Photobiomodulation Therapy in the Management of Burning Mouth Syndrome: Morphological Variations in the Capillary Bed

Abstract

Burning mouth syndrome (BMS) is an idiopathic condition that manifests itself primarily with the onset of a burning sensation. The aim of this research was to perform photobiomodulation therapy (PBM) using a diode laser on the oral mucosa of BMS patients, followed by an objective evaluation of the morphological changes in the vascular bed underlying the mucosa using polarized light videocapillaroscopy. A group of 40 patients were included in the study. The patients were randomly divided into two groups (using simple randomization) as follows: 20 patients were assigned to the laser group and 20 patients were assigned to the placebo group. Each patient of the laser group received eight irradiations (with 4 Watt of power, wavelength 800 nm, energy 1200 Joules, irradiation time of 300 s, energy density 50 J/cm2, 60 mW continuous wave laser, and irradiance 180 mW/cm2), twice a week, blinded to the type of irradiation administered, for four consecutive weeks. The patients in the placebo group underwent the same sessions as the other patients, the only difference was the non-emission of the laser. An initial check of the vascular bed was performed with a polarized light videocapillaroscope. This was followed by treatment with a therapeutic diode laser and a subsequent check with a videocapillaroscope. We observed that in the group of patients who underwent laser therapy, there was a lasting improvement in symptoms. The capillary oral bed of patients in the placebo group did not show any statistically significant difference (p > 0.05). In the laser group we observed the following: in the buccal mucosa the diameter of the capillary had a reduction of 3 μm; in the upper lip mucosa, there was a reduction of 3 μm; in the lower lip mucosa, there was a reduction of 3 μm; and in the dorsal lingual surface, there was a reduction of 2 μm. An increase in capillary length was also obtained in all irradiated regions in the laser group patients (p < 0.05). PBM induces microcirculatory changes that are still present over a long period of time, such as an improvement in the clinical picture. The improvement in the symptoms has been correlated to the reduction of the capillary diameter. The placebo effect only led to a temporary improvement in symptoms that were unrelated to changes in the microcirculatory pattern.

Burning Mouth Syndrome (BMS)—Treatment with Verbal and Written Information, B Vitamins, Probiotics, and Low-Level Laser Therapy: A Randomized Clinical Trial

“…LLLT also blocks the depolarization of C-fibers, which transmit heat and pain stimuli, and amplifies ATP synthesis [15], which contributes to pain reduction. Recently published results have shown that LLLT affects microcirculation, reducing the capillary diameter and inflammatory vasodilatation and improving symptoms in BMS patients [36]. Up to now, LLLT has shown to be effective in the treatment of BMS [15,37].…”

Place of placebo therapy in the treatment of burning mouth syndrome: A systematic review

“…A total of 21 studies included in this systematic review had a low score of bias. [47][48][49][50][51][52][53][54][55][56][57][58][59][62][63][64][65][66][67][68][69] Three studies had a moderate score of bias. 60,61,70 The final bias scores ranged from 53.8% to 100%.…”

“…The studies were published between 1999 57,63 and 2020. 52,64,66 They were conducted in Spain, 49,50,52,53,67,69 Croatia, 64 Serbia, 70 Italy, 48,[55][56][57]60,61 Brazil, 54,58,59,65 Germany, 68 France, 62 and Finland. 63 Three studies failed to report where they were carried out.…”

“…63 Three studies failed to report where they were carried out. 47,51,66 The number of treated participants varied from 20 55,68 to 192, 60 with a wide range of ages, varying from 22 61 to 89 68 years. All BMS participants were appropriately defined as having chronic pain for more than 3, 4 or 6 months with normal oral mucosa.…”

Impacted Palatal Canines and Diode Laser Surgery: A Case Report

“…Finally, laser can be applied in orthodontics to etch enamel prior to adhesive application and orthodontic brackets [ 31 ] and can reduce pain following band application on maxillary first molars for orthodontic treatment [ 32 ]. Photobiomodulation (or low-level laser therapy) with laser or LED can also be used to reduce pain intensity during and following lower third molar extraction and to improve symptoms related to Burning Mouth Syndrome through a reduction of the capillary diameter [ 33 , 34 ].…”