Xerostomia – Sjogren’s Syndrome

Med Pregl.  2012 May-Jun;65(5-6):247-50.

The effects of low-level laser therapy on xerostomia (mouth dryness).

[Article in Serbian]
Pavli V.

Source

Katedra za parodontologiju i oralnu medicinu, Medicinski fakultet, Univerzitet u Banjaluci. dr.vericapavlic@gmail.com

Abstract

INTRODUCTION:

Xerostomia is a subjective complaint of mouth/oral dryness, caused by a reduction in normal salivary secretion due to different causes. Even though there are many available treatment modalities to enhance salivary flow, the therapy often remains unsatisfactory. The low-level laser therapy (low-level laser irradiation, photo-biomodulation) has been extensively used as a new, non-invasive approach and advantageous tool for reduction of xerostomia. Therefore, the aim of this study is to give a systematic overview on the effects of low-level laser therapy on xerostomia.

MATERIAL AND METHODS:

A systematic review of published articles in PubMed database was carried out using keywords: “low-level laser therapy”, “xerostomia”, “mouth dryness”.

RESULTS:

In all published articles, which were considered adequate for this overview, positive effects of low-level laser therapy were reported. Low-level laser therapy could significantly enhance salivary secretion and improve antimicrobial characteristics of secreted saliva (increased level of secretory immunoglobulin A; sIgA). Furthermore, low-level laser therapy could improve salivary flow and regeneration of salivary duct epithelial cells.

CONCLUSION:

The current literature suggests that low-level laser therapy can be safely and effectively used as an advanced treatment modality for reduction of xerostomia. Further in vivo, in vitro and clinical studies using different irradiation parameters are suggested to determine the best laser parameters to be used.

Photomed Laser Surg. 2010 Nov 6. [Epub ahead of print]

The Effect of Low-Level Laser Therapy on Salivary Glands in Patients with Xerostomia.

Lonar B, Mravak Stipeti M, Barievi M, Risovi D.

1 Department of Oral Medicine, School of Dental Medicine, University of Zagreb , Croatia .

Abstract

Abstract Objective: The aim of this study was to investigate the effect of low-level laser irradiation on the secretory function of salivary glands in 34 patients with xerostomia (dry mouth). Background Data: Xerostomia, a common complaint of oral dryness within the elderly population, is caused by a reduction in normal salivary secretion due to different causes. Treatment is aimed at increasing salivary flow, although in most cases it remains palliative.

Materials and Methods: In this study, laser light from a pulsed Ga-As laser operating at 904 nm was applied bilaterally on each salivary gland area: extraorally on the parotid and submandibular gland areas and intraorally on the sublingual gland area. The operational probe distance from the irradiated area was 0.5 cm resulting in an irradiance of 246 mW/cm(2). The exposure time was 120 sec per daily treatment during 10 consecutive days. The average energy density per exposure was 29.5 J/cm(2). The control group consisted of 16 patients who were treated with 15 mL of a 2% citric acid solution applied as a mouth rinse for 30 sec.

Results: The average difference in the amount of salivation (dQ-sal, mL/min) before and after laser therapy increased linearly from dQ-sal =0.05?mL/min on the first day, up to dQ-sal=0.13mL/min on the last (10th) day of therapy. In the control group, the average dQ-sal initially demonstrated a gradual increase, with a reversal of the trend toward the end of the therapy period and eventually yielding no correlation between the duration of therapy and dQ-sal.

Conclusion: The results of our study indicate that the effects of low-level laser therapy on salivary glands are not only stimulating, but also regenerative to a degree since the glandular response to the same amount of applied laser energy increased linearly over time.

Photomed Laser Surg. 2010 Jun;28(3):357-63.

Laser phototherapy as topical prophylaxis against radiation-induced xerostomia.

Simões A, de Campos L, de Souza DN, de Matos JA, Freitas PM, Nicolau J.

Department of Dental Materials, Division of Oral Biology, Universidade de São Paulo, São Paulo, SP, Brazil. lysimoes@gmail.com

Abstract

The common consequences of radiotherapy (RT) to the head and neck are oral mucositis, xerostomia, and severe pain. The aim of this study was to verify how laser phototherapy (LPT) used for oral mucositis could influence xerostomia symptoms and hyposalivation of patients undergoing RT. Patients were divided into two groups: 12 individuals receiving three laser irradiations per week (G1) and 10 patients receiving one laser irradiation per week (G2). A diode laser (660 nm, 6 J/cm(2), 0.24 J, 40 mW) was used until completely healing of the lesions or the end of the RT. At the first and last laser sessions, whole resting and stimulated saliva were collected, and questionnaires were administered. According to Wilcoxon and Student statistical test, xerostomia for G1 was lower than for G2 (p < 0.05), and salivary flow rate was no different before and after RT, except for stimulated collection of G2, which was lower (p < 0.05). Our results suggest that LPT can be beneficial as an auxiliary therapy for hypofunction of salivary glands.

