Does Photobiomodulation Affects CK10 and CK14 in Oral Mucositis Radioinduced Repair?

The mechanisms of action of photobiomodulation (PBM) in oral mucositis (OM) are not completely elucidated. To enlighten the role of PBM in the evolution of epithelial maturity in OM ulcers, the present study evaluated the effect of PBM with red (λ) wavelength of 660 nanometers (nm) and infrared of 780 nm in radio-induced OM wounds on the tongue of rats, eight and twenty days after irradiation with single dose of 20 Gy. The percentage area corresponding to positive staining for cytokeratin 10 (CK10) and 14 (CK14) proteins was evaluated in the epithelial area of the lesions, using an immunohistochemical technique (IHC), 8 and 20 days after the induction of lesions, and compared with an untreated control group. CK10 was significantly more expressed in the group treated with 660 nm PBM. CK14 did not show quantitative differences between the groups evaluated. However, whereas in the groups treated with PBM, CK14 was already restricted to the basal layer of the epithelium, as expected in healthy epithelia, in control group it was also expressed in upper layers of the epithelium. In this work, PBM was able to improve epithelial maturity of the repaired OM wound, especially in the 660 nm group.

Special care in dental curriculum: A transversal axis for integrating oral health with systemic health.

AIMS: Distance between dentistry and medicine is a traditional and historical obstacle that affects multiple levels of the health system, especially the health policies to improve health service quality. Changes in dental education, especially involving the adoption of integrative health models in professional development, are considered essential for reducing this gap. We aimed to show a dental curriculum focused on special care as a tool for medicine-dentistry integration. METHODS: In this study, we present a new proposal for an undergraduate dental curriculum in which topics related to special care are addressed transversally and are the core for interdisciplinary integration of oral health with systemic health. We also describe how themes related to dental home care and hospital dentistry were included in this course as basic professional competencies. RESULTS AND CONCLUSION: This initiative is aligned with the global trend to adopt educational systems that contribute to the reduction of health care inequalities and improve health service quality.

Photobiomodulation Therapy Minimizes the DNA Damage in 5FU-Treated Gingival Fibroblasts.

5-Fluoroufacil (5FU) is a chemotherapeutic agent indicated for solid tumors but causes oral mucositis, which can be prevented and treated using photobiomodulation therapy (PBMT). It is unknown whether PBMT modifies DNA damage induced by 5FU in oral cells. The aim of this study was to investigate the effect of PBMT on DNA damage and repair and on oxidative stress in gingival fibroblasts exposed to 5FU. Primary gingival fibroblasts were exposed to 5FU and then treated with a laser (660 nm, 100 mW, 1 W cm-2 , 0.09 cm2 spot area) for three different irradiation times (6, 10 or 20 s). Six-second irradiation decreased DNA damage and lipidic peroxidation. All irradiated groups showed low H2AX levels and increased p53 expression. Ten-second irradiation showed a trend to induce high lipidic peroxidation levels and DNA damage than other irradiation groups. In conclusion, the PBMT effect on DNA damage and repair was dependent on the time irradiation: 6 s-time irradiation (6.6 J cm-2 ) protect gingival fibroblasts from 5FU-related genotoxicity and oxidative stress, whereas 10s- and 20s-time irradiations (11.1 J cm-2 and 22.2 J cm-2 , respectively) increased the risk of DNA damage after the 5FU exposure.

Long-term safety of photobiomodulation therapy for oral mucositis in hematopoietic cell transplantation patients: a 15-year retrospective study.

