Article

The Effect of 670-nm Low Laser Therapy on Herpes Simplex Type 1

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Abstract

The purpose of this work was to study the effect of low-level laser therapy (LLLT) on the healing and relapse intervals in patients with recurrent labial herpes simplex infections. Several pharmaceuticals are available to reduce symptoms and improbé healing of labial herpes, but only LLLT has been reported to significantly influence the length of the recurrence period. Material and methods: In an initial study, 232 patients with herpes simplex type 1 virus symptoms were consecutively selected for either LLLT or conventional therapy, including acyclovir cream or tablets. One of the dentists was responsible for the diagnosis, a second dentist for the treatment, and and a third for the evaluation, to allow for a semi-blinded procedure. Patients in the laser group received 670-nm laser irradiation, 40 mW, 1.6 J, 2.04 J/cm(2), 51 mW/cm(2) per blister in the prodromal stage and 4.8 J in the crust and secondarily infected stages, plus 1.2 J at the C2-C3 vertebrae. Patients were monitored daily during the first week to control healing, and monthly for 1 year to check on recurrence. In a consecutive study, 322 patients receiving LLLT were followed during 5 years to observe the period of ocurrences. An obvious effect of LLLT was found for both initial healing and for the length of the recurrence periods. LLLTof herpes simples virus 1 (HSV-1) appears to be an effective treatment modality without any observed side effects.

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... Other limitations of these drugs include their relatively short half-life, frequent topical use, risk of nephrotoxicity on systemic administration, and emergence of drugresistant HSV strains [6]. The use of low-level laser therapy (LLLT), also known as laser phototherapy, has been suggested as an alternative treatment modality for the management and prevention of RHL [6,9,10]. The principle of LLL is based on its analgesic, antiinflammatory, anti-infective, and bio-stimulating effects [11][12][13]; it stimulates fibroblast proliferation, tissue regeneration, immune response, and neovascularization [11]. ...
... Honarmand et al. [10] found that treatment with a diode laser reduced the length of recovery time and pain severity in RHL patients, which was significantly faster than treatment with acyclovir cream. Moreover, Sanchez et al. [9] reported a significant decrease in healing time and recurrence rate of RHL with laser compared with acyclovir cream. In contrast, de Carvalho et al. [14] did not find significant differences between laser and acyclovir in reducing pain and recurrence rate of RHL. ...
... An overview of the excluded studies and the reason for exclusion is shown in Table 1. Ultimately, six studies [9,10,14,[26][27][28] were included in the systematic review and processed for data extraction. ...
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Recurrent herpes labialis (RHL) is a highly prevalent viral infection that affects the oro-facial region. Current treatment options have limited efficacy in reducing healing time and recurrence rate of the disease. Recently, low-level laser therapy has been proposed as a potential treatment alternative for the management of RHL with no side effects. This systematic review aims to evaluate the effectiveness of laser therapy in the management and prevention of RHL. A comprehensive search of Medline/PubMed, Scopus, and Web of Science was carried out to identify published clinical trials comparing laser intervention to active and/or non-active controls for the treatment of RHL. Due to marked heterogeneity of available data, studies were assessed qualitatively, and no statistical analysis was performed. Of the retrieved 227 articles, six clinical trials met the eligibility criteria. The wavelengths, the power output, and energy density ranged between 632.5–870 nm, 5–80 W, and 2.04–48 J/cm², respectively. All included studies found laser to be effective in the management and prevention of RHL, without any side effects. The findings of this review suggest that laser is potentially a safe and effective treatment alternative for the management of RHL. However, due to high variability in study designs and inconsistency in laser parameters among the included studies, more well-designed randomized clinical trials with standardized laser parameters are highly warranted.
... Despite the fact that few clinical studies have been published concerning laser phototherapy and the treatment of RHL (Table 1), all of them described some gain from the use of laser therapy48495051. A negative point of the studies is the divergence in laser parameters, which makes it difficult to compare their results. ...
... – All the clinical studies that examined the duration of HSV manifestations found a significant reduction in the duration of herpetic eruptions in patients treated with LPT in comparison to placebo or control groups [48, 49, 51, 56]. Curiously, Vélez-González et al. [51] found a probable therapeutic synergism in the association of acyclovir and LPT. ...
... Therefore, drainage of the vesicle content with a high-power laser or sterile needle before LPT is strongly recommended [55, 56]. Regarding the preventive effects of LPT, it can be used in the perioral area during the latent phase, when no signs of infection are present, and in this case, an increase of the interval between successive HSV-1 infections is expected [49, 50]. Landthaler et al. [64] also achieved significant prolongation of remission intervals, from 30 to 73 days, in patients with recurrent HSV-1 infection. ...
Article
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Recurrent herpes labialis is a worldwide life-long oral health problem that remains unsolved. It affects approx- imately one third of the world population and causes fre- quent pain and discomfort episodes, as well as social restriction due to its compromise of esthetic features. In addition, the available antiviral drugs have not been suc- cessful in completely eliminating the virus and its recur- rence. Currently, different kinds of laser treatment and different protocols have been proposed for the management of recurrent herpes labialis. Therefore, the aim of the present article was to review the literature regarding the effects of laser irradiation on recurrent herpes labialis and to identify the indications and most successful clinical protocols. The literature was searched with the aim of identifying the effects on healing time, pain relief, duration of viral shed- ding, viral inactivation, and interval of recurrence. According to the literature, none of the laser treatment modalities is able to completely eliminate the virus and its recurrence. However, laser phototherapy appears to strongly decrease pain and the interval of recurrences without caus- ing any side effects. Photodynamic therapy can be helpful in reducing viral titer in the vesicle phase, and high-power lasers may be useful to drain vesicles. The main advantages of the laser treatment appear to be the absence of side effects and drug interactions, which are especially helpful for older and immunocompromised patients. Although these results indicate a potential beneficial use for lasers in the manage- ment of recurrent herpes labialis, they are based on limited published clinical trials and case reports. The literature still lacks double-blind controlled clinical trials verifying these effects and such trials should be the focus of future research.
... The experimental group showed a significant reduction in healing time. Muñoz Sanchez et al. (7) conducted a study in 2012 in which they compared the effect of LLLT, 670 nm, on herpes labialis with acyclovir. They reported that LLLT was an effective therapy with no side effects. ...
... Acyclovir and penciclovir have a similar mechanism of antiviral action against HSV, as extensively reported in the literature (16,22,23) . The resistance of HSV to acyclovir can happen, and almost all resistance occurs as a result of adeficiency in thymidine kinase (7) . Nearly all clinical HSV isolated with resistance to acyclovir have been obtained from patients who have received prolonged acyclovir therapy (7,(24)(25)(26)(27) . ...
... The resistance of HSV to acyclovir can happen, and almost all resistance occurs as a result of adeficiency in thymidine kinase (7) . Nearly all clinical HSV isolated with resistance to acyclovir have been obtained from patients who have received prolonged acyclovir therapy (7,(24)(25)(26)(27) . Essential to a successful therapeutic intervention for RHL is an accurate anamnesis for assessment of the patient's overall health and the extent of clinical disease (20,28) . ...
Article
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Abstract Recurrent herpes labialis is a worldwide life-long oral health problem that remains unsolved. It affects approximately one third of the world population and causes frequent pain and discomfort episodes, as well as social restriction due to its compromise of esthetic features. In addition, the available antiviral drugs have not been successful in completely eliminating the virus and its recurrence. Currently, different kinds of laser treatment and different protocols have been proposed for the management of recurrent herpes labialis. Therefore, the aim of the present article was to review the literature regarding the effects of laser irradiation on recurrent herpes labialis in comparison to the effect of acyclovir. The literature was searched with the aim of identifying the effects on healing time, pain relief, interval of recurrence. According to the literature, none of the laser treatment modalities is able to completely eliminate the lesion and its recurrence. However, laser phototherapy appears to strongly decrease pain and the interval of recurrences without causing any side effects.
... The weekly administration of LLLT over 8 weeks resulted in the resolution of pain during a 14month follow-up. LLLT has also been reported to be beneficial in treating recurrent herpes simplex infections, 16,17 possibly via the immune system rather than direct virus inactivation. Because LLLT appears to play a role in neuropathic pain relief, and indirect virus deactivation, we hypothesized that LLLT reduces PHN incidence during the early stage of herpes zoster. ...
... 26 Furthermore, it has also been reported as having an effect of indirect viral deactivation. 16,17 Because the increased cytokine levels in the acute phase of herpes zoster are assumed to be a potential mechanism for inducing PHN, the early suppression of these cytokines by LLLT may help prevent the development of PHN. It may also explain why early application may reduce the incidence of PHN but is less effective in the subacute group. ...
