Quality assessment of PBM protocols for oral complications in head and neck cancer patients: part 2.

PURPOSE: To investigate the role of photobiomodulation (PBM) in patients undergoing head and neck cancer (HNC) treatment. We focused on the consequences of the main complications, such as quality of life (QoL), analgesia, functional impairment, and nutritional status, as well as on the impact on survival/ recurrences, radiotherapy (RT) interruption, adherence, cost-effectiveness, safety, feasibility, and tolerability. METHODS: An electronic search in PubMed and Scopus databases was performed. Full texts were carefully assessed, and data were assimilated into a tabular form for discussion and consensus among the expert panel. RESULTS: A total of 22 papers were included. Overall, a beneficial effect of PBM was evidenced in the amelioration of QoL, nutritional status, the reduction of pain, and functional impairment. Preventive PBM may reduce the incidence and duration of RT interruptions, potentially contributing to improved cancer treatment outcomes. PBM treatments are safe and recommended for routine use, with the caveat of avoiding direct tumor exposures where feasible. However, it does not appear to impact cancer survivorship/recurrences directly. Despite additional clinical efforts involving routine PBM use, the individual and public health benefits will positively impact oncology care. CONCLUSIONS: Quality of life, pain and functional impairment, nutritional status, and survival may be effectively improved with PBM. Given its established efficacy also in reducing RT interruptions and its safety, feasibility, and tolerability, PBM should be included in the field of supportive cancer care in HNC patients. Improved understanding of PBM mechanisms and precise dose parameters is enabling the generation of more robust, safe, and reproducible protocols; thus, it is imperative to support further clinical implementation as well as both applied and basic science research in this novel field.

Quality Assessment of PBM Protocols for Oral Complications in Head and Neck Cancer Patients: Part 1.

Background: Radiotherapy and chemotherapy are frequently employed in head and neck cancer (HNC) patients causing significant side effects that impair life quality and prognosis. Photobiomodulation (PBM) has become a growing approach to managing such oral complications. Despite its proven efficacy and absence of contraindications, there is still a lack of universally accepted disease-specific PBM protocols. Objective: A narrative review was conducted to identify the current proposals relating to the use of PBM to treat complications of oncological treatments in HNC patients. Methods: An electronic search in PubMed and Scopus databases was performed with the following keywords: ("photobiomodulation" OR "PBM" OR "laser therapy" OR "LLLT" OR "laser") AND ("head and neck cancer" OR "oral cancer") AND ("mucositis" OR "oral mucositis" OR "dysgeusia" OR "oedema" OR "xerostomia" OR "dermatitis" OR "trismus") until October 2021. Results: A total of 35 papers were included in the narrative review. Oral mucositis was the most studied complication, and advisable protocols are conceivable. Although there is a growing interest in PBM to manage of xerostomia, radiodermatitis, pain, and trismus, literature is still scarce to propose a universally feasible protocol. Conclusions: PBM therapy could significantly prevent or reduce the severity of many side effects related to cancer therapies. More research is needed to obtain recommendations over the preferable parameters.

Use of Blue and Blue-Violet Lasers in Dentistry: A Narrative Review.

Introduction: Blue and blue-violet diode lasers (450 and 405 nm) seem to represent an interesting approach for several clinical treatments today. The aim of this narrative review is to describe and comment on the literature regarding the utilization of blue and blue-violet lasers in dentistry. Methods: A search for "blue laser AND dentistry" was conducted using the PubMed database, and all the papers referring to this topic, ranging from 1990 to April 2020, were analyzed in the review. All the original in vivo and in vitro studies using 450 nm or 405 nm lasers were included in this study. All the articles on the LED light, laser wavelengths other than 405 and 450 nm and using lasers in specialties other than dentistry, as well as case reports, guideline papers and reviews were excluded. Results: From a total of 519 results, 47 articles met the inclusion criteria and were divided into 8 groups based on their fields of application: disinfection (10), photobiomodulation (PBM) (4), bleaching (1), resin curing (20), surgery (7), periodontics (1), endodontics (1) and orthodontics (3). Conclusion: Blue and blue-violet diode lasers may represent new and effective devices to be used in a large number of applications in dentistry, even if further studies will be necessary to fully clarify the potentialities of these laser wavelengths.

"At-Home" Photobiomodulation: A New Approach for Bell's Palsy Treatment.

