Pentoxifylline and tocopherol as prophylaxis for osteonecrosis of the jaw due to bone-modifying agents in patients with cancer submitted to tooth extraction: a case series.

PURPOSE: To assess the prophylaxis effect of pentoxifylline and tocopherol (PENTO) on the frequency and severity of medication-related osteonecrosis of the jaw (MRONJ) diagnosed at three months in patients with cancer submitted to tooth extractions during the treatment with bone-modifying agents. METHODS: This case series was conducted at the outpatient dental clinic of the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) between April 2021 and April 2022. Patients ≥ 18 years old were included; those with maxillary metastasis or who performed head or neck radiotherapy were excluded. The PENTO protocol was prescribed two weeks before and two weeks after the tooth extraction, and patients were reassessed one week, one month, and three months after the extraction. The main outcome was the development of MRONJ. RESULTS: Of the 114 screened patients, 17 were included; they were aged between 43 and 73 years and were mostly female (88.2%). Thirty-two tooth extractions were performed (22 in the maxilla and 10 in the mandible). Breast cancer was the most predominant neoplasm (70.6%), being metastatic in 35.3% of patients. Also, all patients used intravenous bisphosphonates. Stage 1 MRONJ was diagnosed in three patients (17.6%), representing three (9.4%) of all tooth extractions. The repair of MRONJ was achieved 30 days after the PENTO protocol. CONCLUSION: The prophylaxis use of PENTO reduced the severity of injuries, was well-tolerated, and showed patient compliance.

Photodynamic therapy for treatment of oral mucositis: Pilot study with pediatric patients undergoing chemotherapy.

BACKGROUND: Oral mucositis has become a major dose-limiting toxicity of antineoplastic treatment. AIM: The aim of this study was to evaluate the effect of photodynamic therapy (PDT) and low level laser therapy (LLLT) on the treatment of chemotherapy-induced mucositis in pediatric patients. METHODS: An open, controlled, and blind, randomized clinical trial was conducted with 29 patients, from 10 months to 18 years old, who were divided into two groups. Group A was submitted to photodynamic therapy (0.01% Methylene Blue and red laser, λ660 nm) with 3J energy per point; and Group B submitted to low level laser therapy (λ660 nm) with 1J energy per point. The results were evaluated by using the WHO and ChIMES mucositis scales. The Chi-square, Exact Fisher, Student's-t and Mann-Whitney tests, and the mixed linear regression model were used for comparison between the groups, with the maximum error admitted of 5%. RESULTS: There was no difference between the groups as regards the number of sessions necessary for clinical cure of the oral lesions (p = 0.954) or reduction in pain reported by the patients (p = 0.258; p = 0.486). Within each group, however, there was significant reduction in pain (p = 0.032; p = 0.003). The number needed to treat (NNT) was 4.75. CONCLUSIONS: PDT or LLLT could be used for treatment of oral mucositis in children/young patients. Each were well tolerated and presented satisfactory results in reducing pain associated with the lesion.

Low-level laser therapy prevents severe oral mucositis in patients submitted to hematopoietic stem cell transplantation: a randomized clinical trial.

PURPOSE: The purpose of this study is to evaluate the effectiveness of low-level laser therapy for the prevention of oral mucositis in patients undergoing hematopoietic stem cell transplantation. METHODS: This is a randomized, parallel, superiority trial including 35 patients divided into the following: laser (n = 17) and sham (n = 18). The variables assessed were oral mucositis (grade 2 of the World Health Organization oral toxicity scale), severe oral mucositis (grade 3 or 4), and pain (according to a visual analogue scale). In the laser group, a InGaAlP laser, wavelength of 650 nm, power 100 mW, energy per point of 2 J, time 20 s by point, extremity fiber optic 0.028 cm(2), and energy density 70 J/cm(2), was used, applied the first day of conditioning until D + 5, while the sham group received simulated laser over the same period. RESULTS: No statistically significant difference was found in the incidence of oral mucositis (p = 0.146). Severe mucositis was found in 40% of the patients (14/35), 3 in the intervention group (17.65%) and 11 in the sham group (61.11%) (p = 0.015). The cumulative probability of survival with respect to the development of severe oral mucositis was >0.6 for the intervention group and 0 for the control group (p = 0.0397). On the day on which pain was considered the worst, patients in the sham group were more likely to classify their pain as severe compared to those in the laser group (p = 0.041). CONCLUSION: Low-level laser therapy proved effective for the prevention of severe oral mucositis and intense oral pain in patients submitted to hematopoietic stem cell transplantation.