AIMS:Osteoradionecrosis (ORN) is a severe late complication of head and neck radiotherapy, often refractory to conventional treatment. Photobiomodulation therapy (PBMT) and photodynamic therapy (PDT) have shown regenerative, analgesic, and antimicrobial effects. This report aims to describe the non-invasive management of extensive mandibular ORN with intra- and extraoral fistulas using a combined PBMT-PDT protocol. CASE REPORT:A 72-year-old man previously treated with chemoradiation for laryngeal carcinoma developed chronic mandibular ORN after third molar extraction, complicated by a pathologic fracture, persistent suppuration, and failure of surgery, hyperbaric oxygen, antibiotics, and curettage. Clinical evaluation revealed intra- and extraoral suppurative fistulas and radiographic bone sequestration. A conservative regimen was initiated, consisting of weekly PBMT and PDT sessions following chlorhexidine irrigation. Over approximately one year (50 sessions), the patient reported progressive pain relief and reduced analgesic use. Complete closure of both fistulas was achieved, with recovery of soft-tissue sensitivity and radiographic resolution of sequestration. No adverse effects occurred, and the planned surgical debridement was canceled. CONCLUSION:Combined PBMT and PDT promoted complete resolution of extensive, refractory mandibular ORN using a fully non-invasive approach. This case highlights the synergistic potential of dual phototherapy as a safe and effective alternative when surgery is contraindicated or declined. Further studies are warranted to clarify underlying mechanisms and optimize treatment parameters.

Chronic graft vs host disease (cGVHD) is a complication associated with allogeneic hematopoietic stem cell transplantation (HSCT) that often affects the oral mucosa, causing lesions and pain. Antimicrobial photodynamic therapy (aPDT) has been proposed as a treatment for managing oral cGVHD lesions, potentially improving prognosis and leading to symptom remission. This paper presents a novel case of pediatric oral cGVHD lesions successfully treated with aPDT, alongside oral hygiene instructions and topical corticosteroid therapy. Following four sessions of aPDT, the patient reported alleviation of pain symptoms, and after ten sessions, ulcerated/erosive lesions resolved completely, with no recurrence of pain. In conclusion, in this case, aPDT was shown to be an effective adjuvant therapy for managing cGVHD lesions. This highlights the potential of aPDT as a valuable addition to the treatment regimen for oral manifestations of cGVHD, offering a promising avenue for improving patient outcomes in these cases.

This review aimed to determine whether photobiomodulation therapy (PBMT) is a safe and effective alternative for treating and preventing OM in children. The database search was carried out on PubMed, Embase, and Cochrane. Gray literature was also consulted through Google Scholar. Among 20 studies included, no adverse effect was reported, and only one study did not show any evidence of benefit from the use of PBMT. The analgesic effect of PBMT was emphasized and its action in accelerating the healing process and reducing the severity, duration and even incidence of OM was also noted. Evidence was found to encourage the use of PBMT to treat OM in pediatric patients. Higher quality studies must be developed in order to clarify the PBMT prophylactic effect and the best protocols for each clinical situation. The protocol of this review was registered on PROSPERO (CRD42023418109).

The association of more than one wavelength for photobiomodulation therapy (PBMT) to treat oral mucositis (OM) is unusual in the literature. Thus, this study aims to compare the simultaneous irradiation effects with their isolated application to treat OM. In order of that, 48 male Syrian hamsters were divided into 4 groups: Chemotherapy (Ch), which received only a OM induction protocol (5-fluorouracil chemotherapy and superficial oral mucosa scratches); red laser (RL), which received the OM induction and a PBMT protocol at 660 nm; infrared laser (IRL), which received the OM induction, and a PBMT protocol at 808 nm; and the RL + IRL group, which received the simultaneous application, of 660 and 808 nm wavelengths. Clinical (OM grade classification), histological (light microscopy analysis with H&E and collagen staining), immunohistochemical (TNF-α expression), and biochemical (TNF-α and hydroxyproline concentration) analyzes were performed after 7 and 10 days. Mainly on the 10th day, the RL and IRL groups showed lower OM grades and faster microscopic repair process, with greater expression of collagen fibers and lower TNF-α levels, besides the higher hydroxyproline concentrations, mainly in comparison with the Ch group. In conclusion, in this study, the simultaneous protocol did not present superior results than the isolated irradiations.

