Hyperbaric Treatment for Osteonecrosis of the Jaw

If you have ONJ you will need to see a Maxillofacial Surgeon. One of the treatment options for ON of the Jaw is hyperbaric medicine. I do not have ON of the Jaw but when I was living with my parents in PA I went to their dentist who trained at Temple University in Philadelphia. The dentist said during training in dental school he had worked with many patients with ON of the Jaw. As part of the patient’s treatment plan they often recommended hyperbaric treatment for ONJ with successful results. If you have ON of the Jaw I think it’s something you should DEFINITELY look into.

Here is a recent paper released in July 2012 by the American Association of Oral and Maxillofacial Surgeons concerning Hyperbaric Oxygen treatment:

The email of one of the contributing doctors is listed below. It never hurts to contact someone!

What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics.

Freiberger JJ, Padilla-Burgos R, McGraw T, Suliman HB, Kraft KH, Stolp BW, Moon RE, Piantadosi CA.

Department of Anesthesiology, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC 27710, USAjohn.freiberger@duke.edu

This study tested hyperbaric oxygen (HBO) as an adjunct to surgery and antibiotics in the treatment of bisphosphonate-related osteonecrosis of the jaw (ONJ) and evaluated its effects on gingival healing, pain, and quality of life.


The investigators implemented a randomized controlled trial and enrolled a sample composed of patients with ONJ, where the predictor variable was HBO administered at 2 atm twice a day for 40 treatments as an adjunct to conventional therapy of surgery and antibiotics versus conventional therapy alone. Over the next 24 months, oral lesion size and number, pain, and quality of life were assessed.


Forty-six patients (mean age, 66 yrs; 57% women) contributed data to the trial. There were no statistically significant differences in the distribution of variables used to assess randomization success between the HBO and standard treatment groups. Seventeen of 25 HBO-treated patients (68%) improved versus 8 of 21 controls (38.1%; P = .043, χ(2) test). Mean time to improvement was 39.7 weeks (95% confidence interval [CI], 22.4 to 57.0 weeks) for HBO-treated patients versus 67.9 weeks (95 CI, 48.4 to 87.5 weeks) for controls (P = .03, log-rank test). However, complete gingival healing occurred in only 14 of 25 HBO-treated patients (52%) versus 7 of 21 controls (33.3%; P = .203, χ(2) test), and time to healing was 59 weeks (95% CI, 42.8% to 75.8%) for HBO-treated patients versus 70 weeks (95 CI, 52.2% to 88.36%) for controls (P = .32, log-rank test). Pain decreased faster for HBO-treated subjects (P < .01, linear regression). Quality-of-life scores for physical health (P = .002) and perceived health (P = .043) decreased at 6 months for control group but for not the HBO group.


ONJ is multifactorial and no single treatment modality is likely to reverse it; however, it is treatable and even advanced presentations can improve with intensive multimodal therapy. Clinically, HBO appears to be a useful adjunct to ONJ treatment, particularly for more severe cases, although this study was underpowered to fully support this claim.

4 thoughts on “Hyperbaric Treatment for Osteonecrosis of the Jaw

  1. This is very interesting. Dr. Glueck has published about ONJ and FVL hetero and heparin… Since the use of bisphosphonates in postmenopausal women against osteoporosis, however, the less severe, less obvious cases (for example, not presenting with exposed bone) are perhaps not even diagnosed. The actual definition of ONJ might be changing in the minds of oral surgeons, at least according to my experience last month at UCSF. So perhaps I must wait and see the surgeon Dr. Glueck recommends.

  2. Hyperbaric Oxygen therapy has been shown, in very few chances, to be successful at treating all types of AVN.

    There have been at least 3 studies (that I know of) that illustrate this specifically in femoral head necrosis.

    The way it acts is by increasing the oxygen in the blood and stem cells which leads to re-vascularization. It makes that it is approved for non-healing wounds and osteomyletis, among other maladies for this reason.

    I wonder why it hasn’t been approved for AVN everywhere? One of the studies done in 2003 in Israel found that after 100 consecutive days of HBOT 7 of the 9 hips in the study returned to a 100% normal MRI. 100 days sounds like a lot but for an AVN sufferer that’s a miracle!

    It works best in the early stages (1 and 2) but if you combined treatments or received some other treatment (like an FVFG for your femoral head, or an osteochondral allograft for your hip) I am sure it would help in the re-vascularization process. In fact I think any individual (who can afford it or find a way to afford it!) should use hyperbaric oxygen therapy in combination of whatever treatment they get with their AVN.

    Anyways, enough for that. Cool blog. Good luck with your AVN!!!!!!!!!!! ❤

    Comporesi. 2010. Hyperbaric Oxygen Treatment in Femoral Head Necrosis.

    • John,
      I’ve been trying to write on your blog, but it won’t let me post a comment using my wordpress account. You can probably see a deleted comment by me, it wants to use my gmail address, which I don’t want to post under.

      I’m really impressed by your blog, your research, etc. Thank you for checking out my blog. Where do you have AVN? Are you located in the U.S.? I was thinking not based on your URL. If you’re not comfortable answering those questions on here you can email me directly. I will definitely be linking off to your site. There are other sites that would probably be interested in your blog too. I would like to chat more!

  3. I have Osteonecrosis of the Jaw due to Zometa treatments. The Zometa was for skeletal damage due to Multiple Myeloma. I was being given the standard treatment by a Oral Surgeon which is monitoring and a wound treating mouth wash used twice a day. After 18 months of no progress in healing. my Oncologist recommended Hyperbaric Oxygen Chamber (HOC) treatments. I had 12 2 hour sessions at 2 atmospheres, before Medicare refused to cover the treatments. My secondary Insurance won’t cover any treatments that Medicare won’t cover as primary. It was healing but progress has stopped. I can’t afford the HOC Treatments without Insurance.. Medicare will cover Osteoradionecrosis but NOT Osteonecrosis treatments. Has anyone managed to appeal the Medicare decision NOT to cover HOC for Osteonecrosis?.

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