Photobiomodulation therapy (PBMT) has demonstrated efficacy in the prevention and treatment of oral mucositis (OM) in hematopoietic cell transplantation (HCT). However, based on the cell stimulation properties, its long-term safety has been questioned, mainly in relation to risk for secondary malignancies in the oral cavity. The aim of this study was to investigate if different PBMT protocols for OM control have association with immediate and late adverse effects in HCT patients. Data on autologous and allogeneic transplantation, conditioning regimen, PBMT protocols, and OM severity were retrospectively collected from medical and dental records. Presence of secondary malignancies in the oral cavity was surveyed during a 15-year follow-up. Impact of OM on overall survival was also analyzed. Different PBMT protocols for prevention and treatment of OM were recorded over the years. Severe OM (grades 3 and 4) was infrequently observed. When present, we observed a significant decrease of the overall survival. No immediate adverse effect and secondary malignancy was associated to PBMT. In conclusion, the PBMT protocols used in the study were considered safe. The low frequency of severe OM observed encourages the implementation of this technique, with a special emphasis on the dosimetry adjustments focused on the HCT context.

Photobiomodulation as an adjunctive therapy for alveolar socket preservation: a preliminary study in humans.

Bone remodeling results in loss of alveolar bone height and thickness. Photobiomodulation (PBM) based on photochemical stimulation by low-intensity lasers emerges as an adjunctive therapy for alveolar socket preservation. Our study aimed to evaluate the effects of PBM therapy on alveolar bone repair. Twenty healthy patients in need of bilateral extraction of lower molars were enrolled in this split-mouth randomized and blind clinical trial. The extraction sites were randomly selected to receive either the PBM therapy with a CW GaAIAs diode laser (808 nm; 0.028 mm2; 0.1 W; 3.6 W/cm2; 89 J/cm2; 2.5 J/point) or no treatment (Control). Bone biopsies were harvested 45 days after the dental extraction and evaluated using micro-computerized tomography (µCT), morphometric, and histological analysis. Data were compared using the paired t test, and the level of significance was set at 5%. Bone surface (p = 0.029), bone surface/total volume (p = 0.028), trabecular number (p = 0.025), and connectivity density (p = 0.029) were higher at the PBM group compared with Control. The histological observations confirmed the µCT findings. PBM samples exhibited higher number of organized and connected bone trabeculae along with higher density of blood vessels than Control. Control samples displayed a dense and highly cellular connective tissue at the central area accompanied by the presence of immature bone trabeculae at the periphery. Our results indicated that the PBM therapy improved the newly bone trabeculae formation and their connectivity which increased bone surface, indicating the positive effect of the laser on alveolar human socket repair.

The effect of a single irradiation of low-level laser on nipple pain in breastfeeding women: a randomized controlled trial.

Photobiomodulation with low-level laser therapy (PBM-LLLT) has been introduced as a new tool to relieve nipple pain and repair nipple damage in breastfeeding women; however, evidence is needed to assess its effectiveness. The aim was to evaluate the effect of a single application of PBM-LLLT for breastfeeding women with nipple pain and damage; side effects were also collected. We conducted a randomized double-blinded controlled trial with women with nipple damage who were exclusively breastfeeding and rooming-in at Amparo Maternal maternity service, São Paulo, Brazil (May 2016 to May 2017). Women were randomly assigned into laser (n = 40) or control group (n = 40). Intervention was a single irradiation (660 nm, 100 mW, 2 J, 66.66 J/cm2, 3.3 W/cm2, 20 s of irradiation, punctual, and continuous mode) applied directly. Women reported pain levels at recruitment (before and immediately after irradiation), 6 and 24 h after the treatment. Pain level during a breastfeed was assessed using the Visual Analogue Scale (0 to 10). The primary outcome was the level of nipple pain immediately after the laser irradiation. Data were analyzed using hierarchical model and Wald test. At baseline, pain levels were similar (mean of 7.4 in laser group and 7.1 in control group). Women's perception of pain reduced approximately one point in both groups. Thirty-one percent of participants in the laser group (11/36) reported secondary effects, such as tingling (10/36) and pricking (2/36). The laser protocol of a single application was not effective in reducing pain in women with damaged nipples. Tingling sensation may be experienced by women receiving laser treatment for nipple damage.

