Impact of Photobiomodulation on IL1ß and TGFß-1 concentrations in patients with aphthous stomatitis.

Laser therapy has shown effectiveness in promoting wound healing by influencing various physiological factors such as blood flow, cytokines, histamine, nerve signals, lymphocyte function, tissue oxygenation, and cell growth. This study aims to evaluate the therapeutic efficacy of Photobiomodulation (PBM) treatment, by using diode laser, in modifying the levels of interleukin-1 beta (IL1ß) and transforming growth factor beta-1 (TGFß-1) in patients diagnosed with aphthous stomatitis. A before-after interventional design was conducted over 10 months with 20 subjects. Data on demographic details and serum concentrations of IL1ß and TGFß-1 were collected pre-treatment and on Days 3 and 7 post-treatments. The intervention involved a single session of four 30-second applications of a QuickLase dual-wavelength laser operating at 980 nm. Results show significant reductions in IL1ß and TGFß-1 levels after 7 days of treatment, indicating a time-dependent effect of PBM therapy on these inflammatory markers. The findings suggest that PBM therapy holds promise as an intervention for reducing inflammation associated with aphthous stomatitis.

Management of recurrent aphthous ulcers with therapeutic Nd:YAG laser, using two different methods.

BACKGROUND: Low-level laser therapy (LLLT) has been applied for the management of craniomaxillofacial disorders, including intraoral wounds, as well as recurrent aphthous stomatitis (RAS) lesions. However, the proper combination of laser features and tissue characteristics remains the major challenge in the realm of photobiomodulation (PBM). OBJECTIVES: The aim of the present study was to assess the feasibility of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser therapy in treating RAS lesions, and to compare 2 techniques, different with regard to the distance between the fiber tip and the ulcer. MATERIAL AND METHODS: A total of 138 patients (94 males and 44 females) with untreated RAS were divided into 3 groups: focused laser (energy density: 48 J/cm2; power density: 0.797 W/cm2; spot size: 0.1256 cm2); defocused laser (energy density: 21 J/cm2; power density: 0.354 W/cm2; spot size: 0.2826 cm2); and placebo. In the focused group, laser irradiation was performed with the laser tip kept 1 mm away from the lesion. Acrylic cylinders were prepared to precisely fit the handpiece tip and hold it in the proper position. In the defocused group, acrylic cylinders were prepared to set the laser tip 6 mm away from the lesion to obtain defocused irradiation. Finally, in the placebo group, a routine laser therapy procedure was carried out with a helium-neon (He-Ne) red light laser. The lesion size, and pain intensity and duration were recorded. RESULTS: Photobiomodulation showed a significantly more efficient pain relief as compared to the placebo group (p < 0.001) and also significantly better results in decreasing pain duration (p < 0.001). Besides, the diameter of the lesions in the exposed cases decreased during the 3 consecutive days of the study, while an increase in the diameter of the lesions was noticed in the placebo group. CONCLUSIONS: The Nd:YAG laser therapy, with the conditions and adjustments of the present study, may be successfully applied to manage RAS lesions, using either focused and defocused scanning techniques.

Treatment of recurrent minor aphthous stomatitis using diode laser (940 nm).

BACKGROUND: The exact etiology of recurrent aphthous ulcers (RAUs) is unknown. The management of RAUs is not always straightforward. Ulcers in the mouth (recurrent aphthous stomatitis [RAS]) are very common and may vary in size from very small to very large. OBJECTIVE: To evaluate reduction in pain intensity and duration of pain relief, reduction in size of ulcer, and duration for healing of ulcer (healing time) in patients with RAS after application of Low-Level Light Amplification by Stimulated Emission of Radiation therapy (LLLT) comparing with topical Anginovag spray medication and control group. MATERIALS AND METHODS: A total of 21 individuals diagnosed as RAS were divided into three equal groups as follows: Group 1: Minor aphthous ulcer, which was treated by giving LLLT using Diode LASER; Group 2: Minor aphthous ulcer, which was treated by topical Anginovag spray medication.; Group 3: Minor aphthous ulcer, which was treated conservatively with motivation and follow-up. RESULTS: In this randomized, controlled, clinical study, LLLT using Diode LASER causes reduction in pain intensity due to RAUs, thereby reducing morbidity. There is also reduction in the diameter and healing time of the ulcer as compared to Anginovag spray medication and the control group. CONCLUSION: Although various treatment modalities have been used and LLLT is not commonly used to treat aphthous ulcers, this study suggests that using LLLT would be a safe and effective treatment modality for RAUs patients.