Article
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Background: Postherpetic neuralgia (PHN) is difficult to treat, and currently there are no available treatments that effectively reduce its incidence. Low-level laser therapy (LLLT) has been proposed for indirect virus deactivation in treating recurrent herpes simplex infections. Objective: This study seeks to investigate whether LLLT could reduce the incidence of PHN. Methods: We retrospectively reviewed the incidence of PHN at the first, third, and sixth months after rash outbreak in 3 groups: the acute group of patients who received LLLT during the first 5 days; the subacute group of patients who received LLLT during days 6 to 14 of the eruption; and the control group of patients who did not receive LLLT. Results: There were 48, 48, and 154 patients in the acute, subacute, and control groups, respectively. After adjusting for confounding factors, including age, sex, and use of famciclovir, the incidence of PHN was significantly lower in the acute group versus the control group after 1 month (odds ratio [OR] 0.21, P = .006, 95% confidence interval [CI] 0.068-0.632), 3 months (OR 0.112, P = .038, 95% CI 0.014-0.886), and 6 months (OR 0.123, P = .021, 95% CI 0-0.606). The subacute group only had a lower incidence (OR 0.187, P = .032, 95% CI 0.041-0.865) after 3 months when compared with the control group. Limitations: This is a retrospective study lacking double-blind randomization, and the placebo effect may be a major concern. Lack of standardized and prospective evaluation measures is also a limitation of this study. Conclusion: Applying LLLT within the first 5 days of herpes zoster eruption significantly reduced the incidence of PHN. LLLT may have the potential to prevent PHN, but further well-designed randomized controlled trials are required.
... In patients treated with laser (in comparison to the patients who were given medications), a significant decrease in herpes lesions and in‐ flammatory edema was seen; however there was no significant decrease in pain or monthly recurrences. Munoz Sanchez et al. [11] used a 670 nm wavelength laser, power output of 40 mW; 1.6J; 2.04J7cm², 51 mW/cm² applied to the each vesicle in the prodromal stage and 4.8J on the crust together with 1.2J on the cervical vertebra C2-C3. The same authors [11] concluded that laser therapy improves healing in the beginning and prolongs the intervals between re‐ currences, that is, those patients have fewer recurrences. ...
... Munoz Sanchez et al. [11] used a 670 nm wavelength laser, power output of 40 mW; 1.6J; 2.04J7cm², 51 mW/cm² applied to the each vesicle in the prodromal stage and 4.8J on the crust together with 1.2J on the cervical vertebra C2-C3. The same authors [11] concluded that laser therapy improves healing in the beginning and prolongs the intervals between re‐ currences, that is, those patients have fewer recurrences. Marrotti et al. [12] used a 660 nm wavelength laser, energy density of 120 J/cm², output pow‐ er of 40 mW, during two minutes on spot and 4.8J of energy per spot on four spots. ...
... An obvious effect of PBM was found for both initial healing and for the length of the recurrence periods. 64 Herpetic lesions are found to be most susceptible to PBM during their prodromal stage. When Herpes simplex virus 1 is treated in the prodromal (initial) stage, the attack will likely subside: pain relief is immediate, and the intermediate period between the attacks is prolonged. ...
... Zosters and post-herpetic neuralgia could also be treated. 33,64 There is a need for longitudinal studies in order to establish PBM treatment protocols for infectious agents and other related microorganisms, and for a range of immunosuppressed patients, for whom a generallyaccepted treatment course has yet to be described. 65 ...
Article
Photobiomodulation (PBM) or low-level laser therapy (LLLT) in dentistry is an evolving science, with an increasing number of controlled clinical studies exploring its potential as a treatment modality. The present study provides an outline of the biologic mechanism of PBM and summarizes the findings of clinical studies of PBM for specific applications in oral medicine. Controversies and drawbacks associated with PBM, which require further research, are also identified. Current literature reports the potential of PBM in various applications in oral medicine. Furthermore, well-documented research confirms its efficacy in certain conditions, such as oral mucositis, recurrent herpes simplex infection, and burning mouth syndrome. The absence of any reported adverse effects is an advantage over conventional therapeutic modalities. While PBM has proved to be effective for some specific applications, it is not a panacea. The paucity in standardized studies, coupled with ambiguity over the laser parameters, has limited its credibility as a therapeutic modality. © 2015 Wiley Publishing Asia Pty Ltd.
... Kada su u pitanju preventivni efekti laseroterapije, ona se može koristiti za vreme latentne faze kada nema prisutnih znakova infekcije, a povećanje intervala između pojave novog herpetičnog napada se povećava 23,24 . Dakle, laserska svetlost se koristi kako u prodromalnoj fazi da bi se smanjila ekstenzija lezija tako i u latentnoj fazi za povećanje intervala između dva recidiva. ...
... In fact, the subjects treated with the laser had significantly lower mean value of the pain as compared to subjects treated with aciclovir (p<0,05). When it comes to preventive effects of laser treatment, it can be used during the latent phase when there are no signs of infection, and the interval between the appearance of a new herpetic attack extends 23,24 . Therefore, laser light is used in prodromal stage in order to reduce the extension of lesions, as well as in the latent phase in order to increase the interval between two recurrences. ...
Article
Introductio: Soft laser could be used for the treatment of different painful diseases and conditions in the oral cavity. One of them is Herpes labialis. The aim of the paper was to study the efficiency of soft laser in the treatment of Herpes labialis. Material and method: The study included 43 patients. Laser therapy was applied in 23 patients, whereas 20 patients were treated by Ung. Acycklovir. Results: The level of statistical significance of differences in mean values of pain between the groups was maximum (p <0.001). Patients with herpetic lesions benefit from laser therapy in terms of shortening the progression of the disease, pain, tingling and burning. The patients treated with laser had significantly lower mean value of the pain compared to those treated with Ung. Acyklovir (p <0.05). Conclusion: Based on the obtained results, it can be concluded that the soft laser proved to be an effective therapy in the treatment of Herpes labialis, and, therefore, is recommended in its treatment.
... The current therapy includes the use of anti-viral drugs to control the recurrent occurrence, but they result temporarily. LLLT has been suggested for accelerated healing, reducing symptoms and influencing the length of the recurrence period [22][23][24]. The 2012 updated protocol included the use of a 670nm laser, setting the power at 51 mW/cm 2 daily applied for two weeks [24]. ...
... LLLT has been suggested for accelerated healing, reducing symptoms and influencing the length of the recurrence period [22][23][24]. The 2012 updated protocol included the use of a 670nm laser, setting the power at 51 mW/cm 2 daily applied for two weeks [24]. ...
Article
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Laser devices are powerful instruments and are fully integrated in a dentist’s life working. They are mostly known for the thermal cutting properties, therapeutic lasers find a wide application in the regenerative and adjuvant medicine. The aim of this short review is to provide the definition of Laser Biostimulation, its last updates and applications in dentistry. Employing the photochemical interactions, Laser Biostimulation is widely used to improve the patient comfort, treatment and life quality. Among clinicians, though, this topic can result confusing and not fully understandable. This is because this kind of therapy is relative new and because the exact mechanism of light-tissue interaction is not clarified yet. Even though more randomized clinical trials are needed to verify the real benefit of Laser Biostimulation, understanding the photochemical interactions is fundamental for a more conscious use of therapeutic lasers in dentistry.
... The experimental group showed a significant reduction in healing time. Muñoz Sanchez et al. (7) conducted a study in 2012 in which they compared the effect of LLLT, 670 nm, on herpes labialis with acyclovir. They reported that LLLT was an effective therapy with no side effects. ...
... Low level laser therapy has physiological effects such as anti-inflammatory, analgesic and healing-stimulating characteristics (6). Many studies have evaluated different wavelengths of low level laser on herpes labialis (7)(8)(9)(10). This study also aimed to evaluate the effect of diode laser on treatment of patients with herpes labialis compared with acyclovir. ...
Article
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Background Recently alternative therapies such as the use of diode laser therapy have been introduced for recurrent herpes labial infection. The aim of this study was to evaluate the effectiveness of diode laser for treatment of recurrent herpes labialis. Material and Methods This was single-blind randomized clinical trial to evaluate the efficacy of diode laser for the treatment of recurrent herpes labial. In total, 60 patients whit recurrent herpes simplex labialis were selected and randomly divided in to three groups. 20 patients received treatment whit diode laser (at a wavelength of 870 nm, energy density 4.5 j/cm2), 20 patients were treated with acyclovir cream 5%, 20 patients received treatment with laser-off (placebo). The end point was lesions crusting. Data analyzed by Tukey HSD Test and One-way ANOVA (at a significance level of 0.05) in SPSS-20 software. Results The mean length of recovery time (day) in the laser, off laser, and acyclovir groups was 2.20±0.41, 4.30±1.03, and 3.4±1.142, respectively. There is a significant difference between three groups in this regard (P<0.0001). The mean duration of pain (day) was 1.35±0.74, 2.65±1.27, and 2.30±0.92 for laser, off laser, and acyclovir groups, respectively (P<0.0001). Conclusions Treatment with diode laser reduced the length of recovery time and pain severity faster than treatment with acyclovir cream. Key words:Recurrent herpes labial, Acyclovir, Low level laser therapy.
