Evaluation of photodynamic therapy in pericoronitis: Protocol of randomized, controlled, double-blind study

Interventions for Early-Stage Pericoronitis: Systematic Review of Randomized Clinical Trials

Background: To investigate the efficacy and safety of interventions for early stage pericoronitis. Methods: We searched for randomized controlled trials (RCTs) in databases from inception to July 2020, without language restriction. RCTs assessing adolescents and adults were included. Results: Seven RCT with clinical diversity were included, so, it was not possible to conduct meta-analyses. Individual study data showed an improvement in oral health quality of life in favor of topical benzydamine versus diclofenac capsule (Mean difference (MD) −1.10, 95% Confidence interval (CI) −1.85 to −0.35), and no difference between topical benzydamine and flurbiprofen capsule (MD −0.55 95% CI −1.18 to 0.0). There was no difference between diclofenac and flurbiprofen capsules (MD 0.55, 95% CI −0.29 to 1.39). An imprecise estimate of effects was found for all outcomes, considering (i) oral versus topic pharmacological treatment, (ii) different oral pharmacological treatments, (iii) pharmacological treatment associated with laser versus placebo laser, (iv) pharmacological treatment associated with different mouthwashes, and (v) conventional treatment associated to antimicrobial photodynamic therapy versus conventional treatment, with low to very low certainty of evidence. Conclusions: Until future well-designed studies can be conducted, the clinical decision for early stage pericoronitis should be guided by individual characteristics, settings and financial aspects.

Enzyme-Responsive Materials as Carriers for Improving Photodynamic Therapy

Photodynamic therapy (PDT) is a mini-invasive therapy on malignancies via reactive oxygen species (ROS) induced by photosenitizer (PS) upon light irradiation. However, poor target of PS to tumor limits the clinical application of PDT. Compared with normal tissues, tumor tissues have a unique enzymatic environment. The unique enzymatic environment in tumor tissues has been widely used as a target for developing smart materials to improve the targetability of drugs to tumor. Enzyme-responsive materials (ERM) as a smart material can respond to the enzymes in tumor tissues to specifically deliver drugs. In PDT, ERM was designed to react with the enzymes highly expressed in tumor tissues to deliver PS in the target site to prevent therapeutic effects and avoid its side-effects. In the present paper, we will review the application of ERM in PDT and discuss the challenges of ERM as carriers to deliver PS for further boosting the development of PDT in the management of malignancies.

Level of pain intensity, cytokine profiling and microbial load after photodynamic therapy in acute severe pericoronitis

AIM

We evaluated the efficacy of antimicrobial photodynamic therapy (A-PDT) in the reduction of pain intensity and performed cytokine profiling and measurement of microbiological parameters in patients with acute pericoronitis.

METHODS

Sixty patients with age range 14-19 years were randomized into two groups: 'A-PDT group' which received additional A-PDT with conventional protocol, and 'conventional protocol group' (CPG) without A-PDT. Present pain intensity (PPI) were investigated using McGill Pain Questionnaire (MPQ) and Visual Analogue Scale (VAS). Gingival crevicular fluid were sampled to evaluate the levels of interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) and quantified using enzyme-linked immunosorbent assay. Microbial plaque was collected to evaluate total counts of Porphyromonas gingivalis and Tannerella forsythia expressed as log colony forming unit (CFU)/mL. Level of pain intensity, cytokine profiling and microbial load were assessed at baseline (B0), and post treatment F₇ (Day 7) and F₁₄ (Day 14).

RESULTS

A total of 59 patients (30 CPG and 29 A-PDT) completed the clinical trial. Present pain intensity scores statistically significantly reduced from B₀ to F₇ in both treatment groups (p < 0.05). For VAS, both groups showed statistically significant reduction in pain scores at F₁₄ only when compared with baseline (p < 0.05). There was no inter-group significant difference at any time point for either pain scores (p > 0.05). Only TNF-α showed statistically significant reduction with A-PDT compared to CPG at both F₇ and F₁₄. CPG group showed significant reduction for only T. forsythia at both follow-up points. The microbial counts for P. gingivalis and T. forsythia significantly reduced in A-PDT groups compared to CPG group at both F₇ and F₁₄.

CONCLUSION

The results of this study indicate that A-PDT may be a reliable treatment option in pericoronitis for the reduction of TNF-α and microbial load. However, A-PDT does not have any effect in the reduction of pain.

Treatment of herpes labialis by photodynamic therapy: Study protocol clinical trial (SPIRIT compliant)

BACKGROUND

Lesions of herpes labialis are caused by the herpes simplex virus type 1 and cause pain and aesthetic compromise. It is characterized by the formation of small vesicles that coalesce and rupture forming extremely painful ulcers, that evolve to crusts, dry desquamations until their complete remission. Currently the treatment of these lesions is done with acyclovir. Although it diminishes the symptomatology, it causes viral resistance and does not prevent the recurrence of the lesions. It is known that antimicrobial photodynamic therapy (aPDT) has numerous advantages, among them: the reduction of the time of remission, and does not cause resistance. This protocol will determine the effectiveness of PDT in lesions of herpes labialis.

MATERIALS AND METHODS

A total of 30 patients with herpes labialis in the prodromal stage of vesicles, ulcers, and crusts will be selected to participate in the study and randomized into 2 groups: G1 control and G2 experimental. After signing Research Ethics Committee and TA, patients in group G1 will undergo the standard gold treatment for herpes labialis with acyclovir and simulated PDT treatment. Patients in the experimental G2 group will be treated simulating the gold standard treatment of herpes labialis (placebo) and PDT. In all patients, saliva samples will be collected for analysis of cytokines, and will be performed exfoliative cytology in the lesions. The pain will be assessed through a pain scale and a questionnaire of quality of life related to oral health (OHIP-14) will be given to them. Patients will continue to be followed up after 7 days, 1 month, 3 months, and 6 months; if there is a recurrence of the lesion, they will contact the researchers.Clinical registration: clinicaltrials.gov - NCT04037475. Registered on July 2019.