Introduction- Aphthous ulcers are the most common and painful ulcerative lesion of the oral mucosa affecting as high as 15-25 % of the general population worldwide. They appear as solitary or multiple shallow, with circumscribed margins, having yellow or gray floors surrounded by erythematous halo. |
Etiology-. It is a multifactorial disease having several predisposing and risk factors contributing to its pathogenesis such as hormonal changes, trauma, drugs, food hypersensitivity, nutritional deficiency, stress, tobacco and systemic illness such as Crohn’s disease, HIV, Behcet’s disease etc. The etiopathogenesis is neither viral nor bacterial, but most of the studies states that it’s an autoimmune mediated source of origin.
Treatment Modality- Due to uncertain etiology and unpredictable course of the disease, there is no definitive treatment for aphthous ulcer. The treatment is symptomatic, the goals being to decrease pain, healing time, number and size of the ulcer, and to increase disease free periods which include topical agents, systemic and topical steroids, corticosteroids, cauterization, antibiotics, mouth rinses containing active enzymes, etc. Low level laser therapy (LLLT) has been employed as it is an effective and noninvasive treatment option because of its biomodulation and analgesic effect which promotes healing and provides immediate relief of pain without an overdose of medication or side effects. LLLT is a non-ablative, non-thermal manner of laser irradiation done without anesthesia. PIOON laser offers different wavelengths like 650nm/810nm/980nm which can be used for LLLT (photobiomodulation). The most preferable among them is red light (650nm) for photobiomodulation. The said process is carried out in noncontact mode using 650nm wavelength with a photobiomodulation handpiece. A study carried out by Soliman HA et al. in 2019 suggested that dental diode laser with red light (660nm) is an effective modality in the reduction of pain, ulcer size with faster healing time for treatment of aphthous ulcers. Whereas use of infrared (810nm/980nm) wavelength for LLLT is also appreciable. In a report by Farista S et al in 2014 she concluded that lasers (980nm) at nonablative settings provides immediate pain relief and comfort in case of recurrent apthous ulcer (RAS).
When it comes to establish safety measures for use of laser system, there should not be any compromise. A complete safety protocol should be followed for everyone like using laser protective eye glasses, use of high vacuum suction, avoiding use of flammable substance nearby laser. Highly reflective instruments should be avoided while using lasers.
Rationale behind Use of Lasers- The primary reason for the introduction of laser in our treatment plan was to provide immediate analgesia. Low-level laser therapy stimulates the production of ß-endorphins, thereby relieving pain. Low-level laser therapy enhances ATP synthesis leading to a state of hyperpolarization and blocks the conduction of pain stimuli, thus aiding in a decrease of pain sensation. Laser therapy has also found to have a profound effect on C fibers leading to a decreased activity of these fibers and altering the pain threshold. Secondary clinical effects associated with LLLT are a decrease in the levels of histamine, bradykinins and substance P which reduces the inflammation. In addition, LLLT aids in the transformation of fibroblasts into myofibroblasts, which are responsible for wound contraction thus helping in the rapid healing of ulcer
Conclusion – Photobiomodulation is a safe and clinically effective therapy for the management of apthous ulcers which not only provides immediate pain relief but also reduces the size of the lesion thus promoting healing of the ulcer.
Reference – Soliman HA et al. Clinical Evaluation of 660 nm Diode Laser Therapy on the Pain, Size and Functional Disorders of Recurrent Aphthous Stomatitis. Open Access Maced J Med Sci. 2019; 7(9): 1516–1522 and Farista S et al. Effectiveness of 980 nm Diode Laser Therapy on Recurrent Aphthous Stomatitis. International Journal of Laser Dentistry, 2014; 4(3): 83-86.
By - Dr. Rufi Patel MDS Periodontics Divas in Laser
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