... It generally presents as a primary lesion, with periods of latency and a tendency to relapse. 1 Manifestations can vary from a mild period of fever to a complete loss of appetite as a response to the ulcers that appear after vesicles or blisters burst. ...
Article
Full-text available
Recurrent labial herpes simplex is a pathology of viral origin that is frequently observed in children. The signs and symptoms are uncomfortable and, in many cases, the efficacy of treatment is unproven. However, several studies have demonstrated good results from the use of low-level laser therapy (LLLT), primarily due to acceleration of the healing process and pain relief, which make it a promising resource for use with this pathology. This paper describes a clinical case of a 7-year-old patient affected by this pathology and the therapeutic resolution proposed. How to cite this article: Stona P, da Silva Viana E, dos Santos Pires L, Weber JBB, Kramer PF. Recurrent Labial Herpes Simplex in Pediatric Dentistry: Low-level Laser Therapy as a Treatment Option. Int J Clin Pediatr Dent 2014;7(2):140-143.
... Nevertheless, the monthly recurrence rate was not statistically significant between the two groups, showing that LLLT was as good as topical acyclovir. In a 5-year followup study, Munoz Sanchez et al. (2012) reported that 322 patients receiving LLLT in the blister and the prodromal stage had obvious reduction in HSV-1 recurrent rate as compared to the pretreatment period. DeLand et al. (2007) evaluated the potential of LED in reducing acute radiation-induced dermatitis after lumpectomy. ...
... Medical interest in PBM has increased progressively in the last decade. In oral surgery in particular, PBM has shown promising results in accelerating the healing of oral ulcers, chemotherapy-and radiotherapy-induced mucositis, bisphosphonate-related osteonecrosis of the jaw, and oral lichen planus, as well as shortening the clinical course of herpes simplex [16,17,[30][31][32]. Furthermore, PBM is already used in clinical practice in dentistry, to reduce symptoms after a variety of procedures [33][34][35]. ...
Article
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The aim of the present study was to evaluate the effects of photobiomodulation (PBM) on cytokine levels and angiogenesis during oral wound healing. Ulcers were made on the dorsum of the tongue in 48 Wistar rats. Irradiation with an indium-gallium-aluminum-phosphide (InGaAlP) laser (660 nm; output power, 40 mW; spot size, 0.04 cm(2)) was performed once a day on two points of the ulcer for 14 days. Two different energy densities were used: 4 J/cm(2) (energy per point 0.16 J, total energy 0.32 J) and 20 J/cm(2) (energy per point 0.8 J, total energy 1.6 J). Tissue levels of interleukin (IL)-1β and tumor necrosis factor (TNF)-α were investigated by enzyme-linked immunosorbent assay (ELISA). Image analysis of CD31-immunostained sections was used to investigate microvessel density (MVD). PBM increased the tissue levels of IL-1β at the early stage of oral wound healing (p < 0.01) and increased the tissue levels of TNF-α during all stages of oral wound healing (p < 0.05). PBM at a dose of 4 J/cm(2) produced more significant results regarding cytokine modulation and was associated with higher MVD at day 5. Collectively, these findings indicate that cytokine modulation and increased angiogenesis are among the basic mechanisms whereby PBM improves oral wound repair.
... In our protocol we irradiated the lesion in a noncontact mode, Eduardo Cde et al. [13] used an activated laser tip to rupture the vesicles and eliminate the infective stage accelerating the healing time which can be another useful alternative in that stage. Muñoz et al. [17] in a clinical randomized study irradiate between C2 and C3 vertebrae with 1.2 J in each session in an attempt to inhibit viral reactivation, noticing lower relapse rates in the irradiated group. Nevertheless, the efficacy of this irradiation point is uncertain due to the low energy dose given and the absence of previous human studies to support its effectiveness, but it can be considered for future investigations. ...
Article
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Aims: Describe the use of the diode laser in the treatment of recurrent herpes labialis (RHL) to alleviate the symptoms, accelerate healing and delays recurrences. Presentation of Case: A female patient with a history of 3-4 episodes of RHL per year for the last 5 years was treated with a 940 nm diode laser. Two applications were done during 60 seconds covering the whole area. The Pain was significantly reduced with a complete healing after 7 days and no recurrences have been seen up to now. Discussion: Photobiomodulation has been proposed as a good alternative for this lesion despite the heterogeneity in the application protocols and parameters among the literature and its effects over the recurrent herpes labialis have been proved. Conclusion: The use of photobiomodulation can prevent recurrent relapses in this pathology and improve the quality of life of the patients.
... We can also raise the possibility of controlling the HSV1 oral shedding by means of low-level laser therapy. The use of this therapy has proven to be effective in controlling of active infections of herpes labialis as well as in the control of HSV1 reactivation, thus preventing their recurrence [31][32][33][34][35][36][37]. For other herpesviruses, we found no scientific evidence to support the possible effectiveness of low-level laser therapy in controlling oral shedding. ...
Article
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Objective Opportunistic infections may affect the oral mucosa of patients undergoing radio/chemotherapy through exacerbation of oral mucositis. The aim of this study is to evaluate the oral shedding of all eight human herpesviruses and its possible association with oral mucositis. Materials and methodsIn this prospective cohort study, we analyzed oral rinse samples, collected weekly, from 20 patients during radiotherapy treatment. Serologic status to HSV1 and HSV2, EBV, CMV, and VZV in three different periods was performed by ELISA assay. PCR and enzymatic digestion was performed to detect HSV1, HSV2, EBV, CMV, VZV, HHV6, HHV7, and HHV8. Oral mucositis was evaluated according to the WHO criteria. ResultsOral shedding of EBV, HHV6, and HHV7 was observed in all weeks of radiotherapy. Considering the episodes of shedding, the highest frequency was found in patients with EBV excretion (55.0%). No virus reactivation was observed by serological analysis. EBV oral shedding frequency was significantly higher than that of other viruses and showing a positive correlation with oral mucositis grade ≥2. Conclusions There was a positive correlation between EBV oral shedding and oral mucositis grade ≥2, particularly after 3 weeks of radiotherapy, a period in which the severity of mucositis was statistically higher. These findings allow us to infer that the local inflammatory environment in mucositis grade ≥2 is more favorable for EBV replication. Clinical relevanceMucositis is a frequent and important side effect of radio/chemotherapy treatment. Understanding the possible participation of viruses in the mechanism of this condition is important to develop strategies for treatment and prevention.
... Famciclovir is also proposed successfully but side effects like headache and nausea are connected with its use and data for its use in childhood and pregnancy are limited (Mubareka, 2010). Studies on HLLT and LLLT shows that these devices are effective for treatment of oral HSV but they are very few and overall case reports (Marotti, 2010;Ferreira, 2011;Muñoz Sanchez et al., 2012). Works on photodynamic therapy for oral HSV therapy demonstrates that this type of treatment is effective and safe (Marotti et al., 2009;Ramalho, 2015). ...
Article
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ntroduction: Oral and perioral herpes simplex virus (HSV) infection is one of the most common oral so lation. Many topical and systemic therapies are reported to be effective in lesions treatment. Scientifc Literature reported many cases of recurrent herpes lesions successfully treated with photodynamic therapy (PDT). PDT is based on the interaction of a photosensitizer and light irradiation in oxygenated tissue. This combination leads to a related bacterial cell damage. Methylene blue (MB) and Toluidine blue are the most used photosensitizers. We want to propose a pilot study with 10 patients for the treatment of Herpes simplex infection with photodynamic therapy effected by a 630nm diode lamp and associated photosensitizer.
... Herpes simplex virus type 1 (HSV-1) is a nuclear replicating enveloped virus, usually acquired through direct contact with infected lesions or body fluids (typically saliva) (Arduino & Porter, 2008). It generally presents as a primary lesion, with periods of latency and a tendency to relapse (Munoz Sanchez, Capote Femenias, Diaz Tejeda, & Tuner, 2012). Initial oral HSV infection can be treated with topical, oral, or intravenous acyclovir (a synthetic acyclic purinenucleoside analogue). ...
Article
This narrative review on the use of biophotonics therapies for management of oral diseases is written as a tribute to Prof. Crispian Scully. His seminal contributions to the field are highlighted by the detailed, comprehensive description of clinical presentations of oral diseases. This has enabled a more thorough, fundamental understanding of many of these pathologies by research from his group as well as inspired mechanistic investigations in many groups globally. In the same vein, a major emphasis of this narrative review is to focus on the evidence from human case reports rather than in vitro or in vivo animal studies that showcases the growing and broad impact of biophotonics therapies. The similarities and differences between two distinct forms of low-dose biophotonics treatments namely photodynamic therapy and photobiomodulation therapy are discussed. As evident in this review, a majority of these reports provide promising evidence for their clinical efficacy. However, a lack of adequate technical details, precise biological rationale, and limited outcome measures limits the current utility of these treatments. Future investigations should attempt to address these shortcomings and develop better designed, rigorous, controlled studies to fully harness the tremendous potential of low-dose biophotonics therapies.
