Below you will find answers to the following questions:
- What is Osteonecrosis of the Jaw (ONJ)?
- Can you elaborate on the risks of not doing the surgery? (Ignoring and not treating.)
- Why is Hyperbaric Oxygen (HBOT) important before surgery?
- What are the risks of having jawbone surgery without hyperbaric oxygen?
What is Osteonecrosis of the Jaw (ONJ)?
In layman’s terms, Osteonecrosis of the Jaw (ONJ) is a serious condition where the jawbone begins to die because it has lost its blood supply.
- “Bone Death”: “Osteo” means bone, and “necrosis” means death. Without blood flow, the bone cells cannot survive or repair themselves.
- Exposed Bone: As the bone dies, it may poke through the gums and become exposed in the mouth, which can lead to severe pain, swelling, and chronic infection.
- A “High-Wire” Condition: Without treatment, the jaw can become so weak that simple acts like eating or talking become dangerous “high-wire acts” due to the risk of fractures.
Can you elaborate on the risks of not doing the surgery? (Ignoring and not treating.)
Ignoring a virulent jaw infection while experiencing emerging blood coagulation issues creates a dangerous feedback loop. The infection and the blood problems do not exist in isolation; they actively worsen each other, significantly increasing the risk of life-threatening systemic failure.
The specific risks of not treating the infection surgically under these conditions include:
- Triggering Disseminated Intravascular Coagulation (DIC)
- Accelerated Bone Necrosis (Bone Death)
- Increased Risk of Major Thrombotic Events
- Structural Disintegration and Pathologic Fracture
- Inoperability (Missing the Window)
The details of medical risks are elaborated on below:
1. Triggering Disseminated Intravascular Coagulation (DIC)
A virulent infection in the jaw can lead to sepsis, where the body’s response to infection causes massive, systemic inflammation. In 2026, this is a known trigger for DIC, a severe condition where the blood’s clotting proteins become overactive.
- Widespread Clotting: Small clots form throughout the bloodstream, blocking blood flow to vital organs (kidneys, liver, brain).
- Paradoxical Bleeding: Because these clots use up all the body’s clotting factors, you can suddenly experience uncontrollable bleeding from even minor sites.
2. Accelerated Bone Necrosis (Bone Death)
Blood coagulation problems (hypercoagulability) can lead to “micro-clots” in the small vessels supplying the jawbone.
- Ischemic Bone Death: When these vessels are blocked, the already-infected bone is completely deprived of oxygen and nutrients, causing it to die rapidly (osteonecrosis).
- Antibiotic Failure: Even the strongest IV antibiotics cannot reach the site of infection if the blood flow is obstructed by clots, making surgical removal of the dead bone the only way to stop the infection.
3. Increased Risk of Major Thrombotic Events
Chronic oral infections are direct risk factors for major cardiovascular events.
- Stroke and Heart Attack: Bacteria from the jaw can enter the bloodstream and induce platelet aggregation, directly forming larger clots that can travel to the brain or heart.
- Pulmonary Embolism: Clots originating from the inflammation in your jaw or neck can break loose and travel to the lungs, which is a medical emergency.
4. Structural Disintegration and Pathologic Fracture
As the infection “eats” the bone without surgical debridement, the jaw structurally thins.
Spontaneous Fracture: The jaw can break during simple activities like eating or speaking.
Fistula Formation: The infection can create “tunnels” (fistulas) through the bone that erupt through the skin of your face or neck, causing permanent disfigurement.
5. Inoperability (Missing the Window)
If blood coagulation problems advance too far, you may reach a point where you are “too sick for surgery”.
- High-Risk Anesthesia: Significant clotting or bleeding disorders make any surgery—even life-saving ones—extremely dangerous due to the risk of intraoperative stroke or uncontrollable hemorrhage.
- Window for Reconstruction: Delaying surgery reduces the healthy bone left to anchor future grafts or implants, moving the treatment from a “fix” to a permanent “disability management”.
Clinical Summary: Ignoring these symptoms allows the infection to act as a “factory” for systemic inflammation, which is the primary driver of blood clotting disorders. Early surgical intervention—often paired with Hyperbaric Oxygen to restore blood flow—is critical to breaking this cycle before it becomes a multi-organ emergency.
