Efficacy of low-level laser therapy in treatment of recurrent aphthous ulcers - a sham controlled, split mouth follow up study

Safety parameters of diode laser therapy for the treatment of recurrent aphthous ulcers: a systematic review and meta-analysis

The aim of this study is to evaluate the safety parameters of diode laser (DL) therapy on treating recurrent aphthous ulcer (RAU). We conducted a systematic review in accordance with the PRISMA guidelines. Studies from PubMed, Embase, WOS, Cochrane, Google Scholar, CNKI, Wanfang Data and VIP were searched by hand. The search terms encompassed both Medical Subject Headings terms (Stomatitis, aphthous; Lasers, semiconductor) and their corresponding text words. The meta-analysis was performed using Review Manager 5.4. 16 studies were included in this review with no high-risk studies and no significant publication bias. In this review, we found DL therapy was more effective than medication or placebo in reducing Visual Analog Scale (MD = 2.79, 95% CI: 1.40 to 4.17, P < 0.0001), shrinking ulcer size (MD = 2.62, 95% CI: 1.15 to 4.09, P = 0.0005) and accelerating healing time (MD = -3.72, 95% CI: -4.86 to -2.59, P < 0.00001). Moreover, subgroup analyses demonstrated that DL therapy effectively alleviated immediate pain in patients (MD = 2.88, 95% CI: 1.53 to 4.23, P < 0.0001), and a single exposure significantly shortened the healing time of RAU (MD = -4.20, 95% CI: -5.76 to -2.64, P < 0.00001). DL therapy is an effective treatment for RAU without any adverse effects. A single session (or two) with low-energy density irradiation significantly alleviates RAU symptoms. Consequently, there is no need to pursue longer durations and higher parameters of DL therapy, which also aligns with the economic interests of patients. RAU is typically painful and can impair quality of life. Suitable DL therapy represents a promising strategy.

Clinical efficacy of lasers in the management of recurrent aphthous ulcers of oral cavity: a systematic review of randomized control trials

Recurrent aphthous stomatitis (RAS) is one of mankind's most common diseases with a nonspecific etiology. Lasers are gaining traction in dentistry due to their remarkable effects on pain reduction. Their convenience and lack of side effects have made them an attractive alternative to conventional interventions. This systematic review aims to summarize the current evidence on the efficacy of lasers in managing recurrent aphthous ulcers. This systematic review was performed according to PRISMA guidelines. The databases PubMed, Scopus, and EBSCOHost were electronically queried to retrieve trials published until July 2024 using the appropriate keywords. The outcomes evaluated include pain reduction, healing duration, and lesion size reduction. The bias assessment was conducted using the Revised Cochrane risk-of-bias method designed explicitly for randomized trials (Protocol Registration No: INPLASY2024110096). After evaluating the eligibility of 311 articles, 24 trials were included in the final review. Of 24 trials, data from 16 trials demonstrated that laser therapy is more efficacious in pain reduction than the control regardless of its power. Eleven of the included articles showed that low-level laser therapy had a shorter healing time than the control group. Six trials presented data indicating that low-level laser therapy results in a more significant reduction in ulcer diameter. Current evidence show that low-level as well as CO2 laser treatment are superior to conventional therapy for pain management in RAS. Future research should focus on determining the ideal laser treatment settings by standardizing parameters and outcome measurements to achieve maximum pain reduction and healing in RAS.

Photobiomodulation in recurrent aphthous stomatitis management using three different laser wavelengths. A randomized clinical trial

Recurrent aphthous stomatitis (RAS) is a common oral lesion with no definitive treatment; current therapies primarily focus on symptom relief. This study aims to address the lack of high-quality clinical research by evaluating the effectiveness of Photobiomodulation Therapy (PBMT) using GaAlAs 808 nm, AlGaInp 660 nm, and GaAs 635 nm lasers for managing aphthous lesions. The study focuses on the lasers' effectiveness in reducing pain, accelerating healing, enhancing patient satisfaction, and preventing recurrence compared to a control group. A randomized controlled clinical study was conducted with 64 RAS patients, divided into four groups: 808 nm laser, 660 nm laser, 635 nm laser, and a placebo. Pain severity, ulcer size, and erythema were evaluated at various time points before, immediately after, and several days post-treatment, while patient satisfaction and recurrence were assessed after one month. All laser groups significantly reduced pain intensity, ulcer size, and erythema, with the 808 nm laser showing the most pronounced effects. Mean pain scores in the laser groups decreased to zero by day 7, whereas the control group had a slower reduction (p < 0.001). Ulcer size was significantly smaller in the 808 nm group on days 3 and 7 (p < 0.05). Erythema was significantly reduced by day 7 (p < 0.05). The 808 nm laser also resulted in the highest patient satisfaction, with no recurrences observed in any group. PBMT is an effective treatment for RAS, and the 808 nm laser was the most effective wavelength used.