Histological and Radiographic Evaluation of Equine Bone Structure after Implantation of Castor Oil Polymer.

OBJECTIVE: The main purpose of this study was to evaluate the characteristics of a vegetal polymeric biomaterial intended for bone substitution in horses and to investigate the responses of the equine third metacarpal bone to biomaterial implantation. MATERIALS AND METHODS: Six horses were submitted to osteotomy on the dorsal aspect of the left and right third metacarpal bones; one bone defect was randomly selected for treatment with biopolymer, while the other was left untreated and served as a control. Bone density was monitored radiographically after surgery and bone biopsy fragments were collected at the end of the 120-day follow-up period. Biopsy fragments were analysed using light and scanning electron microscopy. RESULTS: Mean bone density values (mmAL) were greater in control defects (16.33 ± 1.6) than in polymer-treated defects (14.17 ± 1.7) at 120 days (p = 0.027). Light microscopy revealed greater percentages of new bone formation in control defects (50.15 ± 14.8) than in polymer treated defects (26.94 ± 12.1) at 120 days (p < 0.0001). Scanning electron microscopy analysis suggested a similar quality of pre-existing bone and new bone formed in the presence of biomaterial. CLINICAL SIGNIFICANCE: The absence of adverse reactions supports biomaterial biocompatibility and osteoconducting capacity and suggests the castor oil polymer is a suitable bone substitute for the treatment of bone defects in horses.

Histologic and immunohistochemical evaluation of biocompatibility of castor oil polyurethane polymer with calcium carbonate in equine bone tissue.

OBJECTIVE To evaluate the efficacy of castor oil polyurethane polymer with calcium carbonate for use in a unicortical ostectomy on the dorsal surface of the third metacarpal bone of horses. ANIMALS 6 adult horses. PROCEDURES A unicortical ostectomy was created on the dorsal surface of both third metacarpal bones of each horse. Castor bean (Ricinus communis) oil polyurethane polymer with calcium carbonate was implanted into the ostectomy on 1 limb, and the ostectomy of the contralateral limb was left unfilled and served as a control sample. Ostectomy sites were evaluated histologically 120 days later. Biopsy specimens were obtained from the interface of bone and polymer or the interface of bone and newly formed tissue; specimens were processed for histomorphometric evaluation by use of light microscopy, immunohistochemical analysis, histochemical analysis, and transmission electron microscopy. RESULTS Osteoconductive activity of the biomaterial was confirmed by the presence of osteoblasts in the biopsy specimens. Absence of a chronic inflammatory response or foreign body reaction indicated biocompatibility. Expression of osteoblast markers was detected in the newly formed tissue. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that castor oil polyurethane polymer with calcium carbonate could be an acceptable compound for use as a bone substitute in horses with fractures in which bone filling is necessary.

Efficacy of Low-Level Laser Therapy in Relieving Nipple Pain in Breastfeeding Women: A Triple-Blind, Randomized, Controlled Trial.

Pain accruing from nipple lesions caused by inadequate latching by the baby is a common complaint among breastfeeding women and an important obstacle to successful breastfeeding. Nipple pain occurs during the first days after delivery and is considered one of the main causes for early weaning. To investigate the efficacy of low-level laser therapy as a treatment for nipple pain due to breastfeeding. A triple-blind, randomized, clinical study. A university-affiliated hospital in São Paulo, Brazil. Fifty-nine women with nipple lesions at the time of their admission. Thirty women (intervention group) received three sessions of laser therapy (InGaAIP laser, 660 nanometer, 40 milliwatts of power, 5 Joules per square centimeter of energy density for 5 seconds each, total energy = 0.6 Joules) in the region of the nipples at three different points in time (0 hour, 24 hours, and 48 hours after diagnosis of nipple lesion). Twenty-nine women with similar clinical conditions were randomly assigned to the control group. Self-reported pain was recorded before and after laser therapy using a visual analogue scale. The intervention group experienced a decrease of 2.0 centimeters in intensity of pain (p = .016) 24 hours after the first intervention and also presented lower levels of pain compared with the control group. Low-level laser therapy was considered effective for treating nipple lesions in breastfeeding women with pain, providing relief and prolonging exclusive breastfeeding. More clinical trials with different laser dosimetry and parameters are necessary to optimize laser therapy protocols for breastfeeding women.