... In our protocol we irradiated the lesion in a noncontact mode, Eduardo Cde et al. [13] used an activated laser tip to rupture the vesicles and eliminate the infective stage accelerating the healing time which can be another useful alternative in that stage. Muñoz et al. [17] in a clinical randomized study irradiate between C2 and C3 vertebrae with 1.2 J in each session in an attempt to inhibit viral reactivation, noticing lower relapse rates in the irradiated group. Nevertheless, the efficacy of this irradiation point is uncertain due to the low energy dose given and the absence of previous human studies to support its effectiveness, but it can be considered for future investigations. ...
Article
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Introduction: The present study aimed to describe parameters used with 808- to 980-nm wavelength diode lasers for managing dentin hypersensitivity and analyze their results. Methods: The inclusion criteria were based on randomized controlled clinical trials using diode lasers at an 808-980 nm wavelength range in patients with dentine hypersensitivity with a minimum of 1-month follow-up. An electronic search for articles on Medline, PubMed and Cochrane databases was performed. The risk of bias was assessed with the Cochrane collaboration tool. Results: Our electronic search resulted in 130 papers, of which 11 articles met the inclusion criteria. A majority of the studies assessed dentine hypersensitivity using the Visual Analogue Scale, which ranged between 2.3 and 8.8 before treatment and significantly reduced to a mean value of 0.45-3.7 after diode laser application. The power settings ranged between 1.5 mW and 3 W with an emission mode of continuous wave, except for 2 authors who used chopped mode. The energy density varied from 2.5 to 128 J/cm2 , and the exposure time was between 10 and 120 seconds. The authors applied a minimum of 1 to 4 treatment sessions with a 2-day to 1-week interval between them. Most of the studies mentioned the tooth surface as the treatment site but without describing the specific irradiation points. Conclusion: Despite the heterogeneity of the analyzed variables, a statistically significant improvement in all laser groups was described. However, they cannot be compared homogenously.
... However, there was no correlation between HSV-1 oral shedding and onset or worsening of xerostomia as well as no correlation with RT times either. A possible hypothesis for this lack of correlation with the degrees of xerostomia may be the control of the oral excretion of HSV-1 by the application of low-level laser, with similar results to the control of herpes labialis lesions [27][28][29][30][31][32][33]. ...
Article
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Background: Xerostomia is a very relevant and frequent complication of radiotherapy, causing the irradiated oral mucosa to be affected by bacterial, fungal and viral infections. Objective: The objective of this study was to evaluate a possible relationship between oral shedding of human herpesviruses and xerostomia in patients with squamous cell carcinoma of head and neck submitted to radio/chemotherapy. Methods: In this study, oral rinse samples were collected weekly from 20 patients during radiotherapy. The samples were submitted to PCR and enzymatic digestion for detection of human herpesviruses. Xerostomia was evaluated according to the Seminars in Radiation Oncology criteria. Results: There was a higher frequency of grade 1 xerostomia (51.4%), observed first in the 1st week of radiotherapy. In the 4th week of radiotherapy, all patients presented some degree of xerostomia. Analysis of herpesviruses showed oral shedding of EBV, HHV-6 and HHV-7 in all weeks. Considering all the periods, the highest frequency was in patients with EBV excretion (55.0%), which was significantly higher than that of other viruses. Conclusion: We observed that oral shedding of herpesviruses was not affected by xerostomia as there was a progression in their excretion, even with the evolution of xerostomia. This suggested that there is a local replication in the oral cavity that is not completely dependent of salivary excretion.
... Oral lichen planus (OLP), recurrent aphthous stomatitis (RAS), hyposalivation, pemphigus vulgaris (PV), bullous pemphigoid, recurrent herpes simplex, burning mouth syndrome (BMS), medicationrelated osteonecrosis of the jaws (MRONJ), bisphosphonaterelated osteonecrosis of the jaw (BRONJ), trigeminal neuralgia (TN), facial nerve paralysis, geographic tongue, and chronic sinusitis are some of the oral diseases, in which laser therapy has been studied as a therapeutic method. [1][2][3][4][5][6][7][8][9][10][11][12] The history of using light as a therapeutic approach (Helio, Chroma, or Phototherapy) dates back to the BC. Many people of ancient civilizations, including Egyptians and Hindus, have long been familiar with this method of treatment. ...
Article
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.
... The key outcome was an extension of the intercurrent period for up to three years. 26 The continuous IR LILI procedure is less common. Nonetheless, good results have been demonstrated in the treatment of children with herpes simplex (wavelength 780 nm, power 70 mW, PD 62.5 mW/cm 2 , exposure 80 seconds on each of four lesions), 27 as well as in adults. ...
Article
Introduction: Herpesvirus infection has a variety of clinical forms and is extremely widespread in the world while existing treatment methods are not always quite effective. The search for new treatment modalities is a relevant problem and numerous studies show the therapeutic effect of low-level laser therapy (LLLT) on different herpesvirus types. Methods: The mechanisms of laser light action and the impact of LLLT on the pathological pathways of herpes infections are described. A narrative review of the relevant papers is conducted. Results: The reviewed studies confirm that LLLT is a potential prospective treatment method for patients infected with the herpesvirus. However, it is necessary to improve the methodology and optimize the combination of laser action with antiviral medications. Conclusion: The review shows that it is most effective to combine laser impact on skin lesions with the application of topical antiviral gels or creams, additionally using a combined procedure of laser ultraviolet blood illumination (LUVBI, 365-405 nm) + intravenous laser blood irradiation (ILBI, 525 nm).
... Honarmand et al. found that semiconductor laser treatment shortened the recovery time and relieved the pain severity of RHL patients [44]. Sanchez et al. found that compared with acyclovir cream and tablets, laser treatment has fewer side effects and prolongs the recurrence time [45]. Amira et al. conducted follow-up treatment on a young patient with recurrent mucous cysts and also found that the use of 980 nm diode laser treatment can significantly reduce the recurrence rate of mucous cysts. ...
Article
Full-text available
Physical stimulation has been widely used in clinical medicine and healthcare due to its noninvasiveness. The main applications of physical stimulation in the oral cavity include laser, ultrasound, magnetic field, and vibration, which have photothermal, cavitation, magnetocaloric, and mechanical effects, respectively. In addition, the above four stimulations with their unique biological effects, which can play a role at the gene, protein, and cell levels, can provide new methods for the treatment and prevention of common oral diseases. These four physical stimulations have been used as important auxiliary treatment methods in the field of orthodontics, implants, periodontal, dental pulp, maxillofacial surgery, and oral mucosa. This paper systematically describes the application of physical stimulation as a therapeutic method in the field of stomatology to provide guidance for clinicians. In addition, some applications of physical stimulation in specific directions are still at the research stage, and the specific mechanism has not been fully elucidated. To encourage further research on the oral applications of physical stimulation, we elaborate the research results and development history of various physical stimuli in the field of oral health.
... Several studies reported that red (633 nm) light is effective for improving skin texture, reducing melanin levels, and healing inflammatory lesion [4,5]. Furthermore, 670-nm low-level laser therapy (LLLT) with 40 mW/cm 2 irradiation has been suggested as a new method to accelerate the healing process and reduce the spread of herpes simplex virus (HSV) infections [6,7]. Lee at al. investigated the clinical efficacy of blue light (415 ± 5 nm, 40 mW/cm 2 ) and red light (633 ± 6 nm, 80 mW/cm 2 ) combination to treat acne vulgaris [8]. ...
Article
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The biological effects of a light-emitting diode (LED) light therapy device are determined by irradiation parameters, mainly wavelength and power density. However, using a battery to provide power causes a problem in the variation of LED power density during battery discharge. As a result, maintaining a stable LED power density, along with extending battery life and operating time, are the primary concerns in designing a LED light therapy device. The present study aims to introduce a LED light therapy device design with different LED color power density control. A Fuzzy logic, based on the relationship between LED power density and operating time, was proposed to control constant power density in this design. The experimental results demonstrate that by using the designed controller, the LED light therapy device’s power3 density (40 mW/cm2, 50 mW/cm2, 60 mW/cm2 for red, blue, and green light, respectively) can be controlled. The newly designed LED light therapy device could be considered an advanced version with energy savings and stabilized LED power emitting property under a broad range voltage variation.
... LLLT has been used for pain relief stimulation of tissue regeneration and for the reduction of swelling and inflammation [18,19,20,21]. LLLT has also been successfully used to treat herpes simplex virus-1 (HSV-1) infections [22,23]. ...
