Does Pentoxifylline and Tocopherol Prophylaxis For Extractions Reduce the Incidence of Osteoradionecrosis?

Fadi A. Farsakh

Alex Takshyn

Joshua JH Kim

---

Farsakh, Fadi A., Takshyn, Alex, Kim, Joshua, JH
Faculty / Advisor: Habib, Rania, Shanti, Rabie M.
University of Pennsylvania School of Dental Medicine, Department of Oral & Maxillofacial Surgery/Pharmacology

Introduction

Traditional ORN prophylactic management of patients requiring dental extractions treated with radiotherapy for head and neck cancer consists of hyperbaric oxygenation therapy (HBOT) or post-antibiotic treatment. Many studies have shown encouraging effects of pentoxifylline, tocopherol, and clodronate (PENTOCLO) in treating patients with ORN; however, there are very limited studies indicating uses of pentoxifylline and tocopherol (PENTO) prophylactically to prevent the incidence of ORN. This literature review aims to highlight and review the efficacy of PENTO prophylactic use to reduce ORN incidence following dental extractions in patients with prior radiation therapy of the head and neck region.

Methods

We performed a literature review using various databases including PubMed and Google Scholar to identify existing protocols for the prophylactic use of PENTO. We qualitatively analyzed two retrospective studies, and reviewed the methodology described in Patel et al. and Aggarwal et al.

Results

Patel et al. performed a retrospective study on 390 dental extractions in 82 patients who had radiotherapy for head and neck cancer. Patients were given prophylactic pentoxifylline 400mg twice daily and tocopherol 1000 IU daily. The average duration of PENTO prophylaxis was 11 weeks prior to dental extractions with a standard deviation of 23 weeks and 13.6 weeks postoperatively with a standard deviation of 18 weeks. In Patel et al. only 1 patient developed ORN (1.2%).1 Aggarwal et al. also performed a retrospective study with 450 dental extractions in a total of 110 patients who had radiotherapy for head and neck cancer. In this study, patients were given pentoxifylline 400mg twice daily and tocopherol 1000 IU daily. The average duration of prophylaxis use of PENTO was 12 weeks prior to dental extractions with a standard deviation of 24 weeks and 14 weeks postoperatively with a standard deviation of 18 weeks. In Aggarwal et al. only 2 patients developed ORN.2

Conclusion

Both retrospective studies, Patel et al. and Aggarwal et al., analyzed and evaluated PENTO prophylaxis in patients treated with radiotherapy for head and neck cancer. Patel et al. found an ORN incidence of 1.2% with prophylactic PENTO use. Currently, there is a lack of prospective studies that confirm a strong association between PENTO prophylactic use and decreased ORN incidence. Yet, these retrospective studies show promising results. If proven effective, PENTO could eliminate the need for HBOT which would drastically reduce the cost and burden of treatment on cancer patients.