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Title Molecular Hydrogen Has Therapeutic Effects in Patients with Osteoradionecrosis of the Jaw
Clinical Question For a patient at risk for osteoradionecrosis of the jaw, will novel molecular hydrogen therapy be effective at reducing symptoms of osteoradionecrosis of the jaw vs. treatment without molecular hydrogen?
Clinical Bottom Line In animal models, molecular hydrogen therapy reduces the effects seen in osteoradionecrosis of the jaw. This conclusion is based solely on an animal study, and since molecular hydrogen is a novel treatment modality, more clinical trials are needed to assess its efficiency on reducing symptoms of ONRJ.
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) 32451233Chen/202030 male ratsLaboratory study
Key results30 male Sprague-Dawley rats were divided into 3 groups (n=10): control, irradiation + molecular hydrogen saline (I+HS), and irradiation + normal saline (I+NS). The mandibles of the left side were irradiated at doses of 7Gy per fraction for five fractions in total. Six weeks after irradiation, all left mandibular molars were extracted. Six weeks after tooth extraction, the mandibles were harvested for CT scanning and histological testing. In the I+HS group, the mean bone volume fraction (BV/TV; %) was significantly greater than in the I+NS group (18.79 ± 0.001 and 10.18 ± 0.017, respectively; P<0.05). The trabecular thickness (Tb.Th; mm) in the I+HS group was significantly higher than in the I+NS group (0.1703 ± 0.008 and 0.0523 ± 0.015, respectively; P<0.05). The trabecular number (Tb.N; 1/mm) in the I+HS group was significantly higher than in the I+NS group (1.512 ± 0.152 and 0.8915 ± 0.020 , respectively; P<0.05). The degree of separation of trabecular bone (Tb.Sp; mm) in the I+HS group was significantly lower than in the I+NS group (0.4110 ± 0.035 and 0.9081 ± 0.007, respectively; P<0.05). Histological findings in the I+HS group demonstrated reduction in fibrosis and inflammation, higher osteocyte counts, and reduction in empty lacunae count when compared to the I+NS group. The investigators concluded that molecular hydrogen has significant radioprotective properties which warrants further experimental investigations and randomized controlled trials.
Evidence Search ("osteoradionecrosis"[MeSH Terms] OR "osteoradionecrosis"[All Fields] OR "osteoradionecroses"[All Fields]) AND ("hydrogen"[MeSH Terms] OR "hydrogen"[All Fields] OR ("molecular"[All Fields] AND "hydrogen"[All Fields]) OR "molecular hydrogen"[All Fields])
Comments on
The Evidence
Chen/2015 (PMID 26508867) is the proposed hypothesis that lead to this 2020 animal study. External validity is always a key limitation in animal studies. There has been only one animal study conducted regarding ORNJ and molecular hydrogen. This experiment should form the basis for further studies into the implementation of molecular hydrogen as a human therapeutic agent for those at risk for developing ORNJ. Hydrogen-rich saline is safe, easy to administer, has good portability, has multiple delivery routes, and is an effective agent.
Applicability The use of molecular hydrogen as a ‘pre-‘, ‘mid’, and ‘post-‘ treatment modality in patients receiving head and neck radiation shows promise in reducing the effects of radiation induced osteoradionecrosis of the jaw. A comprehensive review in 2015 by Ichihara et al. (PMID: 26483953) nicely summarized the biological benefit of molecular hydrogen in all organs covering 31 disease categories subdivided into 166 disease models, human diseases, treatment-associated pathologies, and even pathophysiological conditions of plants. With this treatment being novel, more clinical trials are needed to better assess the radioprotective performance of molecular hydrogen on ORNJ.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Basic Science)
Keywords Molecular hydrogen, osteoradionecrosis
ID# 3516
Date of submission: 12/04/2022spacer
E-mail bartlettb@uthscsa.edu
Author Ben Bartlett
Co-author(s) Charlie Arndt
Co-author(s) e-mail arndtc@livemail.uthscsa.edu
Faculty mentor/Co-author Hassem Geha
Faculty mentor/Co-author e-mail Geha@uthscsa.edu
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