The Prevention & Management of Medication-Related Osteonecrosis of the Jaw

A panoramic radiograph shows sequestrum formation in the right mandible.

Pentoxifylline & Tocopherol 

Pentoxifylline is a methylxanthine derivative that has been used for management of peripheral vascular diseases. It is known to decrease blood viscosity, improve erythrocyte flexibility and lower fibrinogen levels promoting fibrinolysis. Additionally, pentoxifylline reduces the plasma levels of tumor necrosis factor, interleukin (IL) 1 and IL-16, and decreases neutrophil activation, thereby enhancing anti-inflammatory and anti­oxidant effects.²⁰ Tocopherol belongs to the vitamin E family and is used to decrease the risk of coronary artery disease. It is a potent oxygen radical scavenger with antioxidant and anti-inflammatory properties.²¹

Cell death & suppression of epithelial proliferation ultimately leads to mucosal thinning & breakdown, causing bone exposure & rapid microbial colonization, resulting in MRONJ.

Current literature suggests pentoxifylline in combination with tocopherol promotes both hard and soft tissue healing with minimal adverse effects and has been successfully used in patients with osteo­radionecrosis (e.g., radiation-induced osteonecrosis of the jaw). This combination is used prophy­lactically to prevent osteo­necrosis of jaws after dental extraction in patients with a history of radiation to the jaws. It is now being offered for the medical management of MRONJ. 

The prophylactic use of pentoxifylline and tocopherol two to three weeks prior to a dental extraction and continued therapy post-extraction until the surgical site completely heals have been shown to reduce the incidence of MRONJ.²²

Pooja Gangwani, DDS, MPH, is an assistant professor of oral and maxillofacial surgery at the University of Rochester School of Medicine and Dentistry and Eastman Institute of Oral Health, Rochester, N.Y.

References

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