Photobiomodulation (PBM) / Low Level Laser Therapy (LLLT) reduces severity and duration of oral mucositis, and can be used for prevention.
The effect of photobiomodulation (PBM) therapy (previously known as Low Level Laser Therapy or LLLT) on oral mucositis (by laser or LED) has been reported in 32 randomised controlled clinical trials. These includes patients undergoing chemotherapy, radiotherapy or haematopoietic stem cell transplantation (HSCT) in both pediatric and and adult populations. Most of the studies are therapeutic (treating symptoms) but some clinical trials have shown that treatment concurrent with cancer therapies can be preventative.
PHOTOBIOMODULATION / LLLT IS HELPFUL FOR:
- Oral mucositis
- Hyposalivation and xerostomia
OTHER EMERGING APPLICATIONS
- Radiation dermatitis
- Pain control
CLINICAL TRIAL CONCLUSIONS
"Our results have indicated that the use of low power laser in HSCT patients is a powerful instrument in the treatment of overt OM and is now a standard procedure in this group of patients in our hospital."
Antunes HS, Ferreira EM, de Matos VD, Pinheiro CT, Ferreira CG
"The ease of use of LLLT, high patient acceptance, and the positive results achieved, make this therapy feasible for the prevention and treatment of OM in young patients."
Abramoff MM, Lopes NN, Lopes LA, Dib LL, Guilherme A, Caran EM, Barreto AD, Lee ML, Petrilli AS
"There is consistent evidence from small high-quality studies that red and infrared LLLT can partly prevent development of cancer therapy-induced OM. LLLT also signiﬁcantly reduced pain, severity and duration of symptoms in patients with cancer therapy-induced OM."
Bjordal JM, Bensadoun RJ, Tuner J, Frigo L, Gjerde K, Lopes-Martins RA
"Our results indicate that the use of upfront low power laser in patients who have undergone HSCT is a powerful instrument in reducing the incidence of OM and is now standard in our center."
Antunes HS, de Azevedo AM, da Silva Bouzas LF, Adao CA, Pinheiro CT, Mayhe R, Pinheiro LH, Azevedo R, D'Aiuto de Matos V, Rodrigues PC, Small IA, Zangaro RA, Ferreira CG
"Laser therapy was effective in preventing and treating oral effects induced by radiotherapy and chemotherapy, thus improving the patient's quality of life."
Zanin T, Zanin F, Carvalhosa AA, de Souza Castro PH, Pacheco MT, Zanin IC, Junior AB
Are you a patient? Pass these documents on to your Oncologist
- Download our 'PBM Therapy / LLLT oral mucositis research (PDF)'
- Download our 'PBM Therapy / LLLT radiation dermatitis research (PDF)'
- Download our 'PBM Therapy / LLLT xerostomia, hyposalivation or saliva research (PDF)'
What is PBM Therapy / LLLT ?
Photobiomodulation (PBM) therapy, (previously known as Low Level Laser Therapy or LLLT) is the application of light to tissues to reduce inflammation and improve healing. It works by increasing cellular energy (ATP) and reducing free radicals (oxidative stress). There are over 400 randomised controlled clinical trials published on PBM Therapy / LLLT for a wide range of painful and non healing applications including 32 controlled clinical trials on oral mucositis.
How PBM Therapy / LLLT works
One of the main effects of PBM Therapy / LLLT is on mitochondrial function: There are hundreds of different cell types in the body, each performing different functions, they all contain lots of mitochondria, (cellular power plants) which generate most of the cell's supply of energy (ATP). Mitochondria are also involved in a range of other cellular processes, including signalling, stem cell differentiation, inflammation, cell survival, apoptosis and are consequently implicated in many diseases.
Mitochondria in stressed or ischaemic tissues produce too much mitochondrial nitric oxide (mtNO) which binds to cytochrome c oxidase, competitively displacing oxygen and consequently reducing ATP, but this inhibition of mitochondrial respiration significantly increases production of ROS (free radicals). These excess ROS trigger the process of inflammation, cell death and subsequently oral mucositis.
Light of the correct wavelength (generated by low intensity lasers and LED's), when applied to stressed tissues, is absorbed by cytochrome c oxidase. The light displaces the mtNO thereby reducing oxidative stress and increasing ATP production; this reduces inflammation and increases cell metabolism.
The subsequent cascade of downstream metabolic effects have been shown to include changes in gene transcription (NF-kB and AP-1), activation of latent TGF-β1, increased exchange of Ca2+, secretion of growth factors, activation of enzymes & many secondary messengers.
Within hours (and sometimes minutes) following PBM Therapy / LLLT, increases in cellular activity have been shown in vitro and in vivo in neutrophils, macrophages, fibroblasts, mast cells, endothelial cells and keratinocytes. Reduced inflammatory markers including prostaglandin E2, interleukin 1ß and TNFα have also been seen in many studies.
Clinical trials show a significant improvement in healing of wounds and reduction of pain. A recent systematic review on PBM Therapy / LLLT for OM found that it reduces pain, severity and duration of chemotherapy and radiotherapy induced oral mucositis.
The Multinational Association of Supportive Care in Cancer (MASCC) now recommend PBM Therapy / LLLT for the prevention of oral mucositis in adult patients receiving hematopoietic stem cell transplantation conditioned with high-dose chemotherapy. A new suggestion was made for low-level laser for the prevention of oral mucositis in patients undergoing radiotherapy, without concomitant chemotherapy, for head and neck cancer.
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Annette