Repair of Critical Calvarias Defects With Systemic Epimedium sagittatum Extract.

It is well established in reconstructive surgery the repair of great bone defects is a difficult goal to be achieved. The aim of this study was to evaluate the influence of an extract rich in icariin on bone neoformation in critically sized defects in rat calvaria. Under continual saline irrigation, a circular bone defect was created in 40 rat calvarias with an 8-mm diameter trephine drill. Animals were randomly divided into a test group that received an Epimedium sagittatum extract (containing 5.8 mg/mL of icariin) and a control group that received an equal volume of saline solution. Substances were administered daily through a feeding tube until euthanasia. After 7, 14, 21, and 42 days, 5 animals from each group were euthanized. Calvaria defect samples were fixed in 10% formalin for 48 hours, X-rayed, and histologically processed. In the test group, there was a significant reduction in the bone defect area on X-ray images and an increase in new bone area in all of the experimental periods in the test group. At 42 days, the bone in the test group also exhibited a significant reduction in osteocyte (P = 0.002) and osteoclast density (P = 0.041). The authors conclude that administration of systemic Epimedium extracts containing high concentrations of icariin can induce bone neoformation and reduce osteocyte and osteoclast densities, thereby altering the normal deposition and remodeling patterns that are present in critically sized bone defects.

Intervenções de enfermagem nos cuidados aos pacientes idosos com Alzheimer: revisão integrativa / Intervention in nursing care for the elderly patients with Alzheimer: integrative review

Objetivo: identificar as evidências na literatura sobre as intervenções de enfermagem em idosos com Alzheimer. Metodologia: trata-se de revisão integrativa da literatura. A coleta dos dados ocorreu nos meses de fevereiro a março de 2014 nas bases de dados MEDLINE e LILACS, sendo analisados 9 estudos. Resultados: as intervenções de enfermagem evidenciadas na literatura foram: atividades essenciais da vida diária; alimentação; aumento da socialização; melhora do sono; administração de medicamentos; musicoterapia; estimulação cognitiva; controle da dor; arteterapia. Conclusão: verificou-se a importância das intervenções ao longo dos dias de um idoso com Alzheimer e que essas melhoraram o estado geral dos idosos, diminuindo ou retardando o avanço da doença.

Objective: to identifythe evidence in the literature about nursing interventions in the elderly with Alzheimer's disease. Methodology: this is an integrative literature review. Data collection occurred from February to March 2014 in MEDLINE and LILACS databases, with nine studies being analyzed. Results: nursing interventions high lightedin literatu rewere: essential activities of daily living; feeding; increased socialization; improved sleep; administration of drugs; music therapy; cognitive stimulation; pain control; art therapy. Conclusion: it was observed the importance of intervention sover the days of an elderly with Alzheimer’s and that those improved the general condition of the elderly by reducing or slowing the progression of the disease.

Oral mucositis in pediatric patients undergoing hematopoietic stem cell transplantation: clinical outcomes in a context of specialized oral care using low-level laser therapy.