Article
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Background Human immunodeficiency virus (HIV) infection remains a global health challenge despite the use of antiretroviral therapy, which has led to a significant decline in the mortality rates. Owing to the unavailability of an effective treatment to completely eradicate the virus, researchers continue to explore new methods. Low level laser therapy (LLLT) has been widely used to treat different medical conditions and involves the exposure of cells or tissues to low levels of red and near infrared light. The study aimed to determine the effect of combining two unrelated therapies on HIV infection in TZM-bl cells. Methods In the current study, LLLT was combined with efavirenz, an HIV reverse transcriptase inhibitor to establish their impact on HIV infection in TZM-bl cells. Both the HIV infected and uninfected cells were laser irradiated using a wavelength of 640 nm with fluencies of 2-10 J/cm². Results The impact of HIV, efavirenz and irradiation were determined 24 hours post irradiation using biological assays. Luciferase assay results showed that the combination of LLLT and efavirenz significantly reduced HIV infection in cells, despite the undesirable effects observed in the cells as demonstrated by cell morphology, proliferation and cell integrity assay. Flow cytometry results demonstrated that cell death was mainly through necrosis while fluorescence microscopy showed the production of reactive oxygen species (ROS) in HIV infected cells. Conclusion Efavirenz and LLLT significantly reduced HIV infection in TZM-bl cells. Furthermore, the death of HIV infected cells was due to necrosis.
... Famciclovir is also proposed successfully but side effects like headache and nausea are connected with its use and data for its use in childhood and pregnancy are limited (Mubareka, 2010). Studies on HLLT and LLLT shows that these devices are effective for treatment of oral HSV but they are very few and overall case reports (Marotti, 2010;Ferreira, 2011;Muñoz Sanchez et al., 2012). Works on photodynamic therapy for oral HSV therapy demonstrates that this type of treatment is effective and safe (Marotti et al., 2009;Ramalho, 2015). ...
... There have been previous reports showing the effectiveness of low-level laser therapy (LLLT) to treat herpes infection [32,33]. The LLLT mechanism seems to originate with photon absorption in mitochondria, increased ATP, NO release and the stimulation of signalling pathways [34] that shift the infection in favour of the host for some time after treatment. ...
Article
The clinical use of topical photodynamic therapy in herpes simplex lesions in São Paulo is presented and discussed. Although previous attempts utilising this type of approach in the USA were discontinued in the early 1970s due to several presentations of post-treatment Bowen's disease, none of the cases from the clinic presented here have displayed any complications on follow-up. In addition, lesion recrudescence periods are generally much longer than with conventional approaches. This is thought to be due to improvements in the treatment protocol, viz. use of the non-toxic photosensitisers methylene blue and Hypericum perforatum extract in place of proflavine and neutral red in the original trials, differences in photosensitisation pathway and illumination of the treatment site with red rather than fluorescent/UV light. Post-treatment cosmesis is also excellent.
... Endodoncia -Hipersensibilidad de dentina y pulpa -Reduce la sensibilidad térmica -Mejora la formación de dentina y pulpa dental -Promociona la mineralización de las células de hdp [9][10] Maxilofacial -Bifosfonatos relacionados con la osteonecrosis mandibular -Distracción mandibular -Avance mandibular -Desórdenes temporomandibulares -Trauma mandibular -Reduce el dolor, el edema, el pus y las fístulas, mejora la curación -Mejora la osificación del hueso trabeculado -Mejora la formación de hueso en la región condilar -Mejora la osteogénesis -Reduce el dolor -Mejora el rango del movimiento mandibular -Mejora la curación de hueso [11][12] Patología oral -Síndrome de la boca ardiente -Liquen plano -Mucositis oral -Xerostomía -Reduce los síntomas, disminuye el dolor -Reduce el tamaño de la lesión, disminuye el dolor -Tan eficaz como los corticoesteroides -Reduce la incidencia, duración y severidad -Regeneración de las células epiteliales de los conductos salivales -Mejora el flujo salival y las características antimicrobianas [13][14] Cirugía oral -Curación -Parestesia/nervio alveolar -Extracción del tercer molar -Mejora la curación después de la gingivectomía, reduciendo la inflamación gingival -Mejora la percepción sensorial mecánica -Reduce el dolor, la hinchazón y mejora el trismus [15][16] Ortodoncia -Dolor ortodóntico -Implantes de titanio -Movimiento dental -Reduce el dolor rápido remodelado -Mejora la curación -Mejora la osteointegración -Acelera el movimiento dental -Mejora la actividad de los osteoblastos y osteoclastos -Mejora el depósito de colágeno [17][18] Pediatría -Preparación de la cavidad -Distracción mandibular -Gingivitis -Reduce el dolor -Rápida curación [19][20] Periodoncia -Gingivitis crónica -Ligamento periodontal -Periodontitis -Reduce la inflamación -Mejora la curación -Aumento de la hialinización temprana -Mejora la profundidad de la bolsa -Disminuye la inflamación [21][22] Prostodoncia -Estomatitis protésica -Implantes -Reducción de las colonias de levadura inflamación palatina reducida -Formación ósea más rápida -Mejora resistencia entre hueso-implante -Mejora la osteointegración [23][24] Tabla 1. Mecanismos de acción y parámetros del lllt Fuente: [1] La acción del láser terapéutico depende de la intensidad y de las características relacionadas con el tejido a fotoestimular [25]. Moore et al. [26] evaluaron la eficacia del láser con diferentes longitudes de onda (625, 635, 645, 655, 665, 675 y 810 nm) en la proliferación de los fibroblastos y las células endoteliales en un periodo de 72 horas. ...
Article
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Introducción: El uso del láser terapéutico de baja intensidad (Low-level-laser therapy LLLT) ha traído consigo la evolución de los tratamientos antiinflamatorios, analgésicos y procicatrizantes debido a la fotoestimulación celular sobre la mitocondria, lo cual incrementa la generación de energía (ATP), acelerando la microcirculación sanguínea y produciendo cambios en la presión hidrostática del capilar. Presentación del caso: Este es el Reporte de Caso de un paciente de sexo femenino de 25 años de edad, que asiste al servicio de cirugía oral en las clínicas odontológicas de una entidad universitaria para la exodoncia de los terceros molares inferiores retenidos. Al examen radiográfico se observó el diente 48 asintomático en posición mesioangularsegún clasificación de Winter y Clase B II según clasificación Pell y Gregory. Método: La paciente recibió tratamiento con láser intensidad terapéutico post-exodoncia. Resultados: El efecto logrado con la aplicación de LLLT en el caso dio como resultado un control de dolor a las 48 horas, un efecto antiinflamatorio al tercer día y una regeneración tisular evidente al séptimo día. Conclusiones: La terapia de láser de baja podría ser una alternativa de control posquirúrgico en exodoncia de terceros molares incluidos que evitaría suministrar en algunos casos antiinflamatorios y analgésicos.
... According to them, the combination of monocaprin and low dose doxycycline offers an effective treatment for herpes labialis in both healing time and pain reduction. According to Munoz Sanchez et al. [36], 670nm low level laser therapy seemed to be an effective treatment without side effect for herpes labialis. Unfortunately, they did not perform a statistical analysis because of the large sample size, according to what they wrote. ...
Article
Full-text available
This manuscript aims to highlight all the clinical features of the herpes virus, with a particular focus on oral manifestations and in the maxillofacial district about Herpes Simplex Virus-1 (HSV-1) and Herpes Simplex Virus-2 (HSV-2). Oral herpes virus is a very common and often debilitating infectious disease for patients, affecting oral health and having important psychological implications. The collection of relevant data comes from the scientific databases Pubmed, Embase; initially this collection obtained an extremely high number of results, 1415. After applying the inclusion and exclusion criteria, as well as a manual screening, the results included in this review were limited to 14. The results were expressed by evaluating all the signs and symptoms that this pathology entails during the study, paying attention to the characteristics linked to the quality of life and the psychological implications. This pathology has numerous therapies, which often make the healing phase of the manifestations of this viral pathology more comfortable. The therapies currently used for the treatment of this viral infection are pharmacological, topical, systemic, or instrumental, for example with laser devices.
... We also found that this reduction in viral count was not due to the effect of ICG itself and it should be activated by laser to exert its antiviral effect. Many studies have used 660 nm laser with methylene blue photosensitizer and one study used 670 nm laser without photosensitizer for treatment of recurrent herpes labialis [32,[36][37][38][39][40]. ...
Article
Objective: Perform systematic literature review on photobiomodulation (PBM) devices used at home for nonesthetic applications. Background: Home-use PBM devices have been marketed for cosmetic and therapeutic purposes. This is the first systematic literature review for nonesthetic applications. Methods: A systematic literature search was conducted for PBM devices self-applied at home at least thrice a week. Two independent reviewers screened the articles and extracted the data. Treatment dosage appropriateness was compared to the World Association for Laser Therapy (WALT) recommendations. The efficacy was evaluated according to the relevant primary end-point for the specific indication. Results: Eleven studies were suitable. Devices were applied for a range of indications, including pain, cognitive dysfunction, wound healing, diabetic macular edema, and postprocedural side effects, and were mostly based on near-infrared, pulsed light-emitting diodes with dosages within WALT recommendations. Regarding efficacy, studies reported mostly positive results. Conclusions: Home-use PBM devices appear to mediate effective, safe treatments in a variety of conditions that require frequent applications. Conclusive evaluation of their efficacy requires additional, randomized controlled studies.
