Oral mucositis (OM) is a debilitating complication of chemotherapy, and head and neck radiotherapy. In an effort to offer the best possible advice within the limitations of published research, a systematic review with an extended discussion and commentary on dosimetry and dose delivery is presented. Using keywords as listed, Pubmed, Google Scholar and Cochrane databases were searched during a period extending from 1995 to 2019. A total of 782 abstracts were identified. A total of 50 papers were analysed, and of these, 29 satisfied criteria required for systematic review in accordance with an optimized PRISMA statement. Clinical outcome as reported was subject to analysis with respect to time of intervention, incidence and severity of oral mucositis, and pain amelioration, and a comprehensive combined univariate and multivariate statistical analysis of the methods employed was performed. Recommendations are made with respect to the timing of the intervention. Moreover, there is an extended discussion available on the treatment care rationale of photobiomodulation (PBM), and its adjunctive association with OM. In conclusion, early prophylactic application offers clear advantages in clinical management. The many studies and associated variables and covariables assessed here revealed a choice of delivery techniques, associated wavelengths and many further indices to consider with regard to the accomplishment of optical parameters. It is therefore our recommendation that clinicians use PBM as a therapy with a full and proper understanding and training in order to optimise the clinical effects achievable.

Objective: This systematic review of published research evaluates the parameters and reported outcomes in photobiomodulation therapies (PBMTs) used in management of pain and accelerated tooth movement during orthodontic treatment. Background: Consequent to positive in vitro and animal studies, there has been considerable interest in the potential applications of PBMT to ameliorate pain and to accelerate orthodontic tooth movement. Due to the lack of consistency of wavelengths and parameters applied, there is as yet no consensus in respect of guidance for clinical use. Within the limitations of the reported literature, a digest of key outcomes and parameters is presented here to assist researchers and interested clinicians. Materials and methods: Search engines, PubMed, Google Scholar, and Cochrane, were applied to identify clinical investigations into the potential benefits of PBMTs in orthodontic management. Keywords used were ''low-level laser therapy,'' ''low-level light therapy,'' ''photobiomodulation,'' ''orthodontics,'' ''pain,'' ''tooth movement,'' and ''randomized clinical trial ‡5 years.'' A total of 35 articles were identified, covering the 5-year period January 2013 to December 2018. Only human clinical trials were considered. Seventeen articles were included in this investigation and the reported parameters and outcomes were assessed and presented for comparison. Results: Seven of nine studies supported the effectiveness of PBMT to reduce or prevent pain. There was no consensus on choice of wavelength and a range of parameters were found beneficial. Of the seven tooth movement studies included, four of the seven were positive, of which two used a home-use light-emitting diode (LED) device, as opposed to a clinician-applied laser. A variety of wavelengths and parameters were found to be effective in accelerating tooth movement in the range of 20-40% compared with control. Conclusions: Due to a lack of consistency in approach, further studies are required to achieve a high level of acceptance. The clinical logistics associated with frequent applications supports the concept of patient home delivery use of LED devices, although there are insufficient studies at present to make an evidence-based determination of this type of appliance. To gain more general professional acceptance of the use of PBMT in orthodontics, a continued effort to extend the number of quality human clinical trials is required. Based on the current evidence base, further positive onward progression can be regarded as inevitable.

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Objective: This systematic review and meta-analysis of published randomized controlled trials examines a possible relationship between optical spot size at surface tissue, irradiance, radiant exposure, total energy delivered, operator technique and reported clinical outcomes. Background: Clinical photobiomodulation (PBM) therapy has achieved a high level of evidence-based acceptance in the mitigation of oral mucositis associated with cancer radiotherapy and chemotherapy, and supportive clinical research in relation to orthodontic tooth movement, oral medical conditions, including burning mouth syndrome, xerostomia and lichen planus. Inconsistent outcomes have been reported not withstanding a substantial body of primary supportive research from clinical, in vitro and animal studies. Materials and Methods: PubMed, Cochrane Database of Reviews and Google Scholar search engines were applied to identify human clinical trials of PBM therapy in clinical dentistry. A total of 766 articles between February 2009 and June 2020 were identified and following a full text evaluation, 38 papers with sufficient data to permit analyses are included in this investigation. Results: Following a detailed assessment of potential factors that may have an influence in clinical outcome, a clear trend is apparent associating optical spot size to a positive or negative effect. Furthermore, there is a clear difference in the reported results in relation to total energy applied, delivery techniques and optical parameters, which merits further investigation. Factorial statistical analyses identified an association between smaller optical surface applications and an overall lower level of reported clinical success in treating superficial and deeper targets, and correspondingly sub-surface larger target tissues were found to be more responsive to therapy by use of a larger optical surface spot size. Moreover, use of multiple small diameter probe applications was found to provide inconsistent results. Conclusions: Many factors can confound clinical success including variations in anatomy, site location, clinical condition and subject individuality. To achieve higher levels of predictable outcome, a mature appreciation of these factors, plus an expanded understanding of laser parametry, tissue volume and target depth to deliver an adequate dose within current recommended guidelines, is essential.