OM is a painful inflammatory condition of the oral mucosa, derived from the toxic effects of chemotherapy and radiotherapy. High OM severity is frequently present in HSCT pediatric patients, who exhibit multiple painful ulcers that limit their mastication and swallowing, leading to poor nutritional status. Few studies have demonstrated OM clinical outcomes in young patients undergoing HSCT. Feasibility of oral care and LLLT on OM prophylaxis and treatment is also poorly discussed. The aim of this study was to describe a specialized oral care protocol that included LLLT for pediatric patients undergoing transplantation and to demonstrate the clinical outcomes after OM prevention and treatment. Data from OM-related morbidity were collected from 51 HSCT pediatric patients treated daily with LLLT, followed by standard oral care protocols. All the patients, even infants and young children, accepted the daily oral care and LLLT well. The majority (80.0%) only exhibited erythema in the oral mucosa, and the maximum OM degree was WHO II. Patients who had undergone autologous and HLA-haploidentical transplants showed OM with the lowest severity. The frequency of total body irradiation and methotrexate prescriptions was higher in adolescents when compared with infants (p = 0.044), and adolescents also exhibited OM more severely than infants and young children. We found that good clinical outcomes were obtained using this therapy, mainly in regard to the control of OM severity and pain reduction in the oral cavity. Specialized oral care, including LLLT, is feasible and affordable for HSCT pediatric patients, although some adaptation in the patient's oral hygiene routine must be adopted with help from parents/companions and clinical staff.

Low-level laser irradiation promotes the proliferation and maturation of keratinocytes during epithelial wound repair.

Low-level laser therapy (LLLT) has been extensively employed to improve epithelial wound healing, though the exact response of epithelium maturation and stratification after LLLT is unknown. Thus, this study aimed to assess the in vitro growth and differentiation of keratinocytes (KCs) and in vivo wound healing response when treated with LLLT. Human KCs (HaCaT cells) showed an enhanced proliferation with all the employed laser energy densities (3, 6 and 12 J/cm(2) , 660 nm, 100 mW), together with an increased expression of Cyclin D1. Moreover, the immunoexpression of proteins related to epithelial proliferation and maturation (p63, CK10, CK14) all indicated a faster maturation of the migrating KCs in the LLLT-treated wounds. In that way, an improved epithelial healing was promoted by LLLT with the employed parameters; this improvement was confirmed by changes in the expression of several proteins related to epithelial proliferation and maturation. Immunofluorescent expression of cytokeratin 10 (red) and Cyclin D1 (green) in (A) Control keratinocytes and (B) Low-level laser irradiated cells. Blue color illustrates the nuclei of the cells (DAPI staining).

Cost-effectiveness of the introduction of specialized oral care with laser therapy in hematopoietic stem cell transplantation.

Oral mucositis (OM) is one of the side effects of hematopoietic stem cell transplantation (HSCT), resulting in major morbidity. The aim of this study was to determine the cost-effectiveness of the introduction of a specialized oral care program including laser therapy in the care of patients receiving HSCT with regard to morbidity associated with OM. Clinical information was gathered on 167 patients undergoing HSCT and divided according to the presence (n = 91) or absence (n = 76) of laser therapy and oral care. Cost analysis included daily hospital fees, parenteral nutrition (PN) and prescription of opioids. It was observed that the group without laser therapy (group II) showed a higher frequency of severe degrees of OM (relative risk = 16.8, 95% confidence interval -5.8 to 48.9, p < 0.001), with a significant association between this severity and the use of PN (p = 0.001), prescription of opioids (p < 0.001), pain in the oral cavity (p = 0.003) and fever > 37.8°C (p = 0.005). Hospitalization costs in this group were up to 30% higher. The introduction of oral care by a multidisciplinary staff including laser therapy helps reduce morbidity resulting from OM and, consequently, helps minimize hospitalization costs associated with HSCT, even considering therapy costs.

Aqueous-ozone irrigation of bone monocortical wounds in hyperglycemic rats.