Chapter
Low-level laser therapy (LLLT), nowadays also known as photobiomodulation, consists of the therapeutic use of monochromatic coherent (laser) or noncoherent (LED) light sources.
Article
A low-intensity laser is used in treating herpes labialis based on the biostimulative effect, albeit the photobiological basis is not well understood. In this work experimental models based on Escherichia coli cultures and plasmids were used to evaluate effects of low-intensity red laser on DNA at fluences for treatment of herpes labialis. To this end, survival and transformation efficiency of plasmids in E. coli AB1157 (wild type), BH20 (fpg/mutM-) and BW9091 (xthA-), content of the supercoiled form of plasmid DNA, as well as nucleic acids and protein content from bacterial cultures exposed to the laser, were evaluated. The data indicate low-intensity red laser: (i) alters the survival of plasmids in wild type, fpg/mutM- and xthA-E. coli cultures depending of growth phase, (ii) alters the content of the supercoiled form of plasmids in the wild type and fpg/mutM-E. coli cells, (iii) alters the content of nucleic acids and proteins in wild type E. coli cells, (iv) alters the transformation efficiency of plasmids in wild type and fpg/mutM-E. coli competent cells. These data could be used to understand positive effects of low-intensity lasers on herpes labialis treatment.
Article
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Low-level laser (light) therapy (LLLT) is a fast-growing technology used to treat a multitude of conditions that require stimulation of healing, relief of pain and inflammation, and restoration of function. Although skin is naturally exposed to light more than any other organ, it still responds well to red and near-infrared wavelengths. The photons are absorbed by mitochondrial chromophores in skin cells. Consequently, electron transport, adenosine triphosphate nitric oxide release, blood flow, reactive oxygen species increase, and diverse signaling pathways are activated. Stem cells can be activated, allowing increased tissue repair and healing. In dermatology, LLLT has beneficial effects on wrinkles, acne scars, hypertrophic scars, and healing of burns. LLLT can reduce UV damage both as a treatment and as a prophylactic measure. In pigmentary disorders such as vitiligo, LLLT can increase pigmentation by stimulating melanocyte proliferation and reduce depigmentation by inhibiting autoimmunity. Inflammatory diseases such as psoriasis and acne can also be managed. The noninvasive nature and almost complete absence of side effects encourage further testing in dermatology.
Article
Low Level Laser Therapy (LLLT) is an increasingly studied technique. The authors of a meta-analysis published in 2012 had already confirmed the effectiveness of LLLT for radio-induced mucitis. Our purpose was to check its indication for similar pathologies. The articles were selected with the PubMed engine. The selected terms were "Low Level Laser Therapy", "oral surgery", "oral infection", "oral inflammation", "oral mucosal lesions", "oral mucosal disease", "stomatitis", "aphtous", "Herpes", "oral lichen planus", and "oral ulceration". The analysis was made on the following criteria: assessment criteria, methodological quality, and bias. We estimated the level of proof according to Sackett's modified score. Six articles were selected. Two focused on the effectiveness of LLLT for Herpes simplex virus 1 oral symptoms. Two focused on the effectiveness of LLLT for oral lichen planus. One focused on the effectiveness of LLLT for recurrent aphthous stomatitis. The last one focused on the usefulness of LLLT to control stomatitis pain in the hand-foot-and-mouth disease. All the selected studies were assessed with a Sackett's score of IV. No study presented the required quality standards to recommend the treatment of LLLT for the selected indications.
Article
Objectives: Low level light/laser therapy (LLLT) is the direct application of light to stimulate cell responses (photobiomodulation) in order to promote tissue healing, reduce inflammation and induce analgesia. There have been significant studies demonstrating its application and efficacy at many sites within the body and for treatment of a range of musculoskeletal injuries, degenerative diseases and dysfunction, however, its use on oral tissues has, to date, been limited. The purpose of this review is to consider the potential for LLLT in dental and oral applications by providing background information on its mechanism of action and delivery parameters and by drawing parallels with its treatment use in analogous cells and tissues from other sites of the body. Methods: A literature search on Medline was performed on laser and light treatments in a range of dental/orofacial applications from 2010 to March 2013. The search results were filtered for LLLT relevance. The clinical papers were then arranged to eight broad dental/orofacial categories and reviewed. Results: The initial search returned 2778 results, when filtered this was reduced to 153. 41 were review papers or editorials, 65 clinical and 47 laboratory studies. Of all the publications, 130 reported a positive effect in terms of pain relief, fast healing or other improvement in symptoms or appearance and 23 reported inconclusive or negative outcomes. Direct application of light as a therapeutic intervention within the oral cavity (rather than photodynamic therapies, which utilize photosensitizing solutions) has thus far received minimal attention. Data from the limited studies that have been performed which relate to the oral cavity indicate that LLLT may be a reliable, safe and novel approach to treating a range of oral and dental disorders and in particular for those which there is an unmet clinical need. Significance: The potential benefits of LLLT that have been demonstrated in many healthcare fields and include improved healing, reduced inflammation and pain control, which suggest considerable potential for its use in oral tissues.
Chapter
Low level laser therapy (LLLT) was developed in Hungary in the 1960s by Mester. The inflammatory phase is characterized by five cardinal signs of inflammation: edema, pain, erythema, heat, and loss of function. LLLT has important anti-inflammatory effects in the initial healing processes: reduction of chemical mediators, cytokines, edema, and migration of inflammatory cells, and increased growth factors, which directly contribute to the tissue rehabilitation process, as well as indirectly through the resolution of the inflammation inherent in the process. The technique described in this chapter aims to activate the lymphatic drainage of a region where inflammation is established. This activation is achieved with LLLT by placing the tip of the laser equipment directly on the lymph nodes responsible for the drainage of the region affected. Digital palpation of the lymph node chains will detect any altered surface lymph nodes where irradiation should be applied.
Article
Full-text available
Due to its analgesic, anti-inflammatory, and biostimulating effects, low-level laser therapy (LLLT) has been widely used for oral disorders, such as oral lichen planus (OLP), xerostomia, recurrent aphthous stomatitis (RAS), herpes labialis, burning mouth syndrome (BMS), and oral mucositis (OM). The research team for the present study has reviewed the literature on the subject, with an emphasis on the applicability of LLLT in general and of its various clinical protocols for the management of those oral disorders. In lesions such as the ones occurring in OM, RAS, herpes labialis, and OLP, the course of wound healing and the pain have been shown to decrease, with a few, or most often, no adverse side effects. The literature shows that LLLT can also be effective in reducing symptoms in patients with BMS. For the treatment of hyposalivation and xerostomia, the use of LLLT has been described in the literature, but no consensus has resulted. Very few controlled clinical studies with well-established therapeutic protocols have occurred, except for OM, for which LLLT has been widely researched. Although information on the use of the laser for some lesions has already been consolidated, further research is needed, especially randomized, controlled clinical trials with long-term follow-up. Those studies will allow the safe use of LLLT, permitting the creation of care protocols for the management of oral disorders.
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Besides extensive data about the effects of low-level laser therapy (LLLT) on different cell types, so far, these results were obtained from monolayer cell culture models, which have limitations in terms of cell morphology and phenotype expression. Therefore, for better in vitro evaluation of the effects of LLLT, this study was performed with a 3D cell culture model, where gingival fibroblasts were seeded in collagen matrix. Cells isolated from a healthy patient were seeded in wells of 24-well plates with culture medium (DMEM) supplemented with 10 % fetal bovine serum and collagen type I solution. After 5 days, a serum-free DMEM was added to the matrices with cells that were subjected or not to three consecutive irradiations of LLLT by means of the LaserTABLE diode device (780 nm, 25 mW) at 0.5, 1.5, and 3 J/cm(2). Twenty-four hours after the last irradiation, cell viability and morphology as well as gene expression of growth factors were assessed. Histological evaluation of matrices demonstrated uniform distribution and morphology of gingival fibroblasts within the collagen matrix. LLLT at 3 J/cm(2) increased gingival fibroblast viability. Enhanced gene expression of hCOL-I and hEGF was observed for 0.5 J/cm(2), while no significant changes were detected for the other irradiation densities tested. In conclusion, LLLT promoted biostimulation of gingival fibroblasts seeded in a 3D cell culture model, demonstrating that this model can be applied for phototherapy studies and that LLLT could penetrate the collagen matrix to increase cell functions related to tissue repair.
