Stomatitis

Lasers Med Sci. 2017 Mar 27. doi: 10.1007/s10103-017-2184-z. [Epub ahead of print]

Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review.

Suter VG1, Sjölund S1, Bornstein MM2,3.

Author information

1
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
2
Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland. michael.bornst@hku.hk.
3
Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, SAR, China. michael.bornst@hku.hk.

Abstract

The aim of this systematic review was to assess a potential benefit of laser use in the treatment of recurrent aphthous stomatitis (RAS). The primary outcome variables were pain relief, duration of wound healing and reduction in episode frequency. A PICO approach was used as a search strategy in Medline, Embase and Cochrane databases. After scanning and excluding titles, abstracts and full texts, 11 studies (ten RCTs and one non-randomised controlled trial) were included. Study selection and data extraction was done by two observers. Study participants varied between 7-90 for the laser and 5-90 for the control groups. Laser treatment included Nd:YAG laser ablation, CO2 laser applied through a transparent gel (non-ablative) and diode laser in a low-level laser treatment (LLLT) mode. Control groups had placebo, no therapy or topical corticosteroid treatment. Significant pain relief immediately after treatment was found in five out of six studies. Pain relief in the days following treatment was recorded in seven studies. The duration of RAS wound healing was also reduced in five studies. However, criteria of evaluation differed between the studies. The episode frequency was not evaluated as only one study addressed this outcome parameter, but did not discriminate between the study (LLLT) and control (corticosteroid) groups. Jadad scores (ranging from 0 to 5) for quality assessment of the included studies range between 0 and 2 (mean?=?1.0) for studies analysing pain relief and between 0 and 3 (mean?=?1.1) for studies evaluating wound healing. The use of lasers (CO2 laser, Nd:YAG laser and diode laser) to relieve symptoms and promote healing of RAS is a therapeutic option. More studies for laser applications are necessary to demonstrate superiority over topical pharmaceutical treatment and to recommend a specific laser type, wavelength, power output and applied energy (ablative versus photobiomodulation).

J Dent (Shiraz). 2017 Mar;18(1):17-23.

Clinical Evaluation of High and Low-Level Laser Treatment (CO2vsInGaAlP Diode Laser) for Recurrent Aphthous Stomatitis.

Zeini Jahromi N1, Ghapanchi J1, Pourshahidi S2, Zahed M1, Ebrahimi H3.

Author information

1
Dept. of Oral and Maxillofacial Medicine, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
2
Dept. of Oral and Maxillofacial Medicine, Tehran University of Medical Sciences, Tehran, Iran.
3
Dept. of Oral Medicine, Dental School, Azad University, Tehran, Iran.

Abstract

STATEMENT OF THE PROBLEM:

Recurrent aphthous stomatitis (RAS) is one of the most common lesions in the oral cavity. Due to its multifactorial nature, there is no definitive treatment for RAS. Laser therapy is one of the suggested treatments to reduce patient’s discomfort.

PURPOSE:

The purpose of the present clinical trial is to assess the effect of low and high level laser therapy on pain control and wound healing of RAS.

MATERIALS AND METHOD:

Thirty six patients with minor RAS were divided into three groups. Group 1 (n=14) received CO2 laser, group 2 (n=12) were treated with InGaAlP Diode laser and group 3 (n=10) received sham laser as placebo. All patients were evaluated daily up to 15 days after receiving one session of laser therapy. Pain severity before and after treatment, wound healing, patient’s satisfaction, and functional disturbance before and after treatment were recorded for each patient.

RESULTS:

According to statistical analysis, pain reduction after treatment in group 1 was 7.00±2.41, in group 2 was 2.08±2.31, and in group 3 was 1.40±1.77. In addition, a significant difference was observed in the reduction of functional complications in CO2 laser treated patients compared to the other two groups.

CONCLUSION:

High-level laser treatment showed analgesic effects on RAS, but no healing was observed. Low-level laser therapy demonstrated no positive effect on recurrent aphthous ulcers.

Biotechnol Biotechnol Equip. 2014 Sep 3;28(5):929-933. Epub 2014 Oct 21.

Clinical assessment of the therapeutic effect of low-level laser therapy on chronic recurrent aphthous stomatitis.