Effectiveness of Photobiomodulation in Reducing Pain of Oral Mucosal Diseases: A Case Series

Introduction

Pain management becomes important in the treatment of oral mucosal diseases since it can impair the quality of life. Photobiomodulation (PBM) as an alternative therapy, has potency in reducing pain through several mechanisms targeting peripheral nerves in the target tissue.

Purpose

To discuss the effectiveness of PBM in the management of four cases of oral mucosal diseases.

Case

Four patients, two females and two males, with an age ranging from 24 to 63 years came to the Oral Medicine Department complaining of painful lesions in their oral cavity. Three cases showed ulceration of the oral mucosa and had been diagnosed with recurrent aphthous stomatitis, recalcitrant chronic ulcer, and non-specific chronic sialadenitis. One patient who complained of intense pain and swelling on the right side of the face was diagnosed with post-herpetic neuralgia (PHN).

Case Management

PBM was administered in all four cases (976 nm diode laser, three cases with spot size 0.01 cm², fluency 10 J/cm², and one case with spot size 0.5 cm²; fluency 3 J/cm²). Visual analog scale (VAS) control was performed before and after the PBM at each visit. The recorded VAS results show a reduction in pain that started at the post-laser time, with VAS before PBM ranging from 5 to 7 and after PBM ranging from 0 to 4. Three patients were given triamcinolone acetonide 0.1%, chlorhexidine gluconate 0.2% mouthwash, petroleum jelly, and multivitamins. One patient was given mefenamic acid and multivitamins.

Conclusion

PBM can be a useful adjunctive treatment to relieve the pain of oral mucosal diseases due to its ability to reduce pain intensity.

Oral manifestations serve as potential signs of ulcerative colitis: A review

As an immune dysregulation-related disease, although ulcerative colitis (UC) primarily affects the intestinal tract, extraintestinal manifestations of the disease are evident, particularly in the oral cavity. Herein, we have reviewed the various oral presentations, potential pathogenesis, and treatment of oral lesions related to UC. The oral manifestations of UC include specific and nonspecific manifestations, with the former including pyostomatitis vegetans and the latter encompassing recurrent aphthous ulcers, atrophic glossitis, burning mouth syndrome, angular cheilitis, dry mouth, taste change, halitosis, and periodontitis. Although the aetiology of UC has not been fully determined, the factors leading to its development include immune system dysregulation, dysbiosis, and malnutrition. The principle of treating oral lesions in UC is to relieve pain, accelerate the healing of lesions, and prevent secondary infection, and the primary procedure is to control intestinal diseases. Systemic corticosteroids are the preferred treatment options, besides, topical and systemic administration combined with dietary guidance can also be applied. Oral manifestations of UC might accompany or precede the diagnosis of UC, albeit with the absence of intestinal symptoms; therefore, oral lesions, especially pyostomatitis vegetans, recurrent aphthous ulcer and periodontitis, could be used as good mucocutaneous signs to judge the occurrence and severity of UC, thus facilitating the early diagnosis and treatment of UC and avoiding severe consequences, such as colon cancer.

Efficacy of Topical Intervention for Recurrent Aphthous Stomatitis: A Network Meta-Analysis

Background and objectives: To compare the efficacy and safety of topical interventions used for recurrent aphthous stomatitis. Materials and Methods: This network meta-analysis was conducted in accordance with the PRISMA statement. We searched four electronic databases, PubMed, Web of Science (WOS), Cochrane Central Register of Controlled Trials and Embase, for randomized controlled trials reporting efficacy and safety data on topical interventions for recurrent aphthous stomatitis. We performed a quality evaluation using a methodology based on the Cochrane Handbook. Two authors independently extracted data on healing effect, size reduction effect, symptom reduction effect, recurrence and safety assessment. Network meta-analysis was then performed using ADDIS and RevMan. Results: A total of 72 trials (5272 subjects) involving 29 topical interventions were included. Honey, lnsulin liposome gel, laser, amlexanox, glycyrrhiza and triamcinolone had better efficacy performance. Probiotics and chlorhexidine helped to prolong ulcer intervals and reduce recurrence. Doxycycline and penicillin had a high risk of adverse events. Hematologic evaluation showed no preference. The rank possibility of size-reducing effect and symptom-reducing effect supported the short-term effect of laser and the long-term effect of probiotics. Conclusions: We recommend the use of laser as a short-term intervention during the exacerbation phase of RAS and probiotics as a long-term intervention during the exacerbation and remission phases of RAS.