Effect of different treatments on recurrent aphthous stomatitis: laser versus medication.

Recurrent aphthous stomatitis (RAS) is a common disease with ulcers in oral cavity which may trigger chewing, speaking, and swallowing difficulties to patients. Treatment of RAS is primarily aimed at pain relief and the promotion of wound healing. However, few agents have been found to have definite effect in the management of RAS and most of the medicinal products may cause adverse reactions or other disadvantages, which makes their clinical usage questionable. The purpose of this randomized controlled clinical trial (RCT) was to assess the clinical effect of diode laser and traditional medication treatment on RAS. In this study, 56 patients were randomly assigned to two groups (n = 28). Laser group was treated using diode laser (810 nm, 1.0 W, CW, irradiation time 20 s for 3 applications) once daily for continuous 3 days. Medication group was treated with triamcinolone acetonide 0.1% three times a day until the lesion was healed. Spontaneous and functional pain level on the third day of treatment was significantly less in the laser group. Significant difference was observed with respect to healing time; however, the order of difference is small albeit of statistical significance. Diode laser with the chosen parameters had better effects on pain relief and no distinct advantage on wound healing comparing with medication. Trial registration number: ChiCTR2000030298; date of registration: 26 February 2020 (retrospectively registered).

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, Lamba: 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

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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.

Treatment of recurrent aphthous stomatitis with Er,Cr:YSGG laser irradiation: A randomized controlled split mouth clinical study.

The present randomized controlled split mouth clinical study aimed to investigate the efficacy of Er,Cr:YSGG laser irradiation on pain reduction and healing rate of recurrent aphthous stomatitis. 40 patients with RAS were recruited for this study and RAS ulcerations of each patient were randomly assigned to the control or test group. In the test group, Er,Cr:YSGG laser with non-contact mode was used to irradiate RAS lesions. In the placebo group, RAS lesions were irradiated with the same device without laser emission. Pain was evaluated with visual analog scale (VAS) while a clinician graded healing of RAS (HRAS). In the placebo group at immediate; scores of VAS presented no statistically significance; in the test group, laser application showed significant pain reducing, at 1st day control. In the test group, a significantly healing effect at 1st day control was observed and this effect was maintained throughout the study. In the placebo group, scores of HRAS were statistically significant at controls on 3, 7, 10days. Statistically significant difference between the scores of VAS and HRAS was found for all control days except day 10 according to the intergroup comparisons. Based on these findings, Er,Cr:YSGG laser application at 0.25W without water may be appropriate to reduce pain and also accelerate the healing of RAS.

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).

Management of recurrent aphthous ulcers using low-level lasers: A systematic review.

BACKGROUND AND OBJECTIVE: The exact etiology of recurrent aphthous ulcers (RAS) is unknown. The management of RAS is not always straightforward. The aim of this review is to critically analyze and summarize the clinical literature focusing on the management of aphthous ulcers using low-level lasers. MATERIALS AND METHODS: The Medline (PubMed), Web of Knowledge (ISI), Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases were searched electronically for studies published in last 20 years (1995-2015) using the keywords "recurrent aphthous stomatitis," "aphthous ulcers," and "laser." RESULTS: A total of 85 articles were found during the initial search; 76 studies were excluded for not fulfilling the criteria whereas nine studies were deemed suitable for this review. Among the included studies, two articles were case reports and seven were randomized clinical trials. Study design, sample size, type of intervention and control of each study were critically analyzed and summarized according to the CONSORT protocol. In majority of the patients, immediate pain relief and accelerated ulcer healing was observed following irradiation with lasers. CONCLUSIONS: Although various types of lasers have succeeded in providing immediate pain relief to patients, carbon dioxide (CO2) lasers have the unique advantage of requiring a short exposure time (5-10s). In order to ascertain the efficacy of laser for treating ulcers in the clinical setting, more clinical trials are required.

Treatment of recurrent aphthous stomatitis by laser therapy: A systematic review of the literature.