Lalabonova H1, Daskalov H2.

Author information

  • 1Department of Maxillofacial Surgery, Faculty of Dental Medicine, Medical University of Plovdiv , Plovdiv , Bulgaria.
  • 2Department of Oral Surgery, Faculty of Dental Medicine, Medical University of Plovdiv , Plovdiv , Bulgaria.

Abstract

The aim of this study was to clinically assess the therapeutic effect of low-level laser therapy (LLLT) on chronic recurrent aphthous stomatitis (RAS) using a protocol we developed especially for the purpose. The study included 180 patients: group 1 (the study group) – 90 patients who received LLLT using a laser operating in the red spectrum (658 nm; in a non-contact mode; power output P = 27 mW; frequency f 1 = 5.8 Hz, f 2 – continuous waveform; time T = 1.14 min; dosage of 2 J/cm2 once daily); group 2 (controls) – 90 patients who received pharmacotherapy (Granofurin and solcoseryl given twice daily). The indices we assessed were pain intensity, erythema dynamics and epithelization time. Pain was completely managed in 55.6% of group 1 patients one day after therapy began, while it took three days to alleviate pain for 11.1% of the patients in group 2. The erythema was managed entirely in 24.4% of group 1 patients after the first session, while it did not change in any of the group 2 patients. Pain intensity and erythema had similar dynamics for both groups. In 5 days, 75.6% of group 1 patients showed complete epithelization, while in group 2 the process was completed in only 37.8% of patients. As a whole, the results we obtained using LLLT to treat chronic RAS were better than those obtained in the group receiving pharmacotherapy. Pain and inflammation were very effectively managed with LLLT with the parameters we used and epithelization was considerably accelerated.

Photomed Laser Surg.  2011 Jan;29(1):67-9. Epub 2010 Oct 25.

Laser phototherapy for Stevens-Johnson syndrome: a case report.

Simões A, de Freitas PM, Bello-Silva MS, Tunér J, de Paula Eduardo C.

Source

Centro de Pesquisa em Biologia Oral, Departamento de Materiais Dentários, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, Brazil. lysimoes@usp.br

Abstract

BACKGROUND AND OBJECTIVE:

Stevens-Johnson syndrome (SJS) is a life-threatening dermatosis characterized by epidermal sloughing and stomatitis. We report the case of a 7-year-old boy in whom laser phototherapy (LPT) was highly effective in reversing the effects of an initial episode of SJS that had apparently developed in association with treatment with phenobarbital for a seizure disorder. The patient was first seen in the intensive care unit (ICU) of our institution with fever, cutaneous lesions on his extremities, trunk, face, and neck; mucosal involvement of his genitalia and eyes (conjunctivitis); ulcerative intraoral lesions; and swollen, crusted, and bleeding lips. He reported severe pain at the sites of his intraoral and skin lesions and was unable to eat, speak, swallow, or open his mouth.

MATERIALS AND METHODS:

Trying to prevent and minimize secondary infections, gastric problems, pain, and other complications, the patient was given clindamycin, ranitidine, dipyrone, diphenhydramine (Benadryl) drops, and morphine. In addition, he was instructed to use bicarbonate solution and Ketoconazole (Xylogel) in the oral cavity. Because of the lack of progress of the patient, the LPT was selected.

RESULTS:

At 5 days after the initial session of LPT, the patient was able to eat gelatin, and on the following day, the number and severity of his intraoral lesions and his labial crusting and swelling had diminished. By 6 days after his initial session of LPT, most of the patient’s intraoral lesions had disappeared, and the few that remained were painless; the patient was able to eat solid food by himself and was removed from the ICU. Ten sessions of LPT were conducted in the hospital. The patient underwent three further and consecutive sessions at the School of Dentistry, when complete healing of his oral lesions was observed.

CONCLUSION:

The outcome in this case suggests that LPT may be a new adjuvant modality for SJS complications.

Lasers Med Sci. 2009 Jul;24(4):515-20. Epub 2008 Apr 12

Relieving pain in minor aphthous stomatitis by a single session of non-thermal carbon dioxide laser irradiation.

Zand N, Ataie-Fashtami L, Djavid GE, Fateh M, Alinaghizadeh MR, Fatemi SM, Arbabi-Kalati F.

