Choosing between intraoral or extraoral, red or infrared laser irradiation after impacted third molar extraction.

BACKGROUND AND OBJECTIVE: Swelling and trismus are complications experienced by nearly all subjects after undergoing oral surgery for the removal of impacted teeth. The main purpose of this paper was to compare the effects of photobiomodulation therapy (PBMT) at two different wavelengths applied intra-orally and extra-orally on facial swelling and trismus in the postoperative period following the extraction of impacted mandibular third molars. STUDY DESIGN/MATERIALS AND METHODS: Sixty subjects were randomly divided into five groups, taking into account the type of laser therapy applied after surgery (intraoral or extraoral irradiation with 660 nm laser; intraoral or extraoral irradiation with 808 nm; and sham irradiation). Two and seven days after the surgery, two blinded evaluators measured the subjects' faces (swelling), and mouth opening (trismus). RESULTS: There was a statistically significant interaction between the irradiation site and wavelength (swelling and trismus were smaller if the red laser was applied intra-orally or if infrared laser was applied extra-orally). The intra-group analyses showed that 808 nm laser applied extra-orally favored reductions in postoperative facial swelling and trismus, although the inter-group comparisons revealed no statistically significant differences. CONCLUSION: Besides energy parameters, the combination of irradiation site and wavelength drive the results of phototherapy after the removal of impacted teeth. Lasers Surg. Med. 48:511-518, 2016. © 2016 Wiley Periodicals, Inc.

Oral hygiene associated with antimicrobial photodynamic therapy or lingual scraper in the reduction of halitosis after 90 days follow up: A randomized, controlled, single-blinded trial.

BACKGROUND: Although antimicrobial photodynamic therapy (aPDT) can reduce halitosis immediately after application, it returns after a week. This probably occurs because bacteria residing in the oral cavity may recolonize the dorsum of the tongue. OBJECTIVE: Verify if modification of oral hygiene behavior associated with aPDT or lingual scraper can reduce halitosis after a 90-day follow-up. METHODS: Forty adults with positive halitosis were randomized in G1 (n = 20) -aPDT + oral hygiene behavior (OHB) or G2 (n = 20)- lingual scraper + OHB. G1 group were submitted to 0.005 % methylene blue in the middle and posterior third of the tongue, with pre-irradiation of 1 min. Irradiations were performed with red laser diode (λ =660 nm), 100 mW, 318 J/cm2, 3537 mW/cm2, 9 J per point at 6 points. In the G2 group, the tongue was scraped 10 times on the right side and on the left side with a tongue scraper. All patients were instructed on OHB at baseline, 7 and 90 days (guidance on the use of dental floss and the Bass technique for brushing). Halitosis was evaluated by gas chromatography (OralChroma®). Values ​​> 112 ppb for Hydrogen sulfide (H2S) gas was considered positive halitosis. Methylmercaptanes and dimethylsulfide were also measured. The gas measures were assessed at baseline, immediately, and at 7 and 90 days. Paired t-test was used for the statistical analysis. For comparison between groups, the t-test was used. Values of p < 0.05 were considered statistically significant. RESULTS: There was no difference between groups immediately after treatment (p = .1532) after 7 days (p = 0.9312) and 90 days (p = 0.6642). For the aPDT group, there was a decrease in hydrogen sulfide ​​immediately after treatment (p = 0.0001), after 7 days, values remained 3-fold smaller (p = 0.0088) and 2-fold smaller after 90 days (p = 0.0270). For the scraper group, there was a decrease immediately after treatment (p = 0.0001), the values remains 2-fold smaller ​​(p = 0.0003) after 7 days and 3 months (p = 0.0001). CONCLUSION: The oral hygiene behavior associated with aPDT or tongue scraper was not able to reduce halitosis after 90-day follow-up. Despite halitosis remaining ​​ higher than 112 ppb in all follow-up periods, the mean values remain 2 or 3 fold smaller than baseline values. Future studies should include other oral hygiene behavior to achieve better results in the treatment of halitosis.

Evaluation of halitosis in adult patients after treatment with photodynamic therapy associated with periodontal treatment: Protocol for a randomized, controlled, single-blinded trial with 3-month follow up.

RATIONALE: Halitosis is an unpleasant odor that emanates from the mouth. Studies show halitosis returns in a week, after treatment with PDT. Probably, bacteria living in the periodontal sulcus could recolonize the dorsum of the tongue. Until nowadays, there are no study in adult population that associates halitosis and periodontal treatment with follow-up evaluation. The aim of this randomized, controlled, single-blinded clinical trial is to treat oral halitosis in healthy adults with photodynamic therapy (PDT), associated with periodontal treatment and follow them up for 3 months. PATIENT CONCERNS:: the concerns assessments will be done over the study using anamnesis interviews and specific questionnaire. DIAGNOSES:: halitosis will be evaluated by OralChroma. INTERVENTIONS: The participants (n = 40) with halitosis will be randomized into 2 groups: G1-treatment with PDT (n = 20) or G2-cleaning of the tongue with a tongue scraper (n = 20). OUTCOMES: Halitosis will be evaluated by measuring volatile sulfur compounds using gas chromatography. After the treatments, a second evaluation will be performed, along with a microbiological analysis (RT-PCR) for the identification of the bacteria T. denticola. The assessment of halitosis and the microbiological analysis will be repeated. After that, patients will receive periodontal treatment. The participants will return after 1 week and 3 months for an additional evaluation. Quality of life will be measured by Oral Health Impact Profile questionnaire (OHIP-14). LESSONS: This protocol will determine the effectiveness of phototherapy regarding the reduction of halitosis in adults. clinicaltrials.gov NCT03996915. ETHICS AND DISSEMINATION: This protocol received approval from the Human Research Ethics Committee of Universidade Nove de Julho (certificate number: 3.257.104). The data will be published in a peer-reviewed periodical.

Pilot study on laser propagation in maxillary and mandibular bone: Grey level image analysis for optical measurements.

BACKGROUND: Bone tissue anatomy, density and porosity vary among subjects in different phases of life and even within areas of a single specimen. The optical characteristics of changes in bone tissue are analyzed based on these properties. Photobiomodulation has been used to improve bone healing after surgery or fractures. Thus, knowledge on light propagation is of considerable importance to the obtainment of successful clinical outcomes. OBJECTIVE: This study determines light penetration and distribution in human maxillary and mandibular bones in three different regions (anterior, middle, and posterior). METHODS: A HeNe laser (633nm) irradiated maxillary and mandibular bones in the cervical-apical direction. The light propagation and scattering pattern were acquired and the grey level of the images was analyzed. Three-dimensional plots of the intensity profile and attenuation profiles were created. RESULTS: Differences in optical properties were found between the mandibular and maxillary bones. The maxilla attenuated more light than the mandible at all sites, leading to a shallower penetration depth. CONCLUSION: Our results provide initial information on the behavior of the propagation of red laser on alveolar bone using an optical method.