The effect of low level laser therapy in different wavelengths in the treatment of oral mucositis—proposal for extra-oral implementation

Abstract

The oral mucositis is the most frequent acute oral complication resulting from antineoplastic treatment and may worsen the clinical condition of the patient and interfere with his/her quality of life. This study aimed to comparatively evaluate, from a clinical point of view, the effect of Laser Therapy λ660 nm (wavelength of the red Laser) and λ830 nm (wavelength of the infrared Laser), at extra oral points, in remis sion of severity of oral mucositis and pain associated with it in pediatric oncological patients undergoing che motherapy with the anticancer drug methotrexate, noting which of the two wavelength is the most appropri ate to this new technique. The sample consisted of 13 patients placed at random in each group and subjected to sessions of Low Level Laser Therapy, at pre determined extra oral points for five consecutive days, starting at the beginning of the observation of mucositis injuries. It became possible to note that from the group of patients in the group of Laser λ830 nm (n = 6; 46.15%), four (n = 4; 66.67%) of these patients had remission of injuries to grade 0 (WHO), and as for pain, five patients (n = 5; 83.33%) showed no painful symptoms for mucositis injuries. In the Laser λ660 nm group (n = 7; 53.85%), only two patients (n = 2; 28.57%) achieved a regression of lesions to grade 0 (WHO), while four patients (n = 4; 57.14%) had no pain. So, the extra oral application of Laser Therapy was effective in treating injuries of oral mucositis in the patients treated; and Laser Therapy in the infrared spectrum (λ830 nm) was more effective in the treatment of oral mucositis inju ries compared to the red spectrum (λ660 nm), which can be explained by the greater power of penetration of infrared rays, acting in a more expressive way in deeper places.

Management of oral mucositis

“…While some reports indicate positive effects of chlorhexidine mouth rinse on oral mucositis, recent studies have found either no effect or even negative effects. The bitter taste, dental pigmentation, dysgeusia, and unpleasant sensation experienced together with ineffectiveness provide sufficient reasons for recommending an alternative to the chlorhexidine mouthwash (41,42).…”

Laser de baixa potência na terapêutica da mucosite oral em pacientes após tratamento de neoplasias de cabeça e pescoço: estudo retrospectivo

“…interromper o tratamento antineoplásico. Proporciona alívio da dor, maior conforto ao paciente, controle da inflamação, manutenção da integridade da mucosa, melhor reparação tecidual, obtendo repostas positivas do ponto de vista clínico e funcional; melhorando a qualidade de vida dos pacientes durante o tratamento oncológico (Barash et al, 1995;Cowen et al, 1997;Bensadoun et al, 1999;Bensadoun et al, 2001;Sandoval et al, 2003;Catão, 2004;Nes;Posso, 2005;Maiya et al, 2006;Bensadoun, 2006;Lopes et al, 2006;Schubert et al, 2007;Abramoff et al, 2008;Arora et al, 2008;Klastersky et al, 2008;Campos et al, 2009;Khouri et al, 2009;Kuhn et al, 2009;Moraes et al, 2009;Simões et al, 2009a;Simões et al, 2009b;Zanin et al, 2010). (Catão, 2004apud Veçoso 1 , 1993.…”

“…xerostomia (Cowen et al, 1997;Bensadoun et al, 1999;Sandoval et al, 2003;Catão, 2004;Nes e Posso, 2005;Bensadoun, 2006;Kelner;Castro, 2006;Lopes et al, 2006;Maiya et al, 2006;Schubert et al, 2007;Abramoff et al, 2008;Arora et al, 2008;Bicudo et al, 2008;Klastersky et al, 2008;Campos et al, 2009;Ferreira et al, 2009;Khouri et al, 2009;Kuhn et al, 2009;Moraes et al, 2009;Simões et al, 2009a;Simões et al, 2009b;Zanin et al, 2010).…”

“…A mucosite oral decorrente de RT, QT ou mesmo de transplantes possui características e fases de progressão semelhantes. A laserterapia de baixa potência tem se mostrado importante para o tratamento dessas lesões independente dos fatores predisponentes (Barash et al, 1995;Cowen et al, 1997;Bensadoun et al, 1999;Sandoval et al, 2003;Nes;Posso, 2005;Lopes et al, 2006;Maiya et al, 2006;Kelner;Castro, 2007;Schubert et al, 2007;Klastersky et al, 2008;Arora et al, 2008;Abramoff et al, 2009;Bicudo et al, 2008;Campos et al, 2009;Khouri et al, 2009;Kuhn et al, 2009;Moraes et al, 2009;Simões et al, 2009a;Simões et al, 2009b;Zanin et al, 2010). Barash et al (1995) (Barash et al, 1995;Cowen et al, 1997;Bensadoun et al, 1999;Sandoval et al, 2003;Nes;Posso, 2005;Maiya;Fernandes, 2005;Kelner;Castro, 2006;Lopes et al, 2006;Schubert et al, 2007;Abramoff et al, 2008;Arora et al, 2008;Khouri et al, 2009, Kuhn et al, 2009Moraes et al, 2009)...…”

“…Barash et al (1995) (Barash et al, 1995;Cowen et al, 1997;Bensadoun et al, 1999;Sandoval et al, 2003;Nes;Posso, 2005;Maiya;Fernandes, 2005;Kelner;Castro, 2006;Lopes et al, 2006;Schubert et al, 2007;Abramoff et al, 2008;Arora et al, 2008;Khouri et al, 2009, Kuhn et al, 2009Moraes et al, 2009) e os demais três vezes por semana (Klastersky et al, 2008;Campos et al, 2009;Simões et al, 2009a;Zanin et al, 2010), como aquele estabelecido pelo LELO. Concordando com outros autores (Barash et al, 1995;Cowen et al, 1997;Bensadoun et al, 1999;Sandoval et al, 2003;Nes;Posso, 2005;Lopes et al, 2006;Maiya et al, 2006;Kelner;Castro, 2007;Schubert et al, 2007;Abramoff et al, 2008;Arora et al, 2008;Bicudo et al, 2008;Klastersky et al, 2008;Campos et al, 2009;Khouri et al, 2009;Kuhn et al, 2009;Moraes et al, 2009;Simões et al, 2009a;…”