Iranian Center for Medical Laser (ICML), Academic Center for Education, Culture and Research (ACECR), Tehran, Iran. zand_nas@yahoo.com

This randomized controlled clinical trial was designed to evaluate the efficacy of single-session, non-thermal, carbon dioxide (CO(2)) laser irradiation in relieving the pain of minor recurrent aphthous stomatitis (miRAS) as a prototype of painful oral ulcers. Fifteen patients, each with two discrete aphthous ulcers, were included. One of the ulcers was randomly allocated to be treated with CO(2) laser (1 W of power in de-focused continuous mode) and the other one served as a placebo. Before laser irradiation, a layer of transparent, non-anesthetic gel was placed on both the laser lesions and the placebo lesions. The patients were requested to grade their pain on a visual analog scale up to 96 h post-operatively. The reduction in pain scores was significantly greater in the laser group than in the placebo group. The procedure itself was not painful, so anesthesia was not required. Powermetry revealed the CO(2) laser power to be 2-5 mW after passing through the gel, which caused no significant temperature rise or any visual effect of damage to the oral mucosa. Our results showed that a low-intensity, non-thermal, single-session of CO(2) laser irradiation reduced pain in miRAS immediately and dramatically, with no visible side effects.

Mycoses. 2009 Mar;52(2):154-60. Epub 2008 Jun 21.

Growth of Candida species on complete dentures: effect of microwave disinfection.

Sanitá PV, Vergani CE, Giampaolo ET, Pavarina AC, Machado AL.

Department of Dental Materials and Prosthodontics, Araraquara Dental School, UNESP-São Paulo State University, Araraquara, São Paulo, Brazil.

Abstract

Microwave disinfection of complete dentures has been recommended to treat denture stomatitis in non-immune compromised patients. Oral candidiasis is a frequent manifestation of HIV infection. The objective of this study is to evaluate the effectiveness of microwave irradiation on the disinfection of complete dentures inoculated with American Type Culture Collection (ATCC) and HIV isolates of five species of Candida. Fifty dentures were made, sterilised and inoculated with the tested microorganisms (C. albicans, C. dubliniensis, C. krusei, C. glabrata and C. tropicalis). After incubation (37 degrees C/48 h), dentures were microwaved (650 W/3 min). Non-irradiated dentures were used as positive controls. Replicate aliquots of suspensions were plated at dilutions 10(-1) to 10(-4) and incubated (37 degrees C/48 h). Colony counts (cfu ml(-1)) were quantified. Dentures were also incubated at 37 degrees C for 7 days. Data were analysed with 2-way ANOVA and Tukey HSD tests (alpha = 0.05). Dentures contaminated with all Candida species showed sterilisation after microwave irradiation. All control dentures showed microbial growth on the plates. The cfu ml(-1) for C. glabrata was higher than those of C. albicans, C. dubliniensis and C. tropicalis whereas the cfu ml(-1) for C. krusei was lower. The cfu ml(-1) for clinical isolates was higher than those of ATCC yeast. Microwave irradiation for 3 min at 650 W resulted in sterilisation of all complete dentures.

Sheng Wu Yi Xue Gong Cheng Xue Za Zhi. 2005 Oct;22(5):926-9.

Effects of He-Ne laser on gastric mucosa in rat with chronic atrophic gastritis

[Article in Chinese]

Yang Y, Wang J, Shao X, Dai J

Department of Medical Physics, Hebei North University, Zhangjiakou 075000, China.

This study sought to explore the effects of He-Ne laser irradiation on the gastric mucosa of experimental chronic atrophic gastritis (CAG) in rat. Fifty-two male adult Wistar rats were randomly divided into five groups including normal control group, model group and three different doses He-Ne laser groups. The CAG model in rats was made by administering (per gastrogavage) a compositus liquor, including 2% sodium salicylate and 30% alcohol, for 8 weeks to stimulate the rat’s gastric mucosa, combined with irregular fasting and compulsive sporting as pathogenic factors. He-Ne laser therapy was used at different doses of He-Ne laser, once a day for twenty days, then the morphological changes and the expression of cyclinD1 were observed. Compared with untreated group, the gastric mucosa of 3.36J x cm(-2) He-Ne laser group was significantly thicker (P < 0.01), the inflammatory cells of gastric mucosa were decreased (P < 0.05), the morphology, structure and volume of the cells were restored or nearly normal and the expressions of cyclinD1 were higher (P < 0.05). In a word, small dose He-Ne laser (3.36 J x cm(-2)) has a good adjuvant therapeutic effect on rat’s CAG.