OBJECTIVE: This report is the first one to describe the possibility to use "self-administered" photobiomodulation (PBM) for Bell's palsy (BP) treatment. BACKGROUND: BP is a peripheral disorder of the facial nerve causing sudden paralysis of unilateral facial muscles, and PBM has been successfully suggested for its treatment without any side effect. This is the first case report where a laser device was successfully used at home by the patient herself to treat BP opening new perspectives on the therapy of this disease. METHODS: This report describes the "at-home PBM" treatment performed on a 15-year-old girl who presented BP consisting of acute pain on the right side of her face, difficulty in biting and dripping saliva from the right side of her lips. The treatment was performed twice a day by cutaneous applications, each of 15 minutes (total fluence 48 J/cm2) in an area corresponding to the parotid gland by a device emitting at 808 nm at 250 mW output power. RESULTS: Two weeks after PBM treatment, performed at home twice a day by the patient herself without any kind of pharmacological therapy, the complete disappearing of the disease was noticed with no side effects. CONCLUSION: With the limitations due to a single case report and with the need of further clinical trials to confirm it, "at-home PBM" seems to represent a good and safe approach to the treatment of BP.

Bactericidal effect of Er,Cr:YSGG laser irradiation on endodontic biofilm: An ex vivo study.

AIM: This ex vivo study aimed to evaluate the of Er,Cr:YSGG laser effectiveness in the decontamination of an endodontic biofilm. MATERIALS AND METHODS: Seventy-three single rooted human teeth, freshly were chosen. Each tooth was exposed to four associated species in an endodontic biofilm (Enterococcus faecalis, Streptococcus salivarius, Porphyromonas gingivalis, and Prevotella intermedia) and randomly allocated to one of the seven experimental groups. The group 1 (7 teeth) was used to finalize the reliable biofilm-forming technique. The groups 2 and 3 (15 teeth each group) were irradiated with two different Er;Cr:YSGG laser settings (0,75 W - 40 Hz and 4 W - 40 Hz, respectively). The groups 4 and 5 (15 teeth each group) were irrigated with two different solutions and laser irradiated with the same settings (1,5 W - 15 Hz). The group 6 (6 teeth) was the control group treated only with 4 ml 2,5% NaOCl irrigation during 60 s. RESULTS: The observations of group 2 and 3 specimens showed the ripeness of the biofilm with the presence of Enterococcus faecalis and Streptococcus salivarius in chains but in group 3 thermal edge effects produced by the optic fiber in the canal walls were present. The group 4 specimens observation showed an average cleaning of the root canal walls while on the canal walls of group 5 samples the apical third presented several debris and smear layer and in the centre cracks and melting dentin of the radicular wall were observed. CONCLUSION: In those experimental conditions, this study, demonstrated that Er,Cr:YSGG laser has a canals decontamination ability when associated to NaOCl irrigation.

Nanosecond pulsed fiber laser irradiation for enhanced zirconia crown adhesion: Morphological, chemical, thermal and mechanical analysis.

The increasing demand for aesthetics, together with advancements in technology, have contributed to the rise in popularity of all-ceramic restorations. In the last two decades, the continuous progression in ceramic materials science for dental applications has permitted the fabrication of high-strength materials. Amongst these, zirconia-based ceramics have improved in terms of fracture resistance and long-term viability in comparison with other silica-based materials. Unfortunately, while bonding of resin cement-silica ceramics can be strengthened through creation of a porous surface by applying hydrofluoric acid (5%-9.5%) and a subsequent silane coupling agent, the glass-free polycrystalline microstructure of zirconia ceramics does not allow such a reaction. The aim of the present in vitro study was to observe the effect of 1070 nm fiber nanosecond pulse laser irradiation on zirconia samples through morphological analysis (profilometry, SEM), thermal recording with Fiber Bragg Gratings (FBGs), elemental composition analysis (EDX) and bond strength testing (mechanical tests) in order to evaluate the possible advantages of this kind of treatment on zirconia surfaces, as well as to show the potential side effects and changes in chemical composition. Despite laser irradiation with a 1070 nm wavelength fiber laser and correct process parameters demonstrating suitable outcomes in terms of improved surface roughness and minimal thermal damage, comparison between irradiated and unirradiated samples did not exhibit statistically significant differences in terms of bonding strength.

[Oral care and the Coronavirus COVID-19 epidemic]. / Soins bucco-dentaires et épidémie de Coronavirus COVID-19.

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.

[Oral care and the Coronavirus COVID-19 epidemic] / Soins bucco-dentaires et épidémie de Coronavirus COVID-19.