BACKGROUND/AIM: Recurrent aphthous stomatitis (RAS) is defined as multifactor immunologic inflammatory lesions in the oral cavity, characterized by painful, recurrent single/multiple, shallow, round or ovoid ulcerations of mucosal tissues. To date, a considerable number of RAS treatment protocols have been suggested, but since the etiology of RAS is idiopathic, these treatment options have symptomatic rather than curative or preventive effect. Recently, it has been suggested that laser therapy could be successfully used as an efficient treatment approach in therapy of RAS. Therefore, the aim of this review was to estimate the effects of laser therapy in treatment of RAS analyzing results of clinical studies published in peer reviewed journals. METHODS: The studies published until 31 December 2013 were obtained from the Medline/PubMed, Science Direct and Cochrane Library of the Cochrane Collaboration (CENTRAL) online databases, using following search terms and key words: "laser" AND "recurrent aphthous stomatitis", "laser" AND "aphthous", and "laser" AND "aphthae". In total 4 original research articles met the all required inclusion/exclusion criteria, and were used for this review. The main outcome measures assessed were: a reduction of pain associated with RAS and a reduction in episode duration (faster RAS healing). RESULTS: The assessed literature demonstrates the benefits of laser therapy mainly due to immediate analgesia and ability to speed up a RAS healing process. CONCLUSION: Even thoughthe assessed literature suggests beneficial outcomes of laser therapy in treatment of RAS, these results should be interpreted with caution. The issues related to the study designs and different sets of laser irradiation parameters of a limited number of available studies with the same treatment outcomes prevent us from making definite conclusions.

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.

Recurrent aphthous stomatitis and pain management with low-level laser therapy: a randomized controlled trial.

OBJECTIVE: The aim of the study was to determine whether low-level laser therapy (LLLT) has an analgesic effect in patients with recurrent aphthous stomatitis (RAS). STUDY DESIGN: A randomized single-blinded placebo-controlled trial was conducted with LLLT (wavelength, 809 nm; power, 60 mW; pulse frequency, 1800 Hz; duration, 80 seconds per treatment; dose, 6.3 J/cm(2)) in 40 patients with RAS. The intervention group was treated with LLLT on 3 occasions, with a 1-day interval. The control group was treated similarly, without any laser power. Pain perception (visual analog scale [VAS] rating) and patients' experience of eating, drinking, and brushing teeth was registered. RESULTS: VAS rating decreased (day 0 until day 2) from 84.7 to 31.5 (LLLT) and from 81.7 to 76.1 (placebo) (P < .0001). LLLT also relieved the difficulty of drinking, eating, and brushing teeth. CONCLUSIONS: LLLT reduced the pain and the inconvenience of eating, drinking, and brushing teeth for patients with RAS, compared with placebo.

Low level laser therapy in the treatment of aphthous ulcer.

Recurrent aphthous stomatitis (RAS) is one of the most common and painful ulcerative lesions of the oral cavity, but until now no cure has been recognized for it. Two patients diagnosed with minor RAS were treated in a single sitting with low level laser therapy using 940-nm diode laser. The lesions healed completely within 3-4 days and a follow-up for 1 showed no recurrence in these patients. According to the results of this study, low level laser therapy can decrease the healing time, pain intensity, size, and recurrence of the lesion in patients with minor RAS, and hence can be considered the most appropriate treatment modality for minor RAS, with greatest clinical effectiveness.

Assessment of immediate pain relief with laser treatment in recurrent aphthous stomatitis.

OBJECTIVES: To compare immediate pain relief, healing time between minor recurrent aphthous ulcers treated with a single session of carbon dioxide (CO2) laser and a placebo. STUDY DESIGN: A prospective clinical study was performed on 25 patients with minor recurrent aphthous stomatitis. Pretreatment pain levels were recorded using a numerical rating scale. Ulcers were randomized to either receive treatment or placebo. Pain levels were assessed immediately after treatment and after 24 h. Healing was assessed on days 3 and 4, and once every 2 days thereafter for 2 weeks. RESULTS: Mean pain scores in the laser group were significantly reduced immediately after treatment (0.68 ± 0.6) compared with pretreatment (8.48 ± 0.71; P < .001). In contrast, the placebo group showed little difference in pain scores between pretreatment (8.08 ± 0.70) and immediately after treatment (7.96 ± 0.84). In the laser group, significant improvements in healing times were observed (4.08 ± 0.81 vs. 7.84 ± 0.90 days; P < .001). CONCLUSION: CO2 laser therapy in recurrent aphthous stomatitis (RAS) provides immediate pain relief sustained over 24 h, along with accelerated healing time.

Promoting wound healing in minor recurrent aphthous stomatitis by non-thermal, non-ablative CO(2) laser therapy: a pilot study.