Photomed Laser Surg. 2005 Jun;23(3):328-32.

Effect of Low-Level Laser Therapy on Candida albicans Growth in Patients with Denture Stomatitis.

Maver-Biscanin M, Mravak-Stipetic M, Jerolimov V.

Department of Prosthodontics, Clinical Hospital Centre, Zagreb, Croatia.

Objective: The purpose of our report is to present the effect of low-level laser therapy on Candida albicans growth and palatal inflammation in two patients with denture stomatitis. Background Data: The most common oral mucosal disorder in denture wearers is denture stomatitis, a condition that is usually associated with the presence of the yeast Candida albicans. Different treatment methods have been suggested to treat this symptom, none of which is proven to be absolutely effective. Methods: Two denture-wearing patients, both with palatal inflammation diagnosed as Newton type II denture stomatitis were treated with low-power semiconductor diode laser (BTL-2000, Prague, Czech Republic) at different wavelengths (685 and 830 nm) for 5 d consecutively. In both patients, palatal mucosa and acrylic denture base were irradiated in noncontact mode (probe distance of 0.5 cm from irradiated area) with different exposure times-5 min (830 nm, 3.0 J/cm(2), 60 mW) and 10 min (685 nm, 3.0 J/cm(2), 30 mW). The effect of laser light on fungal growth in vivo was evaluated after the final treatment using the swab method and semiquantitative estimation of Candida albicans colonies growth on agar plates. The severity of inflammation was evaluated using clinical criteria. Results: After lowlevel laser treatment, the reduction of yeast colonies on the agar plates was observed and palatal inflammation was diminished. Conclusion: LLLT is effective in the treatment of denture stomatitis. Further placebo controlled studies are in progress.

J Clin Laser Med Surg. 2003 Dec;21(6):363-7.

Usefulness of low-level laser for control of painful stomatitis in patients with hand-foot-and mouth disease.

Toida M, Watanabe F, Goto K, Shibata T.

Department of Oral and Maxillofacial Sciences, Gifu University School of Medicine, Gifu, Japan. toida@cc.gifu-u.ac.jp

OBJECTIVE: The aim of this study was to evaluate the usefulness of low-level laser therapy (LLLT) for the control of painful stomatitis in patients with hand-foot-and-mouth disease (HFMD).

BACKGROUND DATA: LLLT has been successfully applied to various painful oral mucosal diseases, although there have been few reports on LLLT for HFMD patients.

MATERIALS AND METHODS: Through a randomized double-blind placebo controlled trial, the painful period of HFMD stomatitis was compared between the LLLT group (n=11) and the placebo LLLT one (n=9), which had similar clinical backgrounds. The LLLT parameters supplied were as follows: wavelength of 830 nm, power of 30 mW, frequency of 30 Hz, and energy output of 1.1 J/cm2. Acceptability and safety of the treatment were also evaluated.

RESULTS: The painful period was shorter in the LLLT group (4.0 +/- 1.3 days) than in the placebo LLLT one (6.7 +/- 1.6 days) with a statistically significant difference (p<0.005). The treatment was judged acceptable for 90.0% (18 of 20) of patients. No adverse events were observed in any cases.

CONCLUSION: LLLT is a useful method to control HFMD stomatitis by shortening the painful period, with its high acceptability and lack of adverse events.

Eur J Haematol. 2004 Mar;72(3):222-4.

Successful treatment of oral lesions of chronic lichenoid graft-vs.-host disease by the addition of low-level laser therapy to systemic immunosuppression.

Chor A, de Azevedo AM, Maiolino A, Nucci M.

University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

We report a case of severe oral stomatitis caused by lichenoid chronic graft-vs.-host disease in which low-level laser therapy applied to the oral mucosa, in addition to standard systemic immunosuppressive treatment, resulted in quick healing and symptomatic relief.