OBJECTIVES:The aim of this study was to analyze the effects of three different Photobiomodulation Therapy (PBMT) protocols in the treatment of 5-fluorouracil-induced oral mucositis in hamsters. DESIGN:60 hamsters were divided into five groups: group "C", which did not receive oral mucosa scratching, 5-fluorouracil (5-FU) or PBMT; group "Ch", which received anesthesia, superficial oral mucosa scratching and 5-FU (oral mucositis induction); and three groups that received oral mucositis induction and a PBMT protocol: groups ChLI, ChLII and ChLIII that received 0.24 J (one point), 1 J (one point) and 1.2 J (five points of 0.24 J) of energy, respectively. The laser equipment used had λ = 660 nm and 0.04 cm2 of spot area (0.226 cm diameter). The animals were euthanized on days 7 and 10 of the experiment, and their oral mucosas were removed for histological (light microscopy and collagen staining), immunohistochemical (NF-kB and TNF-α), and biochemical (TNF-α, NF-kB and hydroxyproline) analysis. RESULTS:Group ChLI (less energy), showed the most accelerated repair rates and a lower concentration of inflammatory biomarkers than group Ch. Comparing the three PBMT protocols for treatment of 5-FU-induced oral mucositis in hamsters, the one with low energy (0.24 J) showed better results, regarding reduction of inflammatory biomarkers and tissue repair, than the ones with higher energy (1 and 1.2 J).

Candida albicans is an opportunistic yeast of the oral microbiome which can cause candidiasis in systemically susceptible individuals, such as those undergoing cancer treatment. The local management of the oral lesions is challenging and may be significantly improved with photodynamic therapy (PDT). PDT consists of an association of light with a photosensitizing agent and oxygen, whose interaction produces reactive oxygen species capable of reducing non-specific microbial contamination without causing side effects. This study aimed to report a case in which oral candidiasis was managed with PDT. A 12-year-old male patient undergoing head and neck radiotherapy (HNRT) for Undifferentiated Mesenchymal Neoplasm presented with dysgeusia, oral pain, and yeast infection on the 13th session of HNRT. The patient used topical antifungals for 30 consecutive days with no lesion or symptom remission. PDT was then proposed and the lesion was healed after a single PDT session, with no further clinical signs of infection and return to normal oral function. Local and non-invasive management of oral candidiasis is of utmost importance for immunocompromised patients, with good acceptability, no systemic side effects, and no drug interactions.

Scurvy is a vitamin deficiency historically associated with pirates and sailors that affects collagen synthesis, leading to hemorrhage, skin, and oral lesions. In the 18th century, the lack of consumption of foods rich in vitamin C was found to cause such a severe condition, whose early diagnosis increases the likelihood of a better prognosis. A 58-year-old female patient complained of fatigue, body pain, and gingival bleeding for nearly 24 months. In 2001, she was diagnosed with lupus, now in remission, and osteoporosis more recently. On clinical examination, gingivitis with spontaneous bleeding was observed, despite the patient’s good hygiene, as well as some petechiae over the body. Due to the hypothesis of a possible autoimmune dermatological disease, the patient was referred to a dermatologist, who requested a series of tests, including vitamin C dosage. The results showed a concentration below 0.25mg / dL (IR, 4 to 2.0 mg / dL), and thus the diagnosis of scurvy was established. The patient was administered vitamin C replacement and in about 3 months, the symptoms started to improve. In some cases, such as this, hospitalization is required for intravenous replacement due to bleeding risks. This case report highlights the importance of the dentist in the early diagnosis and treatment of scurvy. This condition causes oral lesions that are often confused with other more common conditions, such as gingivitis or autoimmune dermatological response. Therefore, we recommend a comprehensive physical examination and anamnesis, including dietary history.

Introduction: Oral mucositis (OM) has been considered one of the most feared collateral effects of oncological treatments. Some therapies have been used, such as light-emitting diode (LED), with promising results, but with no sufficient evidence in the literature.Objective: Our study aimed to evaluate, by clinical and histological analysis, the effect of LED on the treatment of chemotherapy-induced OM (CIOM) in an animal model.Methods: Twenty male hamsters were equally distributed to two groups: control (C), which received anesthesia and CIOM induction; and LED (L), which received anesthesia, CIOM induction, and LED treatment (635 nm, 120 mW, 0.48 J). The clinical analysis was performed through two specific scales for OM analysis on days 5, 7 and 10 of the experiment. In addition, the injured area of all hamsters check pouch mucosa was removed and processed for histological analysis on the last experimental day.Results: After statistical analysis, group L showed less severity of OM when compared with the C group (P < 0.05); beyond that, both healed completely on day 10.Conclusion: Our results suggested that the phototherapy with LED had a positive effect on accelerating repair, reducing the severity of CIOM.