Chapter
This chapter discusses the analgesic effects of low level laser therapy (LLLT). There are a number of dental situations and conditions where the analgesic effects of LLLT are used to good effect. Understanding the mechanism of analgesia enables more effective treatment and in each of these conditions laser-induced neural inhibition provides a plausible mechanism for analgesic effects. Laser-induced neural blockade initiates a cascade of events in the peripheral nerve endings in the skin and dermis with important clinical consequences. The most immediate effect is pain relief, which occurs within a few minutes of LLLT application and is consistent with the experimental findings of the timing of onset of conduction blockade in sensory nerves. While neural mechanisms are important in understanding the application of LLLT, it is ultimately the application in practice which will reinforce and assist in progressing the use of LLLT in medicine and dentistry.
Chapter
Herpes is a viral disease, caused by herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). HSV enters the host through skin and mucosal surfaces, commonly the oral cavity, genital tract, and cornea of the eye, by means of direct contact with infected secretions. The most common treatment for HSV-1 is based on antiviral compounds, such as acyclovir, valacyclovir, and famciclovir. High power lasers (HPLs) can be used to promote rupture of and to drain herpetic vesicles. Several studies have reported virus inactivation by means of photodynamic therapy (PDT). HPLs and low power lasers (LPLs) either associated with PDT or not, can be used for the treatment of recurrent herpes labialis (RHL). Herpes zoster is a viral disease, but despite its name and the similarity of its clinical appearance to herpes simplex, it is neither an HSV-1 nor an HSV-2 infection.
Article
Periodontitis is an infectious/inflammatory disease characterized by the loss of periodontal ligament and alveolar bone. Herpesviruses are frequent inhabitants of periodontitis lesions, and the periodontopathogenicity of these viruses is the topic of this review. In 26 recent studies from 15 countries, subgingival cytomegalovirus, Epstein-Barr virus and herpes simplex virus type 1, respectively, yielded median prevalences of 49%, 45% and 63% in aggressive periodontitis, 40%, 32% and 45% in chronic periodontitis, and 3%, 7% and 12% in healthy periodontium. An active herpesvirus infection of the periodontium exhibits site specificity, is a potent stimulant of cellular immunity, may cause upgrowth of periodontopathic bacteria and tends to be related to disease-active periodontitis. Pro-inflammatory cytokines induced by the herpesvirus infection may activate matrix metalloproteinases and osteoclasts, leading to breakdown of the tooth-supportive tissues. The notion that a co-infection of herpesviruses and specific bacteria causes periodontitis provides a plausible etiopathogenic explanation for the disease. Moreover, herpesvirus virions from periodontal sites may dislodge into saliva or enter the systemic circulation and cause diseases beyond the periodontium. Periodontal treatment can diminish significantly the periodontal load of herpesviruses, which may lower the incidence and magnitude of herpesvirus dissemination within and between individuals, and subsequently the risk of acquiring a variety of medical diseases. Novel and more effective approaches to the prevention and treatment of periodontitis and related diseases may depend on a better understanding of the herpesvirus-bacteria-immune response axis. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Article
Objective: Perform systematic literature review on photobiomodulation (PBM) devices used at home for nonesthetic applications. Background: Home-use PBM devices have been marketed for cosmetic and therapeutic purposes. This is the first systematic literature review for nonesthetic applications. Methods: A systematic literature search was conducted for PBM devices self-applied at home at least thrice a week. Two independent reviewers screened the articles and extracted the data. Treatment dosage appropriateness was compared to the World Association for Laser Therapy (WALT) recommendations. The efficacy was evaluated according to the relevant primary end-point for the specific indication. Results: Eleven studies were suitable. Devices were applied for a range of indications, including pain, cognitive dysfunction, wound healing, diabetic macular edema, and postprocedural side effects, and were mostly based on near-infrared, pulsed light-emitting diodes with dosages within WALT recommendations. Regarding efficacy, studies reported mostly positive results. Conclusions: Home-use PBM devices appear to mediate effective, safe treatments in a variety of conditions that require frequent applications. Conclusive evaluation of their efficacy requires additional, randomized controlled studies.
Article
Diabetic foot ulcers (DFUs) incidence is increasing with the rising global prevalence of diabetes. In spite of following best practice standard of care, most DFU are slow to heal. Photobiomodulation (PBM), previously known as low-level laser therapy, has been shown to accelerate healing of acute or chronic wounds, and specifically diabetic foot ulcers. However, the frequent applications required, translates to frequent visits at the clinic which are difficult for patients with DFU. In the following case series, we present our preliminary experience with a recently approved (Health-Canada) consumer home-use PBM device as an adjuvant to standard treatment. Four male patients presented at the clinic (67-84 years old) with diabetic leg/foot ulcers. The PBM treatment (808nm, 250mW peak power, 15KHz, 5J/min, ray size 4.5×1.0cm2) was applied by the patients themselves at the clinic or at home. In the cases presented here all wounds closed within 1-3 weeks with no reported adverse events. Patients found routine easy to follow and painless, and in wounds that involved pain reported pain reduction after 1-3 treatments. Based on our previous experience with these patients self-applied PBM as an adjunct therapy, led to accelerated healing and rapid pain alleviation compared to standard care alone. In summary, hard-to-heal diabetic wounds are a burden for patients, caregivers, and costly for the healthcare system. These observations support the view that the home-use device can be easily integrated as an adjuvant treatment to standard care at the clinic or home and most importantly, encouraged patient’s involvement in his/her own care.
Article
Low Level Light (Laser) Therapy (LLLT) is the direct application of light to stimulate cell and tissue responses (photobiomodulation) to promote healing, reduce inflammation and induce analgesia. Studies have demonstrated its application and efficacy for the treatment of a range of injuries and diseases at many sites within the body. However, its application in dentistry and for oral disease treatment has been limited. This review aims to provide background information on LLLT which relates to its current application in medicine, its mechanism of action and delivery parameters, while considering its potential for dental and oral therapeutic applications. Clinical Relevance: Low level light therapy has the potential to have substantial impact for the treatment and management of oral diseases and pain.
Article
The therapeutic properties of the laser are threefold: analgesic, anti-inflammatory and regenerative. Analgesic mechanisms include not only free nerve endings, but also inhibitory controls in the medullar (gate control) and brainstem. The hypersensitivity of peripheral nociceptors is also reduced, contributing to multimodal anti-inflammatory action. Muscle relaxation induced by increased ATP production contributes to pain relief by removing tension and stimulation of trigger points. The regenerative action is a source of healing for epithelial, tendon and bony tissues.
Article
Background: Herpes simplex labialis (HSL), also known as cold sores, is a common disease of the lips caused by the herpes simplex virus, which is found throughout the world. It presents as a painful vesicular eruption, forming unsightly crusts, which cause cosmetic disfigurement and psychosocial distress. There is no cure available, and it recurs periodically. Objectives: To assess the effects of interventions for the prevention of HSL in people of all ages. Search methods: We searched the following databases up to 19 May 2015: the Cochrane Skin Group Specialised Register, the Oral Health Group Specialised Register, CENTRAL in the Cochrane Library (Issue 4, 2015), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), the China National Knowledge Infrastructure (CNKI) database, Airiti Library, and 5 trial registers. To identify further references to relevant randomised controlled trials, we scanned the bibliographies of included studies and published reviews, and we also contacted the original researchers of our included studies. Selection criteria: Randomised controlled trials (RCTs) of interventions for preventing HSL in immunocompetent people. Data collection and analysis: Two authors independently selected trials, extracted data, and assessed the risk of bias. A third author was available for resolving differences of opinion. Main results: This review included 32 RCTs, with a total of 2640 immunocompetent participants, covering 19 treatments. The quality of the body of evidence was low to moderate for most outcomes, but was very low for a few outcomes. Our primary outcomes were 'Incidence of HSL' and 'Adverse effects during use of the preventative intervention'.The evidence for short-term (≤ 1 month) use of oral aciclovir in preventing recurrent HSL was inconsistent across the doses used in the studies: 2 RCTs showed low quality evidence for a reduced recurrence of HSL with aciclovir 400 mg twice daily (risk ratio (RR) 0.26, 95% confidence interval (CI) 0.13 to 0.51; n = 177), while 1 RCT testing aciclovir 800 mg twice daily and 2 RCTs testing 200 mg 5 times daily found no similar preventive effects (RR 1.08, 95% CI 0.62 to 1.87; n = 237; moderate quality evidence and RR 0.46, 95% CI 0.20 to 1.07; n = 66; low quality evidence, respectively). The direction of intervention effect was unrelated to the risk of bias. The evidence from 1 RCT for the effect of short-term use of valaciclovir in reducing recurrence of HSL by clinical evaluation was uncertain (RR 0.55, 95% CI 0.23 to 1.28; n = 125; moderate quality evidence), as was the evidence from 1 RCT testing short-term use of famciclovir.Long-term (> 1 month) use of oral antiviral agents reduced the recurrence of HSL. There was low quality evidence from 1 RCT that long-term use of oral aciclovir reduced clinical recurrences (1.80 versus 0.85 episodes per participant per a 4-month period, P = 0.009) and virological recurrence (1.40 versus 0.40 episodes per participant per a 4-month period, P = 0.003). One RCT found long-term use of valaciclovir effective in reducing the incidence of HSL (with a decrease of 0.09 episodes per participant per month; n = 95). One RCT found that a long-term suppressive regimen of valaciclovir had a lower incidence of HSL than an episodic regimen of valciclovir (difference in means (MD) -0.10 episodes per participant per month, 95% CI -0.16 to -0.05; n = 120).These trials found no increase in adverse events associated with the use of oral antiviral agents (moderate quality evidence).There was no evidence to show that short-term use of topical antiviral agents prevented recurrent HSL. There was moderate quality evidence from 2 RCTs that topical aciclovir 5% cream probably has little effect on preventing recurrence of HSL (pooled RR 0.91, 95% CI 0.48 to 1.72; n = 271). There was moderate quality evidence from a single RCT that topical foscarnet 3% cream has little effect in preventing HSL (RR 1.08, 95% CI 0.82 to 1.40; n = 295).The efficacy of long-term use of topical aciclovir cream was uncertain. One RCT found significantly fewer research-diagnosed recurrences of HSL when on aciclovir cream treatment than on placebo (P < 0.05), but found no significant differences in the mean number of participant-reported recurrences between the 2 groups (P ≥ 0.05). One RCT found no preventive effect of topical application of 1,5-pentanediol gel for 26 weeks (P > 0.05). Another RCT found that the group who used 2-hydroxypropyl-β-cyclo dextrin 20% gel for 6 months had significantly more recurrences than the placebo group (P = 0.003).These studies found no increase in adverse events related to the use of topical antiviral agents.Two RCTs found that the application of sunscreen significantly prevented recurrent HSL induced by experimental ultraviolet light (pooled RR 0.07, 95% CI 0.01 to 0.33; n = 111), but another RCT found that sunscreen did not prevent HSL induced by sunlight (RR 1.13, 95% CI 0.25 to 5.06; n = 51). These RCTs did not report adverse events.There were very few data suggesting that thymopentin, low-level laser therapy, and hypnotherapy are effective in preventing recurrent HSL, with one to two RCTs for each intervention. We failed to find any evidence of efficacy for lysine, LongoVital® supplementation, gamma globulin, herpes simplex virus (HSV) type I subunit vaccine, and yellow fever vaccine in preventing HSL. There were no consistent data supporting the efficacy of levamisole and interferon, which were also associated with an increased risk of adverse effects such as fever. Authors' conclusions: The current evidence demonstrates that long-term use of oral antiviral agents can prevent HSL, but the clinical benefit is small. We did not find evidence of an increased risk of adverse events. On the other hand, the evidence on topical antiviral agents and other interventions either showed no efficacy or could not confirm their efficacy in preventing HSL.
