ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In A Previously Irradiated Patient, Hyperbaric Oxygen Therapy May Be More Effective Than Antibiotic Therapy In Preventing Osteoradionecrosis Following A Dental Extraction
Clinical Question In an irradiated patient, is Hyperbaric Oxygen Therapy more effective than Antibiotic Therapy in preventing osteoradionecrosis following a dental extraction?
Clinical Bottom Line 2 of 3 papers found that prophylactic Hyperbaric Oxygen Therapy is more effective than prophylactic antibiotic therapy in the prevention of osteoradionecrosis following a dental extraction in an irradiated patient.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21115324Nabil/2011Radiation patientsSystematic Review
Key resultsExtractions performed with prophylactic Hyperbaric Oxygen Therapy had a 4% incidence of osteoradionecrosis, while those treated prophylactically with antibiotics had an incidence of 6%. This review showed weak evidence in support of HBO Therapy over antibiotic therapy in preventing ORN in an irradiated patient.
#2) 20727635Fritz/2010Radiation patientsSystematic Review
Key resultsBased on the studies observed, there is insufficient evidence to show the benefits of HBO therapy in preventing ORN in irradiated patients.
#3) 3897335Marx/1985Radiation patientsRandomized trial
Key resultsIn a randomized trial assessing molar extractions in irradiated mandibles, ORN occurred in 11/37 (30%) patients provided antibiotic prophylaxis and 2/37 (5%) of patients provided HBO prophylaxis. There was no control arm.
Evidence Search "Hyperbaric Oxygenation"[Mesh]) AND "Tooth Extraction"[Mesh])
Comments on
The Evidence
The Marx RCT presented compelling evidence to support prophylactic HBO therapy in lieu of antibiotic prophylaxis to reduce the risk of ORN in previously irradiated patient. However, there was no control arm and more recent studies have been less impressive. Nabil thoroughly assessed 19 relevant studies and estimated the overall rate of post extraction ORN associated with HBO prophylaxis and antibiotic prophylaxis in the previously irradiated patient 4% and 6%, respectively. The authors further concluded the overall rate of ORN is on the decline and that HBO prophylaxis appears most effective when used on the highest risk patients (e.g. radiation dose > 60 Gy in need of a mandibular extraction within the radiated field). The systematic review by Fritz carefully chose the best evidence to review on the subject of HBO therapy, searching Medline from January 1948 through March 2008 and including 1 RCT, 8 cohort-controlled studies, and 5 observational studies. These studies were found to have a small sample size and a large variation in treatments. This study found insufficient information to show the efficacy of HBO in preventing ORN in irradiated patients. Based on these studies, it appears that while HBO therapy appears to be weakly superior to antimicrobial prophylaxis in preventing ORN, further study is needed to determine the overall benefit in HBO prophylaxis in reducing ORN risk.
Applicability If performing an extraction on a previously irradiated patient, prophylactic Hyperbaric Oxygen Therapy appears superior to antibiotic prophylaxis in reducing ORN risk. The use of Hyperbaric Oxygen Therapy prophylaxis appears most useful when applied to patients at highest risk.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Hyperbaric Oxygen Therapy, Osteoradionecrosis, Irradiated patient
ID# 2380
Date of submission: 02/27/2013spacer
E-mail parsonskm@livemail.uthscsa.edu
Author Kelsey Parsons
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Michaell Huber, DDS
Faculty mentor/Co-author e-mail huberm@uthscsa.edu
Basic Science Rationale
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