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.

Auto-Administered Photobiomodulation on Diabetic Leg Ulcers Treatment: A New Way to Manage It?

BACKGROUND: Peripheral arterial disease is a dramatic consequence of an uncontrolled diabetic condition causing an increase of morbidity and mortality and its treatment is currently medical or surgical, finally requiring, in the 7-20% of cases, major or minor amputation. Photobiomodulation therapy (PBM) is a laser treatment used in medicine, thanks to its ability to stimulate the wound healing, the acceleration of inflammatory process, and the modulation of pain. Recently, the self-administration of the treatment has been suggested for different purposes in medicine and dentistry with a great number of advantages and no side effects. METHODS: A 84-year-old woman affected by diabetes type 2 and positive for diabetes complications had diagnosis for an ulcerative lesion of 1 cm diameter on her right leg and started a treatment of the lesion applying the B-Cure Laser Pro (Erika Carmel, Haifa, Israel) on her own with a fluence per minute of 3.2 J/cm2 for 2 sessions of 15 minutes by cutaneous application. RESULTS: After a week of treatment, the ulcer dried and crusted, finally providing complete healing after 30 days of treatment. CONCLUSION: With this short case report, we think to add a further contribution by suggesting this kind of treatment for successful management of the leg ulcers in diabetic patients.

Soins bucco-dentaires et épidémie de Coronavirus COVID-19.

The COVID-19 Coronavirus epidemic started in December 2019 in China, and progressed very quickly in France. Its consequences were the implementation of national measures such as the containment of the population, but also a disorganization of the healthcare system, in particular concerning oral care. Indeed, dental procedures produce aerosols which can be loaded with viral particles, and as such, constitute a major contamination route by the virus. At the request of the Conference of Deans of the Faculties of Odontology, the National College of University Dentists in Public Health (CNCDUSP) set up a working group in order to issue recommendations for oral care in the context of the COVID-19 epidemic, given the specific risks faced by practitioners. Considering the lack of awareness of the specifics of dentistry in the medical world and among decision-makers, and given the speed with which national measures to fight the epidemic were implemented, the recommendations of the CNCDUSP had to be drawn up rigorously and quickly before being released to the profession. They take into account epidemiological data related to the virus, the specificities of oral care, and thus propose protective measures for dental surgery professionals.The necessary adaptation of the healthcare system during an epidemic will certainly make it possible to learn lessons from this health crisis.

Focal Infection and Periodontitis: A Narrative Report and New Possible Approaches.

The "focal infection theory" is a historical concept based on the assumption that some infections may cause chronic and acute diseases in different districts of the body. Its great popularity spanned from 1930 to 1950 when, with the aim to remove all the foci of infection, drastic surgical interventions were performed. Periodontitis, a common oral pathology mainly of bacterial origin, is the most evident example of this phenomenon today: in fact, bacteria are able to migrate, develop and cause health problems such as cardiovascular and respiratory diseases, diabetes, and osteoporosis. The aim of this narrative report is to verify the hypothesis of the association between oral infections and systemic diseases by different ways of approach and, at the same time, to propose new kinds of treatment today made possible by technological progress. The analysis of the literature demonstrated a strong relationship between these conditions, which might be explained on the basis of the recent studies on microbiota movement inside the body. Prevention of the oral infections, as well as of the possible systemic implications, may be successfully performed with the help of new technologies, such as probiotics and laser.

Nd:YAP laser in the treatment of dentinal hypersensitivity: An ex vivo study.

PURPOSE: The aims of this ex vivo study were to evaluate the effectiveness of the Nd:YAP laser in the treatment of dentin hypersensitivity, to compare the temperature rise during laser irradiation at three different dentine thicknesses, and to analyse the composition of the dentine-lased surface. METHODS: A total of 33 teeth were used in this study. For scanning electron microscopy (SEM) observation, 24 teeth were transversely sectioned and divided into 4 groups: group A was irrigated with EDTA; group B was irradiated by Nd:YAP laser with 180 mJ energy/per pulse, 0.9 W average power, and 5 Hz frequency (power density [PD] = 229 W/cm2); group C was irradiated by Nd:YAP laser with 280 mJ energy/pulse, 1.4 W average power, and 5 Hz frequency (PD = 356 W/cm2); and group D was irradiated by Nd:YAP with 360 mJ energy/pulse, 1.8 W average power, and 5 Hz frequency (PD = 458 W/cm2). Energy-dispersive spectroscopy (EDS) analysis was performed on the same teeth evaluated for SEM observations. For temperature increase evaluation performed with thermocouples, 9 teeth were transversely sectioned at 3 different thicknesses (3 for each group) of 1, 2, and 3 mm. RESULTS: Statistical analysis showed significant changes in the diameter of the dentinal tubule orifices among all groups; EDS did not show modification of the Ca/P ratio. Temperature increase under irradiation exceeded 5.5 °C only in the group D samples. CONCLUSIONS: This ex vivo study, based on temperature recording, SEM observation, and EDS analysis, demonstrated that Nd:YAP laser at a PD of 356 W/cm2, corresponding to an average power of 1.4 W, defines the best treatment for dentine hypersensitivity in terms of compromise between efficacy of the treatment and safety of the pulp.

