The area of oral cavity was one of the first ones where LLLT has been applied. On the basis of our ten-year experience with this supportive therapeutic method this paper has originated.

Oral cavity is an area where applications of biostimulation techniques can be taken into consideration very positively thanks to easy access, co-operation with the patient, and especially to its great miscellaneousness of biological material. It should be also noted that patients have a quick opportunity to check positive effects of this therapeutic method. In oral cavity and its neighbourhood we can see possibilities of application of LLLT on the following matters:

• soft tissue = mucose

• soft tissue = muscle parts

• soft tissue = skin

• hard tissue = bones

• hard tissue = teeth

• joints = temporo-mandibular joint

Such a variety of biological structures in a rather small area cannot be found on any other part of human body.

In our surgery two types of lasers are used. We work with several He-Ne lasers with power outputs 2 - 5 mW, as well as with semiconductor lasers with power output 10 and 20 mW. The lasers can emit both continuous and variable pulsed beams.

On the basis of our experience we can establish that in oral cavity continuous as well as pulsed beam should be used. Time of irradiation varies between 3 to 5 minutes with about 0.5 to 3.0 J/cm2 being emitted. We irradiate from shortest possible distance. Mucous tissue we irradiate preferably with He-Ne laser, for hard tissue applications we choose infrared semiconductor laser with higher outputs (10 - 20 mW). The beam is modulated in frequencies according to particular ailment.

Our patients can be divided in two categories, there are patients who have experienced this method of treatment before (and require it) as well as there are others, undergoing this therapy for the first time. It is absolutely necessary that new and for the first time comming patients be acquainted with the overall issue of laser therapy. It is necessary to assure them that this method is totally safe and absolutely painless. Furthermore, the patient must be informed that this is a supportive method, helping his/her own body to fight the illness on its own (see the basic effects of LLLT - analgetic, antiinflammatory, biostimulative). In no case the patient can expect that after irradiation there will be a miraculous cure and restoration.
Soft tissue in oral cavity and its neighbourhood

Oral cavity and its soft tissues are an area where we have to face:

• local manifestations of numerous overall ailments

• attendant symptoms of overall ailments

• ailments specific for this particular anatomical area

These ailments and symptoms can usually be very well treated only with the use of biostimulation lasers, or sometimes in association with other kinds of therapy. However, it is necessary to realize, that LLLT is a supportive (roborative) therapy and not a panacea, and thus there is also necessary to consider other methods of treatment. Each case therapy is only based on knowledge and experience of the doctor. As the technique and method are rather new and young, we can often see overestimation of the potential of the method, or non-suitable applications, resulting in failure of therapy and thus leading to condemnation of the method by therapists as well as by patients.

During the past ten years we have treated, more or less successfully, hundreds of patients, both children and adults, suffering from mucosal affections.

In our group of children patients there were quite often individuals with disorders of ordinary milieu in the oral cavity caused by various reasons. A non-collaborating child-patient with spontaneous pain in the oral cavity, and unable to ingest food, was brought about by parents. Clinical picture indicated a stomatitis including cheilitis, and such a status can be very well influenced by LLLT. Following an ordinary checkup, LLLT represents an advantageous kind of therapy always resulting in success and non-causing any therapeutic problems, such as pain or non - physiological position. Thus a belief of the little patients in the therapy is created.

We cannot comment post injury cases, for these are not treated in our surgery, however, as far as children - patients are concerned, their perception of the therapy has always been very positive and for the past ten years we have not met a child - patient who would show a negative reaction to this method. 

As to adult population, variability and potentials of LLLT are much more wider. In the early days of our laser practice we have been using LLLT mainly to treat herpes simplex labialis. It is relatively frequent and relapsing disease, affecting patients in all categories of age, and precipitating at first in the prodromal stages with uncertain irritation, tonicity and pain in the area of future dermic or mucosal eruption. This is followed by creation of vesicles, very quickly fissuring (quite often with the help of the patient) and resulting in erosion with an exudation, very often haemorrhagic, and badly healing crust. Apart from health problems herpes creates also serious social trauma due to its location and appearance. During my long-term use of a therapeutic laser in my surgery hundreds of patients suffering from this illness have been treated with a big success (nearly 100 per cent) and at present the treatment of herpes is considered a routine method we do not keep any special records of. 

