Can the prophylactic use of pentoxifylline and tocopherol before dental extractions prevent osteoradionecrosis? A systematic review

Paiva, Gustavo Luiz Alkmin; Campos, Wladimir Gushiken de; Rocha, André Caroli; Lemos, Celso Augusto; Migliorati, Cesar A.; Santos‐Silva, Alan Roger

doi:10.1016/j.oooo.2023.01.005

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…It has been proposed that the prophylactic use of PENTO in irradiated head and neck cancer patients needing dental extractions may improve oral mucosa healing, therefore preventing ORN [22,27,[39][40][41][42][43][44][45][46][47]. A recent systematic review of four studies (Patel et al, Aggarwal et al, Samani et al, and Lombardi et al) that prophylactically used PENTO prior to dental extractions in order to prevent ORN estimated the ORN rate at patient level as 3.1% and at individual tooth level as 0.9% [31]. For the fifth study (liquid formulation of PENTO), where the majority of the patients (38/45) had only dental extractions carried out (one patient had both extractions and implant placed and the remaining six patients had implants placed), the ORN rate at patient level was 4.4% (2/45) [32].…”

Section: Discussionmentioning

confidence: 99%

“…There are only five retrospectiv case studies published on the prophylactic use of PENTO to prevent ORN: four studie conducted in Europe, one study in India and none reported in the U.S. Across four retro spective case studies that utilized PENTO in a tablet form, the ORN rate in patients wa Given these findings, it has been hypothesized that the prophylactic use of PENTO in irradiated oral and pharyngeal cancer patients needing dental extractions may improve oral mucosa healing, therefore preventing ORN [27][28][29][30]. There are only five retrospective case studies published on the prophylactic use of PENTO to prevent ORN: four studies conducted in Europe, one study in India and none reported in the U.S. Across four retrospective case studies that utilized PENTO in a tablet form, the ORN rate in patients was 3.1% (12/387), and at the individual tooth level, it was 0.9% (11/1269) [31]. The fifth study used a liquid formulation of pentoxifylline and tocopherol and the majority of the patients (38/45) had only dental extractions carried out; the ORN rate in patients was 4.4% (2/45) [32].…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic Use of Pentoxifylline and Tocopherol for Prevention of Osteoradionecrosis of the Jaw after Dental Extraction in Post-Radiated Oral and Oropharyngeal Cancer Patients: An Initial Case Series

Owosho,

DeColibus,

Okhuaihesuyi

et al. 2024

Dentistry Journal

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Osteoradionecrosis of the jaw is a morbid complication of radiotherapy in patients with oral and oropharyngeal cancers that may be precipitated by dental extractions. Pentoxifylline and tocopherol (PENTO) has been utilized in the management of osteoradionecrosis and as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. This observational study aims to report the outcome of the prophylactic use of PENTO in the prevention of osteoradionecrosis of the jaw after dental extractions in post-radiated oral and oropharyngeal cancer patients and to review the current literature on this topic. Four post-radiated oral and oropharyngeal oncology patients were referred to the dental oncology clinic of the University Dental Practice, University of Tennessee Health Sciences Center for dental extractions. All four patients were prescribed pentoxifylline 400 mg BID (twice a day) and tocopherol 400 IU BID (oral tablets) for 2 weeks before extraction(s) and for 6 weeks after extraction(s). All patients were followed up every week after the second week post-extraction if feasible until the extraction site(s) healed (covered by mucosa). The assessment endpoint was defined as 6 weeks post-extraction with the outcomes assessed as using four categories determined by the area of exposed bone: complete healing (complete mucosal coverage of extraction site); partial healing (reduction in size of extraction site); no change; and progression (increase in size of the extraction site). At the assessment endpoint, all patients had complete healing of all extraction sites. The ORN rate at the patient level (0/4) and individual tooth level (0/8) was 0%. All patients tolerated the PENTO medications and no adverse effects from the use of these medications were reported. This limited study in addition to the other reviewed studies estimates the rate of ORN at the patient level as 3.2% (14/436) for post-radiated head and neck oncology patients after dental extractions/invasive oral procedures. In conclusion, this PENTO regimen can reduce/prevent the incidence of ORN in post-radiated head and neck oncology patients. This safe and cost-effective protocol (PENTO regimen) should be further evaluated as prophylaxis for post-radiated head and neck oncology patients requiring an invasive dental procedure. We recommend large prospective studies to be carried out to further validate these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prophylactic Use of Pentoxifylline and Tocopherol for Prevention of Osteoradionecrosis of the Jaw after Dental Extraction in Post-Radiated Oral and Oropharyngeal Cancer Patients: An Initial Case Series

Owosho,

DeColibus,

Okhuaihesuyi

et al. 2024

Dentistry Journal

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“…Treatment alternatives combining pentoxifylline and tocopherol (PENTO) have been used for the treatment of ORN, with a complete remission rate ranging from 16.6% to 100% and an overall stable/improved rate >68% [ 78 ]. PENTO were also used for the prophylaxis of ORN, but the evidence for its effectiveness is insufficient [ 79 , 80 ].…”