Photobiomodulation in Pediatric Dentistry: A Current State-of-the-Art.

Objective: Given the tremendous progress in biophotonics applications in biology and engineering, we sought to examine the evidence for the use of low-dose biophotonics treatments, termed photobiomodulation (PBM) therapy, in pediatric dentistry. Background: PBM therapy has been noted to alleviate pain and inflammation while promoting tissue healing and regeneration. These basic processes contribute to the fundamental etiopathogenesis of various oral diseases, and hence, there is now a growing list of potential clinical applications with PBM therapy in children. Materials and methods: An exhaustive literature search was conducted for PBM studies in pediatric dentistry that includes patients up to 21 years of age. An analysis of the quality of the included studies was also performed to evaluate the rigor of the evidence. Specific emphasis was placed on the treatment efficacy on the relevant specified outcomes for individual applications. Results: From a total of over 420 initial hits, 19 studies were deemed suitable for inclusion in this review. Among them, PBM therapy has been used in pediatric dentistry for prevention and treatment of oral mucositis associated with oncotherapy (chemotherapy, radiation, and transplants), for postsurgical oral pain and for pulpotomies. Overall, all studies reported therapeutic benefits, and no adverse effects were reported. Conclusions: This review noted that PBM therapy is a safe and effective treatment modality for various clinical applications in pediatric dentistry. Despite potential positive publication bias, there appears to be clear evidence of clinical benefit with this treatment, and we recommend well-designed randomized, placebo-controlled human clinical trial be pursued.

Photobiomodulation in Oral Medicine.

Objective: To provide a review of the literature about the photobiomodulation therapy (PBMT) dental treatment protocols in oral medicine based on validated clinical studies that have been published so far. Background data: The lack of effective therapies for the treatment of various types of oral diseases or the presence of invasive therapeutic methods along with the use of a wide range of medications has had a significant impact on the quality of life of these patients. PBMT as a noninvasive and nondrug method can play an influential role in the treatment of oral diseases. Methods: In this study, published clinical studies up to April 2019 were reviewed from library sources, Google Scholar, PubMed and Medline, Elsevier, Embase, Cochrane, Scopus, and Web of science (ISI). Results: In general, the findings of this study showed that PBMT has had a positive effect on the treatment of oral lichen planus, recurrent aphthous stomatitis, hyposalivation, pemphigus vulgaris, recurrent herpes simplex, burning mouth syndrome, bisphosphonate-related osteonecrosis of the jaw, trigeminal neuralgia, facial nerve paralysis, geographic tongue, and chronic sinusitis. Conclusions: PBMT can be effective (as an alternative treatment or in combination with other therapies) in improving symptoms or in the complete treatment of oral diseases. However, further clinical studies are still necessary to achieve more robust results.

Photobiomodulation Therapy in Oral Medicine: A Guide for the Practitioner with Focus on New Possible Protocols.

Photobiomodulation (PBM) is the term to define the wide range of laser applications using low-energy densities and based on photochemical mechanisms where the energy is transferred to the intracellular mitochondrial chromophores and respiratory chain components. In literature, a great number of works are reported showing the advantages of PBM use in many oral diseases such as recurrent aphthous stomatitis, herpes infections, mucositis, and burning mouth syndrome. Different factors may explain the increasing reported use of PBM in oral medicine: the absence of side effects, the possibility of safely treating compromised patients such as oncologic patients, the possibility of a noninvasive approach not associated with pain or discomfort, and the possibility of performing short sessions. The review's aim is to describe the possible applications of PBM in oral medicine, giving practitioners simple guide for practice together with the information of a new treatment possibility "at home" performed by the patient himself under supervision.

