The Combination of Antimicrobial Photodynamic Therapy and Photobiomodulation Therapy for the Treatment of Palatal Ulcers: A Case Report

Abstract

Introduction: One of the unexpected side effects of the Haas type palatal expander is ulcers progressing to necrotic lesions in the palatal area due to poor hygiene. The use of antibiotic therapy is mandatory. However, long periods of healing/pain and the need for a systemic host response with the aid of metabolization, especially in children, are issues that should be taken into account in the management of this type of injury. Since phototherapy modalities (antimicrobial photodynamic therapy [aPDT] and photobiomodulation therapy [PBMT]) are able to enhance and accelerate the healing process and reduce the bacterial load, this case report aimed to describe the use of the above-mentioned therapies to treat palatal ulcers occurring during orthodontic expansion. Case Report: The patient, a 10-year-old boy, with a chief complaint of bleeding and continuous pain in the region of his expander was verified on a follow-up visit. After a dental examination, the expander was removed and two necrotic lesions which were in contact with the acrylic part of the tooth-tissue expander were found in the palatal region. The proposal was to use one aPDT session with methylene blue followed by 4 sessions of PBMT with a red laser diode. On the 5th day, reorganized tissue was verified, with the absence of bleeding, swelling, and pain. On the 20th day of follow-up, the area showed no signs of inflammation, healthy tissue without any pathological clinical symptoms, and complete wound healing. Conclusion: The concomitant use of PBMT and aPDT therapies may be considered feasible as an adjunct treatment to manage palatal ulcers resulting from the incorrect use of tooth-tissue types of expanders

Autophagy and Apoptosis Induced in U87 MG Glioblastoma Cells by Hypericin-Mediated Photodynamic Therapy Can Be Photobiomodulated with 808 nm Light

“…As mentioned in the introduction, PBM has already been used in combination with PDT, but the aim of PBM application was to heal the treated area [ 34 , 35 ]. Enhancement of endogenous protoporphyrin IX production and homogenization in U87 MG cells by PBM has recently been addressed as a promising protocol for PDT and photodiagnostics [ 51 ].…”

“…PBM at 660 nm was used to treat oral mucosa in combination with curcumin-mediated PDT at 468 nm [ 34 ]. For example, antimicrobial PDT with methylene blue and PBM has been used to improve and accelerate the healing process in the treatment of palatal ulcers [ 35 ]. The combination of PBM and PDT has even been proposed as an innovative approach for COVID-19 treatments [ 36 ].…”

Photobiomodulation (PBMT) and Antimicrobial Photodynamic Therapy (aPDT) In Oral Manifestations of Patients Infected by SARS-CoV-2: Systematic Review and Meta-Analysis

“…27.28 Teixeira, Ramires and Garcez 23,24,25 implemented associative protocols between the PBMT and aPDT techniques, and observed relief of painful symptoms in the first 24 hours and healing of the lesion within 4 days, in accordance with the findings of Maya (2020) for the treatment of palatal ulcers. 29 In the observational evaluation criteria of the 5 articles in question, it is important to emphasize that oral lesions appeared in these patients positive by Covid-19, concomitantly with loss of taste and smell, worsening of Covid-19 symptoms and were more severe in people older and systemically compromised.…”

Advances in photosensitizer-related design for photodynamic therapy

“…For the same reasons, PDT also has the potential to treat other infections by drug-resistant bacteria. A clinical report of Florence Institute of Superior Teaching describes a case of palatal ulcer that is not sensitive to antibiotics but responds well to PDT and photobioregulation therapy (PBMT) [72] . The results show that the combination of PDT and PBMT were able to enhance and accelerate the healing process and reduce the number of bacteria.…”

“… Cutaneous Leishmaniasis caused by parasite L. amazonensis Visible light [68] NE-CUR A NE-CUR has devised which enhances performance of curcumin in PDT against vulvar intraepithelial neoplasia induced by HPV. Intraepithelial neoplasia of vulva caused by HPV infection Operating at 447±10 nm [ 69 , 70 ] 5-ALA An effective 5-ALA based PDT system to treat MRSA infected wounds of diabetic mice, PDT kills bacteria with a mechanism that is different from antibiotics Infection caused by drug-resistant bacteria such as MRSA-infected diabetic wounds 635 nm irradiation [71] Methylene blue A clinical report describes a case of palatal ulcer that is not sensitive to antibiotics but responds well to PDT and PBMT Palatal ulcer 660 nm-light irradiation [72] 5-ALA with MN A clinical trial involving 41 AA patients, most of the patients treated with this PDT approach showed reduced severity of their symptoms Immune-mediated disorder such as AA 630 nm irradiation [73] …”