Comparative Evaluation of Low-Level Laser Therapy and Topical Triamcinolone Acetonide 0.1% in Recurrent Aphthous Stomatitis Subjects

Background

Recurrent aphthous stomatitis (RAS), sometimes known as canker sores, is an infection of the oral mucous membranes caused by an inflammatory process. Triamcinolone and low-level laser therapy for recurrent aphthous ulcers were studied in this research, which evaluated their clinical efficacy.

Methodology

Among 60 subjects, 54 subjects fulfilled the inclusion criteria with an age range between 16 and 46 years. Subjects were randomly divided into two groups, the control group who received four times daily topical application of triamcinolone acetonide 0.1% and the test group who underwent a single application of low-level laser therapy on three alternate days. Evaluations were done on day 1, day 3, day 5, and day 10. Data obtained on oral-health-related quality of life (OHR-QoL) using the OHR-QoL questionnaire were used as baseline data. Clinical parameters like pain score were assessed using a visual analog scale, ulcer size using UNC-15 probe, and erythema and healing score were evaluated using erythema and healing scale.

Result

According to the OHR-QoL data, there was no statistically significant difference in the quality of life of test and control subjects. We found that pain and ulcer size reduced considerably (p=0.007) from the first day to the third day (p=0.000), and then dropped significantly again (p=0.000) on days 3-10 (p=0.000). On days 3 and 5, the test group showed significant reductions in pain and erythema (p=0.13), as well as an improvement in ulcer healing when compared to the control group. On days 3 and 5, the size of the ulcers decreased similarly in the control and test groups. On the 10th day, patients in both groups had less discomfort, erythema, and ulcer size, as well as improved healing of the ulcer.

Conclusion

Pain and erythema reduction and ulcer healing improvement were significantly higher in subjects in the test group as compared to those in the control group by day 3. The reduction in ulcer size was comparable to the control group on days 3 and 5, while the complete reduction in ulcer size was seen in both groups by day 10.

Application of soft tissue laser in the management of recurrent apthous stomatitis

Apthous ulcers are relatively common pathology and are very painful, so in order to facilitate the relief in pain and healing of these ulcers application of LLT has been done in the present study.  The purpose of this study was to assess the efficacy of Low Level Laser Therapy in the treatment of recurrent aphthous ulcers. 30 patients of both sexes and all age groups with two recurrent aphthous ulcers were included in the study. One ulcer in each subject was subjected to Low Level Laser Therapy as study group and one ulcer in each subject was considered for the Sham Control group. The Student’s t-test was used for statistical evaluation of the data. The study group (LLLT) showed a statistically significant reduction in pain as compared to the sham controlled group.  Complete resolution of the ulcers in the study group was observed to be 4.7 ± 1.2 days and control group was 8.4 ± 2.6 days. On comparison with the sham group, the complete healing time for the study group (LLLT) was found to be highly significant, with a p value of <0.001.

Comparative assessment of low-level laser therapy (LLLT) vs. topical application of amlexanox + lidocaine to treat recurrent aphthous ulcers (RAUs): A randomized controlled trial

Background. The present study aimed to assess and compare the pain perception and ulcer sizes before and after applying low-level laser therapy (LLLT) and Amlexanox + lidocaine.

Methods. Twenty-six patients referring to the out-patient department of the institution and diagnosed with recurrent aphthous ulcers (RAU) were assigned to two groups to receive either LLLT or Amlexanox + lidocaine. In group 1, the patients were provided with amlexanox + lidocaine to apply topically four times daily. In group 2, the patients underwent LLLT with no tissue contact in inward circular motions for two cycles for 30 seconds. This study was registered in "the Clinical Trials Registry- India" (CTRI), with the registration number CTRI/2019/09/028222. The data were analyzed with SPSS 16.

Results. The intergroup comparison was performed using Mann-Whitney U test, and intragroup comparisons were made using Wilcoxon’s signed-rank test. The level of significance was set at P <0.05. The results showed that pain perception and ulcer size were significantly lower in group 2 subjects than group 1 subjects (P <0.05).