Antimicrobial Photodynamic Therapy Protocols on Streptococcus mutans with Different Combinations of Wavelengths and Photosensitizing Dyes.

The aim of the study is to test the application of different laser wavelengths, with and without different photosensitizing dyes on different types of cultures. Laser irradiation was realized on Streptococcus mutans in both solid and liquid culture media in continuous mode at three different fluences (10, 20, and 30 J/cm2) with a red diode (650 nm) with toluidine blue dye, a blue-violet diode (405 nm) with curcumin dye, and a green diode (532 nm) with erythrosine dye. Without a photosensitizer, no growth inhibition was obtained with the red diode at any fluence value. Inhibition rates of 40.7% and 40.2% were obtained with the blue diode and green diode. The blue diode laser used with curcumin obtained results in terms of growth inhibition up to 99.26% at a fluence of 30 J/cm2. The red diode laser used with toluidine blue obtained results in terms of growth inhibition up to 100% at fluences of 20 and 30 J/cm2. The KTP (potassium-titanyl-phosphate) laser used with erythrosine was able to determine a complete growth inhibition (100%) at the different fluence values. The combination of a laser and its proper color may dramatically change the results in terms of bactericidal effect. It will be interesting to confirm these data by further in vivo studies.

Antimicrobial effect on Candida albicans biofilm by application of different wavelengths and dyes and the synthetic killer decapeptide KP.

The aim of this study was to test the application in vitro of different laser wavelengths at a low fluence in combination or not with proper photosensitizing dyes on Candida albicans biofilm with or without a synthetic killer decapeptide (KP). Candida albicans SC5314 was grown on Sabouraud dextrose agar plates at 37°C for 24 h. Cells were suspended in RPMI 1640 buffered with MOPS and cultured directly on the flat bottom of 96-wells plates. The previously described killer decapeptide KP was used in this study. Three different combinations of wavelengths and dyes were applied, laser irradiation has been performed at a fluence of 10 J/cm2. The effect on C. albicans biofilm was evaluated by the XTT assay. Microscopic observations were realized by fluorescence optic microscopy with calcofluor white and propidium iodide. Compared with control, no inhibition of C. albicans biofilm viability was obtained with application of red, blue and green lasers alone or with any combination of red diode laser, toluidine blue and KP. The combined application of blue diode laser with curcumin and/or KP showed always a very significant inhibition, as curcumin alone and the combination of curcumin and KP did, while combination of blue diode laser and KP gave a less significant inhibition, the same obtained with KP alone. The combined application of green diode laser with erythrosine and/or KP showed always a very significant inhibition, as the combination of erythrosine and KP did, but no difference was observed with respect to the treatment with erythrosine alone. Again, combination of green diode laser and KP gave a significant inhibition, although paradoxically lower than the one obtained with KP alone. Treatment with KP alone, while reducing biofilm viability did not cause C. albicans death in the adopted experimental conditions. On the contrary, combined treatment with blue laser, curcumin and KP, as well as green laser, erythrosine and KP led to death most C. albicans cells. The combination of laser light at a fluence of 10 J/cm2 and the appropriate photosensitizing agent, together with the use of KP, proved to exert differential effects on C. albicans biofilm.

Er:YAG laser for the aesthetic treatment of developmental enamel defects in frontal teeth: a case report.

BACKGROUND AND AIMS: Several studies highlighted how the ameloblasts, secretory cells responsible of the tooth enamel formation, are highly sensitive to changes in their environment. Due to enamel maturation, their dysfunctions during a limited period of tooth development may lead to permanent morphological consequences, namely Developmental Enamel Defects (DED). The aim of this study was to show the advantages of Er:YAG laser for DED treatment. SUBJECTS AND METHODS: The case report presented describes the treatment, by Er:YAG laser, of some DED lesions present in the upper incisors of a young patient. The settings used were: 1W power, 100mJ energy, 10 Hz frequency corresponding to a Fluence of 0.318 J/cm2 per pulse or 3, 18 J/cm2. RESULTS: The patient, even in absence of local anesthesia, did not feel any pain or discomfort during and after intervention. Follow-up at 2, 6 and 12 months did not show any problems in an aesthetic point of view as well as regarding hypersensitivity. CONCLUSIONS: The use of Er:YAG laser for the treatment of developmental enamel defects in frontal teeth is a safe, painless and minimally invasive; moreover, it is able to assure a good aesthetic result.