PURPOSE: To analyze the effects of aqueous ozone irrigation over bone healing in hyperglycemia-induced rats. METHODS: Forty-eight male Wistar rats were allocated into Group H (hyperglycemic) or Group N (control). Monocortical bone wound were performed on femurs' anterolateral face. Wounds were treated with a trans-operatory single irrigation of 100ml of aqueous ozone [0.004mg/ml] whereas control groups received 100ml of pure water (Milli-Q®). Histomorphological and histomorphometrical analyses were accomplished after seven, 14 and 21 days. Kruskal-Wallis and Mann-Whitney statistical tests were applied for bone neoformation quantification and assessment. RESULTS: Aqueous ozone wounds irrigated revealed diffuse hemorrhage and increased neoformed of blood vessels number. There was no statistical significant difference in bone trabeculae neoformation. After seven and 14 days, the number of osteoclasts was higher in aqueous ozone groups than in those treated with pure water. CONCLUSION: Independently of blood glucose levels, aqueous ozone allowed an increase in blood vessels neoformation and osteoclast migration, without affect bone trabeculae neoformation.

Aqueous-ozone irrigation of bone monocortical wounds in hyperglycemic rats

PURPOSE: To analyze the effects of aqueous ozone irrigation over bone healing in hyperglycemia-induced rats. METHODS: Forty-eight male Wistar rats were allocated into Group H (hyperglycemic) or Group N (control). Monocortical bone wound were performed on femurs' anterolateral face. Wounds were treated with a trans-operatory single irrigation of 100ml of aqueous ozone [0.004mg/ml] whereas control groups received 100ml of pure water (Milli-Q®). Histomorphological and histomorphometrical analyses were accomplished after seven, 14 and 21 days. Kruskal-Wallis and Mann-Whitney statistical tests were applied for bone neoformation quantification and assessment. RESULTS: Aqueous ozone wounds irrigated revealed diffuse hemorrhage and increased neoformed of blood vessels number. There was no statistical significant difference in bone trabeculae neoformation. After seven and 14 days, the number of osteoclasts was higher in aqueous ozone groups than in those treated with pure water. CONCLUSION: Independently of blood glucose levels, aqueous ozone allowed an increase in blood vessels neoformation and osteoclast migration, without affect bone trabeculae neoformation.

Low-level laser therapy can produce increased aggressiveness of dysplastic and oral cancer cell lines by modulation of Akt/mTOR signaling pathway.

Low-level laser therapy (LLLT) is a non-thermal phototherapy used in several medical applications, including wound healing, reduction of pain and amelioration of oral mucositis. Nevertheless, the effects of LLLT upon cancer or dysplastic cells have been so far poorly studied. Head and neck cancer patients receiving LLLT for oral mucositis, for example, might have remaining tumor cells that could be stimulated by LLLT. This study demonstrated that LLLT (GaAlAs--660 nm or 780 nm, 40 mW, 2.05, 3.07 or 6.15 J/cm²) can modify oral dysplastic cells (DOK) and oral cancer cells (SCC9 and SCC25) growth by modulating the Akt/mTOR/CyclinD1 signaling pathway; LLLT significantly modified the expression of proteins related to progression and invasion in all the cell lines, and could aggravate oral cancer cellular behavior, increasing the expression of pAkt, pS6 and Cyclin D1 proteins and producing an aggressive Hsp90 isoform. Apoptosis was detected for SCC25 and was related to pAkt levels.

Phototherapy with low-level laser affects the remodeling of types I and III collagen in skeletal muscle repair.