Conclusion. LLLT was more effective than amlexanox + lidocaine in the management of RAU. It is a cost-effective therapy for treating RAU.

Does the application of GaAlAs laser and platelet-rich plasma induce cell proliferation and increase alkaline phosphatase activity in human dental pulp stem cells?

Blood extracts containing platelet products are gaining popularity in promoting healing and pulp regeneration. This study was designed to evaluate the effect of platelet-rich plasma (PRP) and gallium-aluminum-arsenide (GaAlAs) laser on proliferation and differentiation of human dental pulp stem cells (hDPSCs). In this ex vivo study, hDPSCs isolated from impacted mandibular third molars were cultured in Dulbecco's Modified Eagle's medium )DMEM(with 10% fetal bovine serum (FBS). After reaching the desired confluence, the cells were distributed into 4 groups, namely, control, PRP, laser, and PRP+laser for MTT assay and alkaline phosphatase (ALP) test. In the PRP and PRP+laser groups, 10% PRP was added to each well on the plate. In the laser and PRP+laser groups, as for the proliferation test, laser irradiation was carried out for 45 s, while 135 s was designated for ALP test. After 1, 3, and 5 days, cell proliferation and ALP activity were assessed using MTT and ALP colorimetric assay, respectively. Two-way ANOVA was utilized to analyze data. In PRP and PRP+laser groups, cell proliferation and viability increased until day 3 but began to decline afterwards until the 5th day. In the laser group, the increase in proliferation and viability was observed till day 5 which was less than the control group. Laser and control groups exhibited significantly higher cell viability and proliferation than both PRP and PRP+laser groups. ALP activity was more pronounced in PRP+laser, PRP, and laser in descending order; however, all were less than that of the control group. Only in the control group did the ALP activity augment during the 5-day period. Laser irradiation could induce pulp cell proliferation and demonstrated a better performance than PRP in this regard.

Low-Level Laser Therapy and Topical Medications for Treating Aphthous Ulcers: A Systematic Review

Objective

The study compares low-level laser therapy with topical medications for treating aphthous ulcers.

Methods

A search of articles in this systematic review was completed in six databases. Treatment and comparative groups comprised of patients subjected to laser therapy and topical medications, respectively. Two different treatment outcomes were considered; pain and size of the lesion. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials.

Results

From 109 articles, five randomized control trials fulfilled the selection criteria. The overall sample comprised of 98 males and 232 females, with a mean age of 32.4 years. The laser therapies in each included study had different active media and varying wavelengths. Topical medication used in the comparative group were triamcinolone acetonide, amlexanox, granofurin, and solcoseryl. Findings showed that patients who reported lower pain and decreased aphthous ulcer lesions were more in the laser therapy group than in the topical medication group.

Conclusion

Low-level laser therapy was better in treating aphthous ulcer lesions in comparison to topical medications, and all laser wavelengths in the included reports were seen to be effective. However, the results should be interpreted with caution, because no study demonstrated low-risk of bias in all the assessed domains.

Assessment of Efficacy of 5% Topical Amlexanox and 0.1% Topical Triamcinolone Acetonide in Management of Recurrent Aphthous Stomatitis

Aim:

The aim of this study was to assess the efficacy of 5% topical amlexanox and 0.1% topical triamcinolone acetonide in recurrent aphthous stomatitis (RAS) management.

Materials and Methods:

Sixty adult patients of RAS of both genders were divided into two groups with each group having 30 patients. In group I, 0.1% topical triamcinolone acetonide was prescribed. In group II, 5% topical amlexanox was prescribed. Patients were recalled regularly and size of ulcer, erythema, and pain score was recorded on days 1, 3, and 5.

Results:

The mean ulcer size (mm) on day 1 in group I was 4.3 and in group II it was 4.1, on day 3 it was 3.5 in group I and in group II it was 3.6, on day 5 in group I it was 1.3 and in group II it was 1.7. The result was not statistically significant (P > 0.05). The mean pain score recorded on visual analog scale was in descending grade day by day on first, third, and fifth days. In group I, healing was seen in 29 (96.6%) patients and in 28 (93.3%) patients in group II. Partially healing was seen in 1 (3.3%) patient in each group, whereas in group II nonhealing was observed in 1 (3.3%) patient. The statistical significance was not achieved as P > 0.05.

