ADVANCED RECOVERY

Osteomyelitis- Bone Infection 

HBOT can help to heal bone disorders by stimulating both the osteoclasts and the osteoblasts. This helps and leads to the re-absorption of dead bone and the creation of new bone. In addition, HBOT stimulates the production of new blood vessels, so that the growing bone receives a steady supply of nutrients, including oxygen. This blood vessel network does two other things: it helps support the function of the osteoclasts and brings infection-fighting white blood cells to the area. Osteomyelitis is a bacterial infection that usually involves both the outer layers of the bone and the inner bone marrow. Staphylococci is a common form of bacteria that can cause infections ranging from pimples to meningitis. Chronic osteomyelitis may follow an acute form or may develop over time; this is also when the acute form is not completely cured by treatment. Long-term Osteomyelitis which in some cases continues for years. Refractory osteomyelitis is a term referring to the condition of bone infection that did not respond to either surgical or antibiotic therapy. Part of the difficulty in treating osteomyelitis lies in the fact that it causes a lack of oxygen in the tissues. HBOT, by providing forced oxygenation, helps fight this disorder along with antibiotic therapy and or surgical intervention. Hyperbaric Oxygen Therapy helps preserve healthy bone, restore, and help build new bone and helps with the immune system. In some cases, in both bones and wounds, HBOT draws a clear line by which the surgeon can aid in the removal of dead or diseased bones. These types of infections can occur sometimes in the extraction of a tooth.

Benefits From Hyperbaric Oxygen Treatment

HBOT increases oxygen tension in infected tissue including bone, to normal or above normal levels. Can increase oxygen saturations of plasma around infected areas that have some remaining degree of diffusion, encouraging healing.

Conditions Benefitted

• Osteomyelitis
• Osteoradionecrosis
• Non-healing wounds
• Non-healing infection
• Post-oral surgery healing

Dental surgeons utilize HBOT Because of It:

• Significantly shortens the inflammation process
• Growth of new blood vessels (Angiogenesis)
• Increases oxygen perfusion area around wounds
• Increases new capillary growth
• Increases production and improves the action of osteoblasts and osteoclasts
• Helps prevent infection
• Enhances the ability of Leukocytes to remove bacteria and debris
• Potentiates the use of antibiotics and helps kill bacteria

Many patients, when following closely the prescribed protocol for Hyperbaric Oxygen Therapy notice the following cumulative benefits from the oxygen:

Provides adequate oxygen for fibroblasts-cells that make connected tissues/ and so promote healing and hypoxic tissue. Cells that remove dead bone (osteoclasts) need oxygen to function, and intermittent oxygen tensions of 30-40mmHg are needed to grow new blood vessels.

Hyperbaric oxygen is bacteriostatic (bacteria-stopping). Neutrophils require PO2 30-40mmHg to do their work against bacteria.

Augments in the effect of antibiotics such as Aminoglycosides, quinolones, and some sulfonamides.

Prevents polymorphonuclear (PMN) leukocytes (a kind of white cell) from adhering to damaged blood vessel linings, increasing the inflammation that often accompanies surgical treatment for refractory osteomyelitis.

HBOT Is Used Commonly Before and/or After Surgery

HBOT can help to heal bone disorders by stimulating both the osteoclasts and the osteoblasts. This helps and leads to the re-absorption of dead bone and the creation of new bone. In addition, HBOT stimulates the production of new blood vessels, so that the growing bone receives a steady supply of nutrients, including oxygen. This blood vessel network does two other things: it helps support the function of the osteoclasts and brings infection-fighting white blood cells to the area. Nerve repairing and quicker healing are also positive side effects many notice when undergoing HBOT. A good three-part treatment for bone infections include the use of antibiotics, surgery to remove the dead bone, and HBOT as a supporting or adjunct treatment. Many dental surgeons are using HBOT before and after surgery.

74 patients who needed teeth removed from high-dose radiated mandibles were split into two equal groups. One group underwent tooth removal with standard techniques and antibiotics, while the other group underwent 20 treatments before and 10 treatments after tooth removal through hyperbaric oxygen protocol with no antibiotics given at any time. After 6 months, those with exposed, nonhealing mandibles were considered to have osteoradionecrosis. The incidence of osteoradionecrosis was 29.9% in the antibiotic-treated group versus 5.4% in the hyperbaric no-antibiotic group (p=0.005). In addition, 8 of the 11 affected antibiotic patients required jaw resection and were given HBOT for resolution. Of the 2 patients from the HBOT group who developed osteoradionecrosis, neither required jaw resection, indicating a less severe form of necrosis. The 20/10 protocol has since become the standard treatment protocol for single and multiple tooth removals, as well as for surgery in any radiated tissue. (1985, Marx et al.)

Although Antibiotics will help kill microorganisms in the nonossified tissues around the focus of infection and surgery will remove the macroscopic portions of dead, infected bone, HBO improves host responsiveness by making the environments more favourable to WBC oxidative killing, neovascularization, and resorption, of dead, infected bone (reproduced from Strauss 1987, by permission) K.K. Jain, The Textbook of Hyperbaric Medicine, 5th ed, pg 146

Moorey et al (1979) treated 40 cases of Chronic osteomyelitis using HBOT, with 89.5% of these patients becoming free from clinical signs of osteomyelitis. Jamil et al (2000) showed marked improvement for 9 patients with osteomyelitis of the Jaw.