Section: Osteoradionecrosismentioning

confidence: 99%

Oral Complications from Oropharyngeal Cancer Therapy

Sankar,

2023

Cancers

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Post-oropharyngeal cancer treatment complications include a multitude of oral side effects that impact overall survival and quality of life. These include acute and chronic conditions affecting the oral cavity and head and neck, such as mucositis, infection, xerostomia, dysgeusia, radiation caries, osteonecrosis, and trismus. This review will summarize the most common oral complications from oropharyngeal cancer therapy. The authors would like to point out that the literature cited frequently combines oropharyngeal and head and neck cancer results. If recommendations are made strictly related to oropharyngeal cancers, this will be highlighted.

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“…Similarly, the PENTO protocol has been proposed for the management of medication-related ORN of the jaw (MRONJ) [83]. The PENTO protocol has been proposed as a prophylactic therapy for ORN in patients requiring oral surgery procedures after undergoing head and neck RT, but very few data are available [84]. To the best of our knowledge, only three clinical studies had evaluated the effectiveness of PENTO as a prophylactic therapy for ORN [78,85,86] The PENTO protocol has been proposed as a prophylactic therapy for ORN in patients requiring oral surgery procedures after undergoing head and neck RT, but very few data are available [84].…”

Section: Pentoxifylline and Tocopherolmentioning

confidence: 99%

“…The PENTO protocol has been proposed as a prophylactic therapy for ORN in patients requiring oral surgery procedures after undergoing head and neck RT, but very few data are available [84]. To the best of our knowledge, only three clinical studies had evaluated the effectiveness of PENTO as a prophylactic therapy for ORN [78,85,86] The PENTO protocol has been proposed as a prophylactic therapy for ORN in patients requiring oral surgery procedures after undergoing head and neck RT, but very few data are available [84]. To the best of our knowledge, only three clinical studies had evaluated the effectiveness of PENTO as a prophylactic therapy for ORN [78,85,86] incidences after dental extractions in patients who previously underwent head and neck RT of 1.2% and 1.8%, respectively [85,86].…”

Section: Pentoxifylline and Tocopherolmentioning

confidence: 99%

Oral Surgery and Osteoradionecrosis in Patients Undergoing Head and Neck Radiation Therapy: An Update of the Current Literature

Corrao,

Mazzola,

Lombardi

et al. 2023

Biomedicines

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Osteoradionecrosis (ORN) is a serious long-term complication of head and neck radiotherapy (RT), which is often triggered by dental extractions. It results from avascular aseptic necrosis due to irradiated bone damage. ORN is challenging to treat and can lead to severe complications. Furthermore, ORN causes pain and distress, significantly reducing the patient’s quality of life. There is currently no established preventive strategy. This narrative review aims to provide an update for the clinicians on the risk of ORN associated with oral surgery in head and neck RT patients, with a focus on the timing suitable for the oral surgery and possible ORN preventive treatments. An electronic search of articles was performed by consulting the PubMed database. Intervention and observational studies were included. A multidisciplinary approach to the patient is highly recommended to mitigate the risk of RT complications. A dental visit before commencing RT is highly advised to minimize the need for future dental extractions after irradiation, and thus the risk of ORN. Post-RT preventive strategies, in case of dento-alveolar surgery, have been proposed and include antibiotics, hyperbaric oxygen (HBO), and the combined use of pentoxifylline and tocopherol (“PENTO protocol”), but currently there is a lack of established standards of care. Some limitations in the use of HBO involve the low availability of HBO facilities, its high costs, and specific clinical contraindications; the PENTO protocol, on the other hand, although promising, lacks clinical trials to support its efficacy. Due to the enduring risk of ORN, removable prostheses are preferable to dental implants in these patients, as there is no consensus on the appropriate timing for their safe placement. Overall, established standards of care and high-quality evidence are lacking concerning both preventive strategies for ORN as well as the timing of the dental surgery. There is an urgent need to improve research for more efficacious clinical decision making.

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Can the prophylactic use of pentoxifylline and tocopherol before dental extractions prevent osteoradionecrosis? A systematic review

Cited by 6 publications

References 19 publications

Prophylactic Use of Pentoxifylline and Tocopherol for Prevention of Osteoradionecrosis of the Jaw after Dental Extraction in Post-Radiated Oral and Oropharyngeal Cancer Patients: An Initial Case Series

Prophylactic Use of Pentoxifylline and Tocopherol for Prevention of Osteoradionecrosis of the Jaw after Dental Extraction in Post-Radiated Oral and Oropharyngeal Cancer Patients: An Initial Case Series

Oral Complications from Oropharyngeal Cancer Therapy

Oral Surgery and Osteoradionecrosis in Patients Undergoing Head and Neck Radiation Therapy: An Update of the Current Literature

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