Conclusion:

Authors found that above drugs were effective in reducing pain, size of ulcer, erythema, and improving healing in patients with recurrent aphthous stomatitis. There were better results with triamcinolone acetonide as comparison of amlexanox.

Low-level laser therapy in the treatment of recurrent aphthous stomatitis and oral lichen planus: a literature review

Recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP) present inflammatory, recurrent diseases of the oral mucosa with not fully understood aetiology. Despite numerous attempts to discover an effective treatment for RAS and OLP, the current main treatment strategies are largely confined to the reduction of symptoms. Low-level laser therapy (LLLT) is of interest as a novel treatment modality. The aim of the paper was to discuss the mechanism of action and the biological effects of LLLT and to critically review and summarize recent clinical reports on the management of RAS and OLP. Most of the studies demonstrated the beneficial effect of LLLT in accelerating the healing process and pain reduction. However, the results should be interpreted with caution due to the limited number of studies available and empirical design using various irradiation parameters.

Photobiomodulation therapy for the management of recurrent aphthous stomatitis in children: clinical effectiveness and parental satisfaction

Background

This study aims to evaluate the effectiveness of the photobiomodulation therapy (PBMT) in the treatment of minor recurrent aphthous stomatitis (MiRAS) in children, in terms of pain relief, lesion size reduction and the parental satisfaction of the therapy.

Material and Methods

This randomized controlled study was carried out on 60 children with clinical diagnosis of MiRAS. Patients were randomized into two groups: group A receiving laser therapy and group B receiving sham therapy (placebo). Laser therapy (diode laser, λ: 645 nm) was administered on day 1 (T0) for three consecutive days. Patients were evaluated also on day 4 (T1), on day 7 (T2) and on day 10 (T3). Oral aphthous lesions size was assessed through a periodontal probe to measure the diameter length (mm); pain was evaluated through the Visual Analogue Scale (VAS); parental satisfaction was assessed through a questionnaire.

Results

The difference in the reduction of ulcers diameters between the two groups resulted statistically significant at T1 and at T2 (p<0.05). A statistically significant difference in pain reduction between two groups was found at T1 (p<0.05). No statistically significant difference between the two groups of parents was found as concerns the parental acceptance of the procedure and the discomfort for the need of multiple appointments.

Conclusions

PBMT is to be considered effective in the treatment of MiRAS in children and well- accepted by the parents of the children themselves.

Key words:Ulcers, children, lasers

Possible healing effects of Salvadora persica extract (MISWAK) and laser therapy in a rabbit model of a caustic-induced tongue ulcers: histological, immunohistochemical and biochemical study

Caustic ingestion is a potentially detrimental event that can cause serious devastating damage on contact with tissues. Local exposure is associated with severe pain, swelling and ulceration. Caustics-induced oral ulcers can be painful enough to compromise the patient's quality of life. Treatment of oral ulcers is crucial in clinical practice. Albeit, some ulcers do not respond adequately to the conventional treatment. The current study was conducted to evaluate the potential healing effects of topical Salvadora persica (SP) extract, low-level laser (LLL) and high-level laser (HLL) therapies in a rabbit model of caustic-induced tongue ulcers and explore the underlying mechanisms. Fifty male rabbits with a caustic induced tongue ulcers were included in the study. Rabbits were equally divided into four groups: positive control (ulcer) group, SP, LLL and HLL groups in addition to the negative control (healthy) group. All treatments were given thrice weekly for 14 days. Results showed that acetic acid-induced tongue ulcers caused extensive structural tongue damage secondary to overexpression of apoptotic BAX, pathological angiogenesis indicated by VEGF overexpression, marked collagen fibers deposition as well as upregulation of tissue pro-inflammatory TNF-α and upregulation of tissue anti-inflammatory IL-10. The healing potential of topical SP, LLL and HLL therapy are mostly comparable. In conclusion, acetic acid-induced extensive tongue damage. Topical SP extract, LLL and HLL are equally effective therapies against caustics-induced tongue ulcers. However, we recommend SP extract, owing to its safety, non-invasiveness, availability and low cost.

Clinical Evaluation of 660 nm Diode Laser Therapy on the Pain, Size and Functional Disorders of Recurrent Aphthous Stomatitis

BACKGROUND:

Minor recurrent aphthous stomatitis (MiRAS) is one of the most common, recurrent, and painful mucosal pathological condition. It is characterised by round or shallow oval ulcers, less than 10 mm in diameter, surrounded by a thin erythematous halo. It involves non-keratinized mucosa such as the labial and buccal mucosa, the ventral surface or borders of the tongue and the floor of the mouth, but it is uncommon to occur on the keratinised mucosa. It heals spontaneously within 10-14 days without scarring. There is no curative remedy to prevent its recurrence; also, available modalities only reduce the symptoms and severity of the lesion.