BACKGROUND AND OBJECTIVE: This randomized controlled clinical trial (RCT) was designed to evaluate the effects of non-thermal, non-ablative CO(2) laser therapy (NACLT) to promote wound healing in minor recurrent aphthous stomatitis (miRAS). STUDY DESIGN/MATERIALS AND METHODS: Ten patients with 20 minor aphthous ulcers completed this study. Each patient had two discrete aphthous ulcers that had developed within 72 h before enrollment. One of the ulcers was randomly allocated to be treated with NACLT and the other one served as placebo. Before laser irradiation, a layer of transparent, non-anesthetic oral gel with high water content was placed on the laser and placebo lesions both. The CO(2) laser device was operated using 1 W power in defocused continuous mode, scanning rapidly over the lesion. The placebo lesion was irradiated with the same laser, but with an inactive probe. The healing times of the lesions were recorded by a blinded physician. RESULTS: The healing period was significantly shorter in ulcers treated by NACLT than in those treated with placebo (p=0.02). The process was not painful and anesthesia was not required. There were no visible side effects after NACLT and during follow-up periods. CONCLUSIONS: The results of this RCT suggest that single session of NACLT could be used to promote wound healing in minor aphthous ulcers, with no visible side effects.

Clinical evaluation of low-level laser treatment for recurring aphthous stomatitis.

OBJECTIVE: The aim of the present study was to assess the effect of low-level laser on the control of pain and the repair of recurring aphthous stomatitis (RAS). BACKGROUND: One of the most frequent pathologic conditions in the oral cavity is RAS. This multifactor immunologic inflammatory lesion causes patient discomfort, and treatment is controversial because of its unknown etiology. A number of treatment modalities have been proposed, but none is definitive. Low-level laser treatment (LLLT) has been used for lesions of an inflammatory nature, not as an inhibitor of the process, but for its modulating action and reparative effect on tissues. MATERIALS AND METHODS: Twenty patients with RAS were divided into one group treated with a topical corticoid agent (n = 5) and another group treated with laser (n = 15). Group I received conventional treatment with triamcinolone acetonide 4 times per day. The patients in Group II received laser treatment with an InGaA1P diode laser with wavelength of 670 nm, 50 mW, 3 J/cm(2) per point in daily sessions (once per day) on consecutive days. Both treatments were applied until the disappearance of the lesions. All patients were evaluated on a daily basis, and the following clinical parameters were determined during each session: pain intensity before and after treatment and clinical measurement of lesion size. RESULTS: The results revealed that 75% of the patients reported a reduction in pain in the same session after laser treatment, and total regression of the lesion occurred after 4 days. Total regression in the corticoid group was from 5 to 7 days. CONCLUSION: The use of LLLT under the conditions administered in the present study demonstrated analgesic and healing effects with regard to RAS.

Relieving pain in minor aphthous stomatitis by a single session of non-thermal carbon dioxide laser irradiation.

This randomized controlled clinical trial was designed to evaluate the efficacy of single-session, non-thermal, carbon dioxide (CO(2)) laser irradiation in relieving the pain of minor recurrent aphthous stomatitis (miRAS) as a prototype of painful oral ulcers. Fifteen patients, each with two discrete aphthous ulcers, were included. One of the ulcers was randomly allocated to be treated with CO(2) laser (1 W of power in de-focused continuous mode) and the other one served as a placebo. Before laser irradiation, a layer of transparent, non-anesthetic gel was placed on both the laser lesions and the placebo lesions. The patients were requested to grade their pain on a visual analog scale up to 96 h post-operatively. The reduction in pain scores was significantly greater in the laser group than in the placebo group. The procedure itself was not painful, so anesthesia was not required. Powermetry revealed the CO(2) laser power to be 2-5 mW after passing through the gel, which caused no significant temperature rise or any visual effect of damage to the oral mucosa. Our results showed that a low-intensity, non-thermal, single-session of CO(2) laser irradiation reduced pain in miRAS immediately and dramatically, with no visible side effects.

An evaluation of different treatments for recurrent aphthous stomatitis and patient perceptions: Nd:YAG laser versus medication.

OBJECTIVE: The aim of this randomized controlled clinical trial was to determine the anxiety levels of patients with recurrent aphthous stomatitis (RAS) prior to therapy with the Nd:YAG laser or medication, and to compare the effects of these different treatment methods on the degree of post-treatment pain, discomfort, and functional complications (eating and speech) experienced. MATERIALS AND METHODS: Twenty patients with RAS-related oral problems were included in the study. Levels of pre- and post-treatment pain and functional complications were assessed at patient visits on days 1, 4, and 7. RESULTS: The results indicated that patients treated with the Nd:YAG laser had less post-treatment pain and fewer functional complications, and reported immediate relief of pain and faster healing (p +/- 0.05). However, only after 5 d was there a significant reduction in the pain levels of the patients treated with medication. CONCLUSION: Our results suggest that the Nd:YAG laser has better patient acceptance, shorter treatment time, and lower rates of pain and post-treatment adverse events among patients with RAS.