Why is Hyperbaric Oxygen (HBOT) important before surgery?
Think of Hyperbaric Oxygen Therapy as the “ultimate rehearsal” that prepares the body for the main performance: surgery.
- Creating a “Safety Net”: Dead bone has virtually no blood supply, making it impossible for normal surgery to heal on its own. HBOT involves sitting in a pressurized chamber to flood the body with 100% pure oxygen.
- Rebuilding Infrastructure (Angiogenesis): This “super-charged” oxygen stimulates the growth of entirely new blood vessels—a process called angiogenesis.
- Ensuring the “Show Goes On”: By doing 6 weeks of of HBOT before surgery, we “re-awaken” the surrounding tissue. This ensures that when the surgeon removes the dead bone, there is enough healthy, oxygen-rich blood flow to actually heal the wound and prevent the necrosis from returning. Then HBOT continues for another 4 weeks, to keep the tissue vibrant during the healing challenge that follows due to the biofilm being disrupted.
What are the risks of having jawbone surgery without hyperbaric oxygen?
Clinical standards emphasize that treating a virulent infection—such as chronic refractory osteomyelitis—in the jawbone without the support of Hyperbaric Oxygen Therapy (HBOT) carries several significant risks. HBOT is not just a “bonus” for healing; it fundamentally changes the environment that allows virulent bacteria to thrive.
The primary risks of proceeding with surgery while a virulent infection is present, without utilizing HBOT, include:
1. Progressive Bone Death (Necrosis)
Infected bone tissue often suffers from severely restricted blood flow (hypoxia). Without the pressurized oxygen of HBOT, the body cannot deliver enough oxygen to sustain bone cells in an infected environment. This can lead to:
- Sequestrum Formation: Large pieces of the jawbone may die and separate from the healthy bone.
- Pathologic Fracture: The weakened, necrotic jawbone may break during or after surgery because it lacks structural integrity.
2. High Risk of Surgical Failure and “Non-Union”
Surgical intervention alone has an approximately 50% success rate for chronic bone infections.
- Failure of Reconstruction: If the plan involves bone grafts or implants, they are highly likely to fail in an infected, low-oxygen environment.
- Repeat Procedures: Without HBOT to “prime” the tissue, patients often face a cycle of repeated, unsuccessful debridements (surgical cleanings).
3. Systemic Spread of Infection (Sepsis)
Virulent bacteria, especially if they are resistant to standard antibiotics, can enter the bloodstream through the surgical site.
- Sepsis and Organ Failure: A local jaw infection can rapidly turn into a life-threatening systemic medical emergency.
- Brain Abscess or Meningitis: Because of the jaw’s proximity to facial spaces and blood vessels leading to the brain, an uncontrolled infection can migrate upward, causing permanent neurological damage or death.
4. Antibiotic Resistance and Biofilm Protection
Many virulent bacteria create “biofilms”—protective shields that standard antibiotics cannot penetrate.
- Antibiotic Ineffectiveness: Without the oxidative stress provided by HBOT to weaken these biofilms, even high-dose antibiotics may fail to reach the bacteria.
- Leukocyte Failure: Your white blood cells (leukocytes) require a minimum level of oxygen to kill bacteria. In an infected jaw, oxygen levels often drop below this threshold, essentially “disarming” your immune system.
5. Escalation to Major Disfigurement
If an infection is not halted before or during surgery, it can progress to the point where “conservative” surgery is no longer an option.
- Mandibulectomy: You may risk needing a total or partial removal of the jawbone (mandibulectomy), followed by complex microvascular reconstructive surgery using bone from other parts of your body (like the fibula).
Summary of HBOT Importance
By integrating HBOT, the success rate for treating these complex infections rises from 50% to over 85%. It works by:
- Killing anaerobic bacteria that cannot survive in high-oxygen environments.
- Stimulating new blood vessel growth (angiogenesis) to restore blood supply to the “dead zones” in the bone.
- Supercharging antibiotics, making them up to several times more effective at penetrating the bone.
What you will find in this current presentation: (This is very early drafting stage)
Please email me at Kim@MedFundraiser.org to participate in planning or donate.