Curr Opin Oncol. 2010 May;22(3):221-5.

Supportive care in head and neck oncology.

de Castro G Jr, Guindalini RS.

Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Abstract

PURPOSE OF REVIEW: Survival gains were achieved in head and neck cancer patients treated with a multidisciplinary approach, including platinum-based concurrent chemoradiation, with a substantial increase in toxicity. The prompt diagnosis and treatment of these toxicities – the focus of this review – are essential aspects in the daily care of head and neck squamous cell carcinoma patients.

RECENT FINDINGS: Low-level laser is a promising therapy for prevention and treatment of mucositis. Amifostine, as an acute and late xerostomia-preventive agent, may be considered in patients undergoing fractionated radiation therapy alone. The incidence of xerostomia was significantly reduced in patients treated with intensity-modulated radiation therapy. Severe cutaneous reactions can occur when epidermal growth factor receptor-targeting agents are administered concurrently to radiation therapy. Erythropoiesis-stimulating agents should not be administered to head and neck cancer patients under radiation therapy or chemotherapy outside of the context of clinical trials.

SUMMARY: The best outcomes in head and neck squamous cell carcinoma patients treated in the multidisciplinary context can only be achieved with an adequate patient selection, an experienced and motivated team and if the best possible supportive care is offered. Randomized studies on promising supportive therapies must be encouraged.

Spec Care Dentist. 2009 May-June;29(3):134-7.

Laser as a therapy for dry mouth symptoms in a patient with Sjogren’s syndrome: a case report.

Simões A, Platero MD, Campos L, Aranha AC, Eduardo Cde P, Nicolau J.

Oral Biology Research Center, Department of Biomaterials and Oral Biochemistry, School of Dentistry, University of São Paulo, São Paulo, Brazil. lysimoes@usp.br

This clinical case study reports on dry mouth symptoms in a patient with Sjögren’s syndrome (SS) who was treated with laser phototherapy (LPT). A 60-year-old woman diagnosed with SS was referred to the laboratory for lasers in dentistry to treat her severe xerostomia. A diode laser (780 nm, 3.8 J/cm2, 15 mW) was used to irradiate the parotid, submandibular, and sublingual glands, three times per week, for a period of 8 months. The salivary flow rate and xerostomia symptoms were measured before, during, and after LPT. Dry mouth symptoms improved during LPT. After LPT, the parotid salivary gland pain and swelling were no longer present. Treatment with LPT was an effective method to improve the quality of life of this patient with SS.

Photomed Laser Surg. 2009 Apr;27(2):371-4.

 

Improvement in quality of life of an oncological patient by laser phototherapy.

Campos L, Simões A, Sá PH, Eduardo Cde P.

Oral Biology Research Center, Department of Biomaterials and Oral Biochemistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.

Abstract

OBJECTIVE AND BACKGROUND DATA: Common side effects of radiotherapy (RT) to the head and neck include oral mucositis, xerostomia, and severe pain. The aim of this study is to report improvement in the quality of life of an oncological patient by laser phototherapy (LPT).

CLINICAL CASE AND LASER PHOTOTHERAPY PROTOCOL: The patient, a 15-year-old girl diagnosed with mucoepidermoid carcinoma, underwent surgical excision of a tumor of the left palatomaxilla. After that, she was subjected to 35 sessions of RT (2 Gy/d). Clinical examination revealed the spread of severe ulcerations to the jugal mucosa, gums, lips, hard palate, and tongue (WHO mucositis score 3). She had difficulty in moving her tongue and she was unable to eat any solid food. Oral hygiene orientation and LPT were performed throughout all RT sessions. A continuous diode laser, 660 nm, 40 mW, 6 J/cm(2), 0.24 J per point in contact mode, with spot size of 0.04 cm(2) was used in the entire oral cavity. A high-power diode laser at 1 W, 10 sec per cm of mucositis, approximately 10 J/cm(2), was used in defocused mode only on ulcerative lesions. After the first laser irradiation session, decreases in pain and xerostomia were reported; however, a more significant improvement was seen after five sessions. At that point although the mucositis score was still 2, the patient reported that she was free of pain, and consequently a palatine plate could be made to rehabilitate the entire surgical area. Seventeen laser irradiation sessions were necessary to eliminate all oral mucositis lesions.

CONCLUSION: Normal oral function and consequent improvements in the quality of life of this oncologic patient were observed with LPT.