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We made our aim to investigate the effect of the low intensive laser with λ=630 nm in the visible red spectrum of light at Herpes simplex treatment. For this purpose we carried out a clinical research upon 62 persons with Herpes simplex lesions which have been divided into two groups of 31 persons. At the first group the effect of laser with power density 100 mW/cm2 +/- 5 mW/cm2 and time of exposure 3 min. on field was traced out. At the second group the low intensive laser with the same characteristics has been used but in combination with the patent medicine Granofurin H as a photosensibilizer. The clinical approbations of this method showed high therapeutical effectiveness. The obtained results showed that at both groups there is an expressed anaesthetic, anti-inflammatory and regeneration stimulating effect and at the second group with the use of Granofurin H the reconvalescent period is shorter.
Chapter
The effects of phototherapy on herpes lesions have been clinically demonstrated by either preventing the lesion formation or speeding their repair. The aim of this in vitro study was analyze the effect of phototherapy on epithelial cells and HSV-1 in culture. Cultures of HSV-1 and epithelial cells (Vero cell line) were used. The irradiations were done using a GaAlAs laser (660 e 780 nm, 4.0 mm(2)). One, two and three irradiations with 6 h-intervals were done. The experimental groups were: Control: non-irradiated; 660 nm and 3 J/cm(2) (2.8 sec); 660 nm and 5 J/cm(2) (3.8 sec); 781) nm and 3 J/cm(2) (1.9 sec), and 780 nm and 5 J/cm(2) (2.5 sec). The HSV-1 cytopatic effect and the cell viability of irradiated cultures and controls were analyzed in four different conditions: irradiation of non-infected epithelial cells; epithelial cells irradiated prior infection; virus irradiated prior infection; irradiation of HSV infected cells. The mitochondrial activity and cytopathic effects were assessed. The number of irradiations influenced the cell growth positively and proportionally, except for the 660 nm/3 J/cm(2) group. Any variation in cytopathic effects was observed amongst the experimental groups. The viability of infected cells prior irradiation was significantly higher than that of non-irradiated cultures when 2 irradiations were done. Under the experimental conditions of this study we concluded that phototherapy is capable of enhancing epithelial cell growth and prolonging cell viability of HSV-1 infected cells. Positive benefits of phototherapy could be resultant from prolongation of infected cells viability, corroborating with host defenses.
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This study sought to evaluate the clinical outcome of patients who had been diagnosed with recurrent herpes labialis (RHL) after treatment with photodynamic therapy (PDT) associated with low-level laser therapy (LLLT). PDT has shown great effectiveness for treating already-established RHL vesicles, compared to ordinary treatments involving antiviral compounds. Two patients with vesicles on their lips were treated with PDT, followed by irradiation with LLLT. Both patients reported pain relief immediately after the procedure; at a six-month follow-up, neither patient showed signs or symptoms that related to RHL.
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Red light of a krypton laser (lambda = 647 nm) was used for treatment of patients suffering from herpes zoster (n = 4), postherpetic neuralgias (n = 8) and herpes simplex recidivans in loco (n = 13). The afflicted skin was irradiated daily for ten days (laserpower 50 mw, exposure time 90 sec). Improvement was observed in 7 out of the 12 patients suffering from herpes zoster and postherpetic neuralgias respectively, and in 8 out of 13 patients afflicted with recurrent herpes simplex.
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Low power Laser irradiation is used in medical practice for different indications. Several firms which commercialise Laser claim that Laser irradiation may be beneficial towards Herpes virus pathogenicity. We observe that, in the ear experimental model of HSV latency [3], repeated exposure to infrared Laser radiation of cervical ganglia following HSV inoculation appears to specifically hinder the establishment of virus latency in mouse.
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Recurrent infection with herpes simplex virus is a common disease. Recently, alternative therapies have been introduced. Among those, low-intensity laser therapy mainly used for the acceleration of wound healing and in pain therapy has previously been shown to be of benefit in herpes zoster infections. In this study we evaluated the influence of low-intensity laser therapy (wavelength 690 nm, intensity: 80 mW per cm2, dose: 48 J per cm2) in 50 patients with recurrent perioral herpes simplex infection (at least once per month for more than 6 mo) in a randomized, double-blind placebo-controlled trial design. Patients in the laser group received daily irradiations for 2 wk, whereas patients in the placebo group were sham-irradiated. After completion of the laser/sham treatment, patients were asked to return to the Department of Dermatology, University of Vienna Medical School at the time of recurrence. All except two patients completed the study and were monitored for 52 wk. The median recurrence-free interval in the laser-treated group was 37.5 wk (range: 2-52 wk) and in the placebo group 3 wk (range: 1-20 wk). This difference was found to be statistically significant (p < 0.0001; Wilcoxon's Rank Sum Test). In conclusion, we demonstrated that a total of 10 irradiations with low-intensity laser therapy significantly lowers the incidence of local recurrence of herpes simplex infection. Since this athermic phototherapeutic modality represents a safe, noninvasive treatment, it might be considered as an alternative to established therapeutic regimens in this indication.
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It has been suggested that low-level laser therapy (LLLT) can modulate inflammatory processes. The aim of this experiment was to investigate what effects red laser irradiation with two different wavelengths (660 nm and 684 nm) on carrageenan-induced rat paw edema and histology. Thirty two male Wistar rats were randomly divided into four groups. One group received a sterile saline injection, while inflammation was induced by a sub-plantar injection of carrageenan (1 mg/paw) in the three other groups. After 1 h, LLLT was administered to the paw in two of the carrageenan-injected groups. Continuous wave 660 nm and 684 nm red lasers respectively with mean optical outputs of 30 mW and doses of 7.5 J/cm(2) were used. The 660 nm and 684 nm laser groups developed significantly (p<0.01) less edema (0.58 ml [SE+/-0.17] ml and 0.76 ml [SE+/-0.10] respectively) than the control group (1.67 ml [SE+/-0.19]) at 4h after injections. Similarly, both laser groups showed a significantly lower number of inflammatory cells in the muscular and conjunctive sub-plantar tissues than the control group. We conclude that both 660 nm and 684 nm red wavelengths of LLLT are effective in reducing edema formation and inflammatory cell migration when a dose of 7.5 J/cm(2) is used.
Buccal Pathology. Diagnosis and Treat-ment
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