Neutropenic ulcers are characterized by regular margins with a yellowish membrane, and are usually associated with severe pain and signs of inflammation due to opportunistic infections. Considering the immunosuppressed condition of these patients, local management of these lesions is a challenge. Antimicrobial photodynamic therapy (aPDT) is the association of light, which can be a low-power laser, with a photosensitizing agent and oxygen, whose synergy produces reactive oxygen species capable of reducing non-specific microbial contamination without causing side effects. The aim of this paper is to report a case of oral neutropenic ulcer treated with aPDT. A 50-year-old diabetic woman undergoing breast cancer treatment, presented with a malodorous malodorous and painful ulcer, which limited her basic oral functions. It was located in the maxillary alveolar ridge in the left first upper molar region and did not present bone involvement. Blood tests showed grade 2 of neutropenia. Thus, conservative treatment with aPDT technique was proposed. After one week, the lesion showed an improvement and pain had halved. The region was totally healed after three weeks. Local and noninvasive management of these lesions is of utmost importance for immunosuppressed patients, because it avoids systemic side effects and bacterial resistance resulting from overuse of antibiotics.

Background. Dental implants are used to rehabilitate missing teeth, and despite high success rates, failures are inevitable. Ostensibly avoidable human errors in planning or technique can contribute to implant failure. Case presentation. Herein, we report a case of an unsuccessful dental implant surgery due to an inadequate surgical technique and bone exposure in a 54-year-old healthy woman. Conclusions. This report underscores the relevance of reporting the consequences of these human factors, such as loss of the implant, alveolar bone segment, and three teeth.

Antecedentes: Algunos estudios han demostrado que el uso profilactico de cloruro de betanecol (CB) puede ser util para prevenir la incidencia y/o gravedad de la xerostomia (XT). Sin embargo, la indicacion de CB en pacientes irradiados con XT necesita ser mejor caracterizada. El objetivo del estudio fue evaluar la influencia de CB en XT, flujo salival y composicion salivar en pacientes previamente sometidos a radioterapia de cabeza y cuello. Materiales y Metodos: Cuarenta y cinco pacientes irradiados que refirieron XT usaron 50mg/dia de CB durante tres meses, y los parametros salivales fueron evaluados en 4 Fases (antes del tratamiento CB, despues de un mes de CB, 2 meses de CB y 3 meses de CB). El analisis bioquimico incluyo capacidad tampon o buffer; pH; concentracion proteinas totales (PT); concentracion de amilasa (AM); catalasa (CAT) y peroxidasa (PX). Ademas, se determino el flujo de tasa salival no estimulada y estimulada, y se clasifico la XT. Resultados: Segun el sistema de clasificacion de XT utilizado, los pacientes mostraron mejoria en XT entre la fase 1 la fase 2, y entre 3 y 4. Ademas, se observaron algunos cambios en la concentracion de PT (disminucion); concentracion de AM (aumentada); y actividad de PX Y CAT (disminuido y aumentado, respectivamente) despues de la fase 2, para la recogida estimulada de saliva (p<0.05). Conclusiones: Nuestros resultados sugirieron que cuando CB se uso para tratar la disfuncion de las glandulas salivales inducida por radioterapia de cabeza y cuello, se mostraron mejoras en los sintomas de XT y algunos cambios en la composicion de la saliva.

Oral mucositis (OM) is a debilitating consequence of cancer treatment that could be treated with photobiomodulation therapy (PBMT); however, there is no consensus about its dosimetric parameters for OM healing. The aim of this study was to compare different PBMT protocols on OM treatment, through clinical and histological analysis. Thirty hamsters were used, in an induced model of OM by 5-fluorouracil (5-FU) and superficial scratching, in seven days of follow-up. The animals were divided into five groups: control (C), which received only anesthesia and chemotherapeutic vehicle; chemotherapy (Ch), which received anesthesia, 5-FU, and scratches; laser 1 (L1), the same as Ch group, PBMT 6 ?? J / c m 2 and 0.24 J (one point); laser 2 (L2), the same as Ch group, PBMT 25 ?? J / c m 2 and 1 J (one point); and laser 3 (L3), the same as Ch group, PBMT 4 points of 0.24 J and 6 ?? J / c m 2 each. The laser used has ? = 660 ?? nm , 0.04 ?? c m 2 of spot area, and 40 mW. The best PBMT protocol to maintain lowest OM levels compared to Ch group was L1, followed by L2 and L3. Our results suggest that the application mode of PBMT and the energy delivered per area could interfere with the OM healing.