Having gained more experience gradually I started widening of the spectrum of mucosal applications. Anguli infectiosi - LLLT can improve the condition, however the ailments reappear if the main cause of the problem is not cured. Aphtae (Stomatitis aphtosis) - successful treatment can be achieved with about 4/5 treated patients. 

A requirement to remove scars from facial area is also very frequent. This issue should be divided to two groups, solitary scars which may even be of a greater extent, or small numerous cicatriculae, for instance caused by a broken windshield in a car crash. Even though treatment of both cases is the same, therapeutic success with small numerous scars is usually lower because the number of visits and long-term treatment can stress the patient and sometimes can even discourage him/her from further treatment.

Virtually all soft tissues in the oral cavity are sensitive to light therapy with a biostimulation laser (LLLT). Thanks to penetration of laser irradiation into tissue nearly all ailments can be treated in full. This is very important in order not to irradiate tumorous affections and pigmented naevi.

Hard tissue in the oral cavity and its neighbourhood

As far as hard tissues are concerned, it is necessary to underline that LLLT is basically a supportive therapy, not substituting standard therapeutic techniques. However, LLLT only becomingly complements these techniques and makes them more effective. We had started to apply LLLT on sensitive teeth necks (Hypersensibilitas dentinalis) and it can be stated that this method is successful for about 90 per cent of our patients and the symptoms fade out after about three applications. It was necessary to repeat the therapy with some patients, but not earlier than after one year.

With hard tissues patients expect that LLLT diminishes pain. I am convinced that overall analgesia after irradiation of hard tooth tissue before preparations, if any, is very weak and cannot be virtually relied on. In general, we expect that pain limitation is caused by leveling up of threshold of pain.

I have also noticed that after irradiation of pulpitis acuta as well as of pulpa aperta painful symptoms completely fade out very often (virtually in all cases). However, this is limited to time period of not more than 24 hours.

Very good experience has been gained with applications of LLLT on painful reactions after definitive fillings of root canals. In this case we can establish 95 per cent success.

Dolor post extractione (Alveolitis sicca/purulenta) is also one of the affections, where I choose application of LLLT. After classical standard treatment I immerse a lightguide with special sphery irradiation tip right into the extraction wound. LLLT shortens time of complaints by about 50 per cent in compasison with non irradiated post-extraction wounds.

I also use LLLT as supplementation of ambulatory little dental surgery. We irradiate not only before the intervention and after it, but also during the operation, usually after toilet of the wound before suture.

LLLT application on a complaint usually called parodontosis I consider very controversial. Acute inflammations of gingiva can be well influenced by LLLT in conjunction with other kinds of treatments. However, as to my experience, I would consider the effect of irradiation in case of a chronic inflammation, especially with bone regeneration and re-adherence of gingiva, at least arguable (even though positive cases can be traced in literature).


Other applications in a dental office

One of other possible applications in the orofacial area is irradiation of temporo-mandibular joint. In this case I utilize semiconductor lasers with power output of 20 mW. However, our clinic is very limited in this case and I do not dare to generalize. 

Last but not least, I would like to mention that it is not only patients to be treated by LLLT in dental surgeries, but also employees and especially dentists do use LLLT for their own benefit. All dentists are well aware of unnatural positions they are working in for the whole day, and they also experience back pain shooting in chest and belly. Stimulation of pain zones in the area of vertebra including acupuncture points can very often lead to diminishing or even to elimination of complaints.

The most frequent diagnoses for LLLT

In general, the purpose of this article was to bring out the possibilities of LLLT in a dental office after gaining some experience. However, it is not intended to explain technique of therapy and its performance.

LLLT - a typical dental application