AIM:

Since these lesions may be extremely painful, we decided to estimate the pain-relieving and healing properties of low energy level laser therapy using diode laser 660 nm on MiRAS.

MATERIAL AND METHODS:

Twenty healthy patients suffering from minor aphthous ulcers were randomly selected from the Out-Patient Clinic of Oral Medicine Department, Faculty of Dentistry, Alexandria University. They were equally divided into two groups, study group who received 660 nm diode laser irradiation while the control group received placebo (sodium bicarbonate rinse). The visual analogue scale, size reduction, effectiveness indices and functional disorders were compared between the groups.

RESULTS:

Both groups presented a statistically significant difference from baseline to follow up periods. But, diode laser 660 nm treatment showed more remarkable improvements in reduction of healing time, pain and lesion size.

CONCLUSION:

We concluded that diode laser 660 nm should be further considered as an effective alternative therapeutic regimen to patients who suffer from recurrent aphthous stomatitis.

Comparative Evaluation of the Efficacy of Laser Therapy and Fibroblastic Growth Factor Injection on Mucosal Wound Healing in Rat Experimental Model

Introduction: The aim of the present study was to compare the effects of laser and basic fibroblastic growth factor (bFGF) treatment on operative wound healing in a rat model. Methods: Sixty-six male Wistar rats were employed in this study. A 10-mm surgical wound was created on the buccal mucosa of each rat, under anesthesia, and then the rats were divided into 3 groups of 22: (1) GF group (received subcutaneous injection of bFGF), (2) laser group (treated with low-level laser irradiation), and (3) control group (received no treatment). On day 5, half of the rats in each group and on day 10 the other half, were sacrificed. Afterward, samples were taken from rats' buccal mucosa for histological assay and scoring. The data were analyzed using MannWhitney test (α =5%). Results: On day 5 there was not any significant difference between GF and control groups; however, the laser group showed clinically delayed wound coverage, compared to other groups (P<0.05). On day 10, histological examination demonstrated marked vascular granulation tissue ( GT) in GF group. Collagen production was significantly prominent in laser group compared to GF treated samples (P=0.004). Inflammation of GT in GF and laser groups was significantly less than that in control samples (P=0.005 and P=0.001, respectively). Conclusion: The components of wound matrix induced by GF and laser treatment were significantly different. Although bFGF or laser treatment of oral wounds, under the conditions of the present study, did not accelerate wound healing, they showed some other notable effects on the quality of healing.

Low laser therapy as an effective treatment of recurrent aphtous ulcers: a clinical case reporting two locations

Apthous ulcers, commonly referred to as canker sores, are the most common ulcerative lesions of the oral mucosa. These are usually painful and are associated with redness and occasional bleeding from the affected area(s). Low Level Laser Therapy (LLLT) has shown excellent results in relieving the pain and complete remission of the oral ulcers. Through a clinical case, we report two locations of oral ulcers treated successfully with diode laser.

Effect of laser on pain relief and wound healing of recurrent aphthous stomatitis: a systematic review

The aim of this systematic review was to assess a potential benefit of laser use in the treatment of recurrent aphthous stomatitis (RAS). The primary outcome variables were pain relief, duration of wound healing and reduction in episode frequency. A PICO approach was used as a search strategy in Medline, Embase and Cochrane databases. After scanning and excluding titles, abstracts and full texts, 11 studies (ten RCTs and one non-randomised controlled trial) were included. Study selection and data extraction was done by two observers. Study participants varied between 7-90 for the laser and 5-90 for the control groups. Laser treatment included Nd:YAG laser ablation, CO₂ laser applied through a transparent gel (non-ablative) and diode laser in a low-level laser treatment (LLLT) mode. Control groups had placebo, no therapy or topical corticosteroid treatment. Significant pain relief immediately after treatment was found in five out of six studies. Pain relief in the days following treatment was recorded in seven studies. The duration of RAS wound healing was also reduced in five studies. However, criteria of evaluation differed between the studies. The episode frequency was not evaluated as only one study addressed this outcome parameter, but did not discriminate between the study (LLLT) and control (corticosteroid) groups. Jadad scores (ranging from 0 to 5) for quality assessment of the included studies range between 0 and 2 (mean = 1.0) for studies analysing pain relief and between 0 and 3 (mean = 1.1) for studies evaluating wound healing. The use of lasers (CO₂ laser, Nd:YAG laser and diode laser) to relieve symptoms and promote healing of RAS is a therapeutic option. More studies for laser applications are necessary to demonstrate superiority over topical pharmaceutical treatment and to recommend a specific laser type, wavelength, power output and applied energy (ablative versus photobiomodulation).

