet aggregation. Alpha-tocopherol is also able to scavenge reactive oxygen species involved in the ORN disease process, by inducing cell membrane peroxidation. Clodronate is a non-nitrogenous bisphosphonate used in the treatment of numerous diseases, such as hyperparathyroidism, osteoporosis, and multiple myeloma. Clodronate functions by inhibiting bone resorption, due to the reduction in the activity and quantity of osteoclasts. Clodronate also acts directly on osteoblasts, which increases bone formation and reduces the growth of fibroblasts. == References ==