Karen Müller Ramalho

Laser treatment of recurrent herpes labialis: a literature review

Recurrent herpes labialis is a worldwide life-long oral health problem that remains unsolved. It affects approximately one third of the world population and causes frequent pain and discomfort episodes, as well as social restriction due to its compromise of esthetic features. In addition, the available antiviral drugs have not been successful in completely eliminating the virus and its recurrence. Currently, different kinds of laser treatment and different protocols have been proposed for the management of recurrent herpes labialis. Therefore, the aim of the present article was to review the literature regarding the effects of laser irradiation on recurrent herpes labialis and to identify the indications and most successful clinical protocols. The literature was searched with the aim of identifying the effects on healing time, pain relief, duration of viral shedding, viral inactivation, and interval of recurrence. According to the literature, none of the laser treatment modalities is able to completely eliminate the virus and its recurrence. However, laser phototherapy appears to strongly decrease pain and the interval of recurrences without causing any side effects. Photodynamic therapy can be helpful in reducing viral titer in the vesicle phase, and high-power lasers may be useful to drain vesicles. The main advantages of the laser treatment appear to be the absence of side effects and drug interactions, which are especially helpful for older and immunocompromised patients. Although these results indicate a potential beneficial use for lasers in the management of recurrent herpes labialis, they are based on limited published clinical trials and case reports. The literature still lacks double-blind controlled clinical trials verifying these effects and such trials should be the focus of future research.

Prevention of recurrent herpes labialis outbreaks through low-intensity laser therapy: a clinical protocol with 3-year follow-up

IntroductionThe recurrent herpes labialis (RHL) is a chronic lifelonginfection that affects a great part of the world’s population.It is caused by the herpes simplex virus type 1 (HSV 1) [1].The first virus contact causes the primary infection, whichis characterized by symptoms like multiple oral vesicles,fever, chills, fatigue, and muscle aches, lasting for 10 to14 days [2]. In general, primary infection is more severethan recurrences and is more commonly observed inchildren, teenagers, and young adults [3].After the primary infection and resolution of the lesions,the virus moves through the nerve endings and establishes alatent state at sensory ganglia, most commonly thetrigeminal ganglion. The exposition of the host to severalkinds of stress causes virus reactivation and migrationthrough sensory nerves to skin and mucosa, achieving thebasal epithelium of the lips and perioral area. Replication ofthe virus at these sites takes place and initiates a clinicalepisode of recurrent herpes labialis [4]. During theseepisodes, most of the clinical symptoms such as pain,redness, and swelling are consequences of the anti-inflammatory response generated by the immune systemof the host [5]. Thus, it is well known that patients withrecurrent herpes simplex infections have two concomitantmedical problems: virus multiplication and the overreactingimmune system [5].The virus reactivation may be triggered by fever, sunexposure, menstruation, psychological stress, or physicaltrauma. Afterwards, recurrent herpes labialis infection willmanifest clinically in different stages [6, 7]. The “coldsores” are the visible sign of RHL orofacial outbreaks andappear most frequently on the lips, at the juncture of themucous membrane, and perioral skin or inside the nose [8,9]. Up to 60% of the patients will experience a prodromicstage, after which the cold sores outbreaks develop through

Use of laser phototherapy on a delayed wound healing of oral mucosa previously submitted to radiotherapy: case report

Radiotherapy produces both acute and delayed effects on mucosal tissues, disturbing their healing. This report shows a successful treatment with laser phototherapy (LPT) on a delayed wound healing in oral mucosa previously submitted to radiotherapy with a follow up of 3 years. A 47‐year‐old patient treated 6 months earlier for tongue squamous cell carcinoma by surgery and radiotherapy presented with a mass in the operated area. Biopsy showed chronic inflammatory infiltrate around a residual polyglactin suture. After 2 months there was a painful mucosal dehiscence on the biopsy site. LPT was performed using a semiconductor laser with 660‐nm wavelength (InGaAlP) and spot size of 0·04 cm2. The parameters applied were 40 mW, 4 Jcm2/point, 0·16 J/point, 2·4 J/session. The irradiation was performed punctually, through contact mode in 15 points (4 seconds/point), on top of and around the lesion, during ten sessions. The wound healed completely after ten sessions. This treatment proved to be conservative and effective, inducing healing of a chronic wound in a tissue previously submitted to radiotherapy.

Lasers in Esthetic Dentistry: Soft Tissue Photobiomodulation, Hard Tissue Decontamination, and Ceramics Conditioning

The increasing concern and the search for conservative dental treatments have resulted in the development of several new technologies. Low and high power lasers can be cited as one of these new technologies. Low power lasers act at cellular level leading to pain reduction, modulation of inflammation, and improvement of tissue healing. High power lasers act by increasing temperature and have the potential to promote microbial reduction and ablation of hard and soft tissues. The clinical application of both low and high power lasers requires specific knowledge concerning laser interaction with biological tissues, so that the correct irradiation protocol can be established. The present case report describes the clinical steps of two metal-ceramic crowns development in a 60-year-old patient. Three different laser wavelengths were applied throughout the treatment with different purposes: Nd:YAG laser (1,064 nm) for dentin decontamination, diode (660 nm) for soft tissue biomodulation, and Er:YAG laser (2,940 nm) for inner ceramic surface conditioning. Lasers were successfully applied in the present case report as coadjutant in the treatment. This coadjutant technology can be a potential tool to assist treatment to reach the final success.

Treatment of herpes simplex labialis in macule and vesicle phases with photodynamic therapy. Report of two cases.

a Integrated Clinic Discipline, Department of Stomatology, School of Dentistry, University of Sao Paulo (USP), 05508-000 Sao Paulo, SP, Brazil b Special Laboratory of Lasers in Dentistry (LELO), Department of Restorative Dentistry, School of Dentistry — University of Sao Paulo (USP), 05508-000 Sao Paulo, SP, Brazil c Department of Biomaterials and Oral Biology, School of Dentistry, University of Sao Paulo (SSP), 05508-000 Sao Paulo, SP, Brazil Available online 10 March 2015