Efficacy of Oral and Intralesional Pentoxifylline in Grade II and Grade III Oral Submucous Fibrosis: a Systematic Review.

Purpose: Oral submucous fibrosis (OSMF) is a debilitating oral disease. The underlying cause of its pathogenesis is progressive loss of vascularity in the diseased mucosa resulting in epithelial atrophy. Various non-surgical treatment modalities have been prescribed in various literatures, but due to the multifactorial nature of the disease no single treatment has been advocated. Various intralesional injections in combination with oral medications have been advocated for the treatment. Currently, pentoxifylline is reported to have satisfactory results in the management of OSMF due to its immune modulation, alteration of fibroblast physiology, rheologic modification and anti-inflammatory property. Among these, oral pentoxifylline in combination with intralesional injections of dexamethasone and hyaluronidase have shown promising results. There is very less evidence of intralesional pentoxifylline use in the treatment of OSMF. The present study conducted a systematic review to find the efficacy of oral and intralesional pentoxifylline in grade II and grade III oral submucous fibrosis. Methods: This review followed the principles of systematic reviews. We conducted a comprehensive literature search of 5 databases according to PRISMA guidelines. Research articles published in English from 2006 till 2022 were reviewed. The keywords consisted of OSMF, oral, intralesional, pentoxifylline, dexamethasone, and routes of administration. In this study, Rayyan online software was used to identify and eliminate duplicate articles, and another reviewer was invited to screen the articles independently. The included articles' data were extracted, and conclusions were drawn after cross-comparison. Primary outcomes assessed were objective changes, like an increase in interincisal distance, and subjective changes, including a reduction in pain and burning sensation using the visual analog scale (VAS) and cheek flexibility. Secondary outcomes assessed were subjective or objective changes, which included any side effects of intervention and subjective changes in quality of life. Results: Ninety articles were identified through the database search, and an additional study was identified through the other sources. After screening the articles based on the inclusion criteria, 52 articles were excluded due to non-compliance of adequate data according to the specified criteria. 38 full-text articles were assessed, and finally, 16 articles were included in qualitative synthesis. Conclusion: The therapeutic benefits of oral pentoxifylline are unclear in terms of patient compliance as well as the side effects that may result due to its route of administration as compared to intralesional pentoxifylline combined with other intralesional steroids, where the effect will be seen in local tissues with nil or minimal side effects. Hereby proves beneficial in improving the symptoms of the disease.