BACKGROUND:Some studies have shown evidence that the prophylactic use of bethanechol chloride (BC) may be useful in preventing the incidence and/or severity of xerostomia (XT). However, the indication of BC in irradiated patients with XT needs to be better characterized. The study aimed to evaluate the influence of BC on XT, salivary flow rate, and salivary composition in patients previously submitted to head and neck radiotherapy.MATERIAL AND METHODS:Forty five irradiated patients complaining of XT used 50 mg/day of BC for 3 months, and the salivary parameters were evaluated in 4 Phases (Before BC therapy, after one month of BC, 2 months of BC, and 3 months of BC). Biochemical analysis included buffering capacity; pH; total protein concentration (TP); amylase concentration (AM); catalase (CAT) and peroxidase (PX) activities. In addition, unstimulated and stimulated salivary flow rates were determined and XT was classified.RESULTS:According to the XT grading system used, patients showed improvement in XT between Phase 1, and Phases 2, 3 and 4. In addition, some changes were observed in TP concentration (decreased); AM concentration (increased); and PX and CAT activities (decreased and increased, respectively) after Phase 2, for stimulated saliva collection (p<0.05).CONCLUSIONS:Our results suggested that when BC was used to treat salivary gland dysfunction induced by head and neck radiotherapy, improvement in XT symptoms, and some changes in saliva composition were shown.

To evaluate the effects of bethanechol chloride (BC) in irradiated patients and its influence on the saliva composition.

Nothing in life is to be feared, it is only to be understood.Now is the time to understand more,

Cotomacio, CC.Wound healing process regarding different photobiomodulation therapy protocols to treat oral lesions induced or not by 5-FU in hamsters [thesis].São Paulo: Universidade de São Paulo, Faculdade de Odontologia; 2020.Versão Corrigida.Oral lesions cause discomfort and increase the susceptibility to infections, impairing people quality of life.Oral mucositis (OM), a type of these lesions, is one of the most debilitating side effects of cancer treatment, and It can also be responsible for treatment interruption, which increases patient's morbidity and mortality.5-Fluorouracil (5-FU) is an antimetabolic chemotherapy drug that inhibits cellular mitosis.It is one of the most stomatotoxic of its category, and it is able to cause OM.The Photobiomodulation Therapy (PBMT) with low-level laser has been widely used for the treatment and prevention of these oral lesions.However, there is no consensus in the literature about the best irradiation protocol, the inflammatory modulation process ability, and the tissue repair induction.Thus, the aim of this study was to analyze the repair process of oral lesions in either the presence or absence of 5-FU, as well as the PBMT effect, using different protocols in the treatment of those lesions.In order of that, 108 hamsters were used: some of them had OM induced by the combination of 5-FU and scratches, while others received just scratches.The animals were separated into nine groups: one group "C", which received just anesthesia and chemotherapeutic vehicle; four "S" groups (one control and three laser protocols), which received anesthesia, chemotherapeutic vehicle and oral mucosa superficial scratching; four "Ch! groups (one control and three laser protocols), which received anesthesia, oral mucosa superficial scratching and 5-FU.The groups which received laser were divided as follows: S and Ch LI groups received PBMT 6 J/cm2/0,24 J; S and Ch LII groups, received PBMT 25 J/cm2/1 J; and S and Ch LIII groups received PBMT 6 J/cm2/ 1,2 J.The laser equipment used had λ = 660 nm and 0.04 cm² of spot area.The animals were euthanized after 7 and 10 days of experiment, and their oral mucosa were removed for histological (light microscopy and collagen staining), immunohistochemical (NF-kB and TNF-α) and biochemical (TNF-α, NF-kB and hydroxyproline) analysis.The most evident influence of PMBT action occurred between the groups that received OM induced by chemotherapy and scratches.In group ChLI (less energy) there were found accelerated repair rates and a lower concentration of inflammatory indicators comparing to group Ch.Regarding S groups, the group which received less energy also presented decreased inflammatory indicators.In that way, the presence of chemotherapeutic enhance the PBMT effect and less energy protocols seemed to accelerate tissue repair and modulate the inflammatory response.