The purpose of this article was to analyze the photobiomodulator role of low-level laser therapy (LLLT) on the skeletal muscle remodeling following cryoinjury in rats, focusing the types I and III collagen proteins. Laser phototherapy has been employed to stimulate repair in different tissues. However, its role in skeletal muscle remodeling is not yet well clarified, especially its effect on the collagen component of the extracellular matrix. Fifty adult Wistar rats were divided into four groups: control, sham, cryoinjury, and laser-treated cryoinjury. Laser irradiation was performed three times a week on the injured region using the InGaAlP (indium-gallium-aluminum-phosphorous) laser (660 nm; beam spot of 0.04 cm(2), output power of 20 mW, power density of 0.5 mW/cm(2), energy density of 5 J/cm(2), 10-s exposure time, with a total energy dose of 0.2 J). Five animals were killed after short-term (days 1 and 7) and long-term (14 and 21) durations following injury. The muscles were processed and submitted to hematoxylin and eosin (H&E) and immunohistochemical staining. The histological slices were analyzed qualitatively, semi-quantitatively, and quantitatively. The data were submitted to statistical analysis using the Kruskal-Wallis test. The qualitative analysis of morphological aspects revealed that the muscle repair were very similar in cryoinjury and laser groups on days 1, 14 and 21. However, at 7 days, differences could be observed because there was a reduction in myonecrosis associated to formation of new vessels (angiogenesis) in the laser-treated group. The analysis of the distribution of types I and III collagen, on day 7, revealed a significant increase in the depositing of these proteins in the laser-treated group when compared to the cryoinjury group. InGaAlP diode laser within the power parameters and conditions tested had a biostimulatory effect at the regenerative and fibrotic phases of the skeletal muscle repairs, by promoting angiogenesis, reducing myonecrosis, and inducing types I and III collagen synthesis, following cryoinjury in rat.

Photodynamic therapy mediated by methylene blue dye in wound healing.

OBJECTIVE: We sought to investigate the wound-healing process after photodynamic therapy (PDT) mediated by methylene blue dye (MB). BACKGROUND DATA: Few scientific studies show the PDT roles in wound healing. MATERIALS AND METHODS: One hundred rats were given a circular wound on the back, inflicted with a 6-mm-diameter punch. The animals were divided into four groups: control (no treatment); dye (topical application of MB); laser (InGaAlP, 117.85 J/cm(2), 100 mW, 660 nm, single point); and PDT (topical application of MB followed by laser irradiation). After 1, 3, 5, 7, and 14 days, the cutaneous wounds were photographed and assessed with histopathologic examination by using light microscope. Changes seen in edema, necrosis, inflammation, granulation tissue, re-epithelialization, and number of young fibroblasts were semiquantitatively evaluated. The wound-area changes were measured with special software and submitted to statistical analysis. RESULTS: The laser group demonstrated the smallest wound area at 14 days after the surgical procedure (p < 0.01). Concerning complete re-epithelialization, the laser group showed it at 5-7 days after surgery, whereas the PDT and the other groups showed it at 14 days. CONCLUSIONS: Laser interaction with tissue is somehow changed when exposed to the MB. PDT mediated by MB was not prejudicial to wound healing, as no delay occurred compared with the control group.

Severity of oral mucositis in patients undergoing hematopoietic cell transplantation and an oral laser phototherapy protocol: a survey of 30 patients.

BACKGROUND DATA AND OBJECTIVE: Oral mucositis (OM) is one of the worst cytotoxic effects of chemotherapy and radiotherapy in patients undergoing hematopoietic cell transplantation (HCT), and it causes severe morbidity. Laser phototherapy has been considered as an alternative therapy for prevention and treatment of OM. The aim of this study was to describe the incidence and severity of OM in HCT patients subjected to laser phototherapy, and to discuss its effect on the oral mucosa. PATIENTS AND METHODS: Information concerning patient age and gender, type of basic disease, conditioning regimen, type of transplant, absence or presence of pain related to the oral cavity, OM grade, and adverse reactions or unusual events were collected from 30 patients undergoing HCT (allogeneic or autologous). These patients were given oral laser phototherapy with a InGaAIP laser (660 nm and 40 mW) daily. The data were tabulated and their frequency expressed as percentages. RESULTS: In the analysis of those with OM, it was observed that 33.4% exhibited grade I, 40% grade II, 23.3% grade III, and 3.3% grade IV disease. On the most critical post-HCT days (D+5 and D+8), it was observed that 63.3% of patients had grade I and 33.3% had grade II disease; no patients had grade III or IV disease in this period. This severity of OM was similar to that seen in other studies of laser phototherapy and OM. CONCLUSION: The low grades of OM observed in this survey show the beneficial effects of laser phototherapy, but randomized clinical trials are necessary to confirm these findings.