Photobiomodulation of gingival lesions resulting from autoimmune diseases: systematic review and meta-analysis

Abstract

Objectives To evaluate the effects of photobiomodulation (PBM) in gingival lesions resulting from autoimmune diseases; to compare PBM and topical corticosteroid (CS) treatment; and to assess PBM outcome over time of follow-up. Materials and methods A comprehensive electronic search was performed in four electronic databases. Treatment effects were measured through visual analog scale of pain (VAS) and clinical evolution of lesion (Thongprasom scale for oral lichen planus (OLP)). Meta-analysis was performed to compare PBM with topical corticosteroid treatment and to evaluate PBM effect over time of follow-up. Results Seventeen studies were included in this review, of which six were used for the meta-analysis. Meta-analysis results showed no significant differences between PBM and topical CS in pain reduction at baseline (MD = 0.20, 95% CI = − 0.92, 1.32, p = 0.72) and 60-day follow-up (MD = 0.63, 95% CI = − 3.93, 5.19, p = 0.79); however, VAS showed significant pain reduction when compared before and after PBM at 30-day (MD = − 3.52, 95% CI = − 5.40, − 1.64, p = 0.0002) and 60-day (MD = − 5.04, 95% CI = − 5.86, − 4.22, p < 0.00001) follow-up. Thongprasom clinical scale for OLP also showed significant improvement at 30-day follow-up (MD = − 2.50, 95% CI = − 2.92, − 2.08, p < 0.00001) after PBM. Conclusion PBM led to significant reduction of pain and clinical scores of the lesions, not having shown significant differences when compared to topical CS. Clinical relevance PBM has been used in the treatment of autoimmune gingival lesions, but so far there is little strong evidence to support its use.

Desquamative Gingivitis in the Context of Autoimmune Bullous Dermatoses and Lichen Planus—Challenges in the Diagnosis and Treatment

“…A recent meta-analysis that analyzed 17 studies has concluded that photobiomodulation determined an overall amelioration of clinical scores and significant pain reduction of treated areas, similar to topical corticosteroids, thus representing a viable alternative [ 95 ]. Although the preliminary results are promising, these alternative therapies should be further tested and compared to the classical therapy in order to assess their efficacy over time and for different disease stages.…”

Effect of Photobiomodulation on Atrophic–Erosive Clinical Forms of Oral Lichen Planus: A Systematic Review

“…The studies included in this systematic review showed that the biological effects of PBM treatment are beneficial compared to those of other conventional therapies such as corticosteroids [ 26 , 30 , 32 ] as shown by the reduction of symptoms such as pain and signs associated with LPO lesions, highlighted by de Carvalho et al [ 24 ]. Other authors clarified that, in addition to PBM, there is another type of therapy, i.e., high-power laser (HLLT) [ 33 ] which, they claim, allow achieving significantly better results than PBM in the aforementioned parameters.…”

“…In addition, it should always be kept in mind that PBM therapy is not applied to cure lesions but rather to improve the aforementioned clinical aspects, as reported in the studies by Mutafchieva et al [ 30 ] and Khater et al [ 32 ], who described that most of their patients obtained a moderate recovery, and some a complete one. These poor results are due to the lack of a long-term follow-up after therapy administration, as pointed out by Hanna et al [ 21 ] and Carvalho et al [ 24 ], which also makes it difficult to assess the possible side effects that PBM can produce in the long term, although we already know that it is much less invasive than other conventional treatments such as corticosteroids. In addition, it was observed in different studies such as Mirza et al [ 29 ], Lavaee et al [ 31 ] and Ferri et al [ 38 ] that, in the short term, no side effect was been detected.…”

“…This is due to their beneficial effects at the cellular level, such as on proliferation at lower doses of energy and apoptosis at higher doses of energy [ 23 ], and at the systemic level, with an analgesic action. PBM was shown to reduce pain and promote clinical improvement of OLP lesions [ 24 ], with a decrease in size and erythema, using wavelengths between 630 and 980 nm with an output power of 20 to 300 mW and an exposure time of 10 s to 15 min [ 25 ]. These beneficial effects of PBM on OLP would be explained by its ability to delay cell differentiation, improve healing and re-epithelialization, reduce inflammation through immunomodulation and exert an analgesic effect (through the production of beta-endorphins and enkephalins and the reduction of histamine and bradykinin, in addition to the reduction of the activity of sensitive C fibers) [ 18 ].…”