Effectiveness of Laser Therapy in the Management of Recurrent Aphthous Stomatitis: A Systematic Review

Objectives. Laser therapy is a promising new treatment for patients with recurrent aphthous stomatitis (RAS). However, the clinical effect and security issue of laser therapy remain controversial. This systematic review was conducted to evaluate the clinical effectiveness and security of laser treatment in RAS patients. Methods. Five electronic databases were searched (MEDLINE (PubMed), EMBASE, ScienceDirect, the Cochrane Library, and Web of Science) to identify all studies that were about randomized controlled clinical trials, involving the effect of laser therapy in RAS patients. Conclusion. Twenty-three studies were retained for full-text analysis after screening the titles and abstracts of potential articles, but only 10 studies satisfied the inclusion criteria after the full texts were reviewed. The included studies reported a comparison of the effectiveness between the laser treatment and placebo laser therapy (or conventional drug therapy) when managing the RAS patients. It can be concluded that laser therapy has the superiority in relieving ulcer pain and shortening healing time when compared with placebo group or medical treatment group. Although laser therapy is a promising effective treatment for RAS, high-quality clinical studies with large sample size must be further performed to confirm the effectiveness of this therapy.

Different modalities for treatment of recurrent aphthous stomatitis. A Randomized clinical trial

Background

The underlying etiology of recurrent aphthous stomatitis (RAS) is unclear and treatment aims to provide symptomatic and faster relief. This study compared the efficacy of diode laser, a herbal combination of Acacia nilotica and Licorice (A and L) and Amlexanox in the management of RAS.

Material and Methods

Sixty patients with minor aphthae were selected and randomly divided into four groups of 15 each. Group I and II received adhesive preparations of a herbal mixture of A and L and a 2 mg Amlexanox paste respectively, group III received diode laser and the fourth group (control) used a placebo. Ulcer size, pain score were recorded on days 1, 2 and 5.

Results

Laser group showed the statistically highest mean percentage (%) of reduction in pain scores and ulcer size than the other groups. The mean % of reduction in pain scores was 43.3+20.0 at day 2 and 67.8+21.5 % at day 5 in the laser group while Amlexanox group demonstrated a 29.8 +11.3 and 61.9+24.5 mean % of reduction in pain scores at day 2 and 5 respectively. A and L group showed a lower mean % of reduction in pain scores than laser and Amlexanox groups with a 22.2+10.5 and 43.4+15.8 mean % reduction in pain scores at day 2 and day 5 respectively. Similarly the highest mean % of reduction in ulcer size was seen in the laser group being 52.7+19.8 at day 2 and 85.1+22.0 at day 5, while it was 48.1+16.5 at day 2 and 77.8+28.7 at day 5 in the Amlexanox group and 42.0+11.5 at day 2 and 63.0+20.5 at day 5 in the A and L group.

Conclusions

All treatment modalities reduced pain and ulcer size than placebo group. Laser therapy demonstrated the highest percentage of reduction of pain score and ulcer size.

Key words:Aphthous stomatitis, laser, herbal plants, Acacia nilotica, Licorice.

Effectiveness of Amlexanox and Adcortyl for the treatment of recurrent aphthous ulcers

Background

Recurrent aphthous stomatitis (RAS) is a common condition that affects approximately 20% of the general population. The ulcers can interfere with speech and eating and cause significant pain and discomfort. This study aimed to evaluate the efficacy of Amlexanox and Adcortyl in the treatment of aphthous ulcers.

Material and Methods

In this randomized double blind clinical trial with sequential patient entry, a total of 40 patients who presented with aphthous ulcers were included. Patients were received Amlexanox or Adcortyl four times daily for 7 days. Patients were evaluated for pain, lesion size, and tingling at one day, three days, five days and seven days follow-ups. The treatment effects were then evaluated using the Wilcoxon–Mann–Whitney (WMW) test. Values of p<0.05 were considered significant.

Results

No significant differences in pain score, tingling and lesion size were observed on similar days between Amlexanox and Adcortyl groups. In both groups, reduction in the assessed variables was significant between days 1-3, 3-5, and 5-7 (p < 0.001).

Conclusions

This study indicated that Amlexanox as well as Adcortyl was effective in relieving pain and reducing the lesion size during the treatment of aphthous ulcers.

Key words:Recurrent aphthous stomatitis, Amlexanox, Adcortyl, pain relief.

Safety assessment of trans-tympanic photobiomodulation

We evaluated functional and morphological changes after trans-tympanic laser application using several different powers of photobiomodulation (PBM). The left (L) ears of 17 rats were irradiated for 30 min daily over 14 days using a power density of 909.1 (group A, 5040 J), 1136.4 (group B, 6300 J), and 1363.6 (group C, 7560 J) mW/cm(2). The right (N) ears served as controls. The safety of PBM was determined by endoscopic findings, auditory brainstem response (ABR) thresholds, and histological images of hair cells using confocal microscopy, and light microscopic images of the external auditory canal (EAC) and tympanic membrane (TM). Endoscopic findings revealed severe inflammation in the TM of C group; no other group showed damage in the TM. No significant difference in ABR threshold was found in the PBM-treated groups (excluding the group with TM damage). Confocal microscopy showed no histological difference between the AL and AN, or BL and BN groups. However, light microscopy showed more prominent edema, inflammation, and vascular congestion in the TM of BL ears. This study found a dose-response relationship between laser power parameters and TM changes. These results will be useful for defining future allowance criteria for trans-tympanic laser therapies.

Low-level laser therapy in the treatment of recurrent aphthous ulcers: a systematic review

Recurrent aphthous ulcers (RAUs) are the most common lesion found in the oral cavity. There is no definitive cure for RAUs and current treatments are aimed at minimizing symptoms. Since low-level laser therapy (LLLT) modulates inflammatory responses, and promotes pain reduction and cellular biostimulation, LLLT can be suggested as an alternative treatment for RAUs. The literature concerning the potential of LLLT in the treatment of RAUs was evaluated. A systematic literature review identified 22 publications, of which only 2 studies were adopted. The eligibility criteria consisted of randomized controlled trials (RCTs). Both RCTs achieved significant results concerning LLLT and pain-level reductions and reduced healing times. Despite the variance in irradiation conditions applied in both studies, very similar wavelengths were adopted. There is accordingly strong evidence that wavelength plays an important role in RAU treatment. Taking into account the different parameters applied by selected RCTs, it is not possible to suggest that a specific protocol should be used. However, in light of the significant results found in both studies, LLLT can be suggested as an alternative for RAU treatment. Additional RCTs should be performed in order to reach a clinical protocol and better understand the application of LLLT in RAU treatment.

Effect of low level laser therapy on proliferation and differentiation of the cells contributing in bone regeneration

INTRODUCTION

Low level laser therapy (LLLT) also known as photobiomodulation, is a treatment that uses low-level lasers or light-emitting diodes (LEDs) to change cellular function and is a clinically well accepted tool in regenerative medicine and dentistry. Considering the variety of laser, exposure, cells and study types, the exact effects of low level laser therapy seems to be unclear. The aim of this study was to review the data published in the field of the effects of low level laser therapy on proliferation and differentiation of the cells contributing in bone regeneration.

METHODS

To access relevant articles, an electronic search in PubMed was conducted from 2001 to April 2014. English language published papers on low level laser therapy were found using the selected keywords .The full texts of potentially suitable articles were obtained for final assessment according to the exclusion and inclusion criteria.

RESULTS

240 articles were found from 2001 to April 2014. Following the initial screening of titles and abstracts as well as the final screening of full texts, 22 articles completely fulfilled the inclusion criteria of this study. Wavelength used in LLLT irradiation varied between 600 to 1000 nm with an energy density of 0.04-60J/cm(2) . Although almost all studies agreed on getting positive effects from LLLT, some had opposing results.

CONCLUSION

Low level laser with low-energy density range appears to exert a biostimulatory effect on bone tissue, enhance osteoblastic proliferation and differentiation on cell lines used in in vitro studies. Despite the fact that many researches have been recently done on the effects of LLLT on different cell lines, without knowing the precise mechanism and effects, we are not able to offer a clinical treatment protocol. This paper is a beginning to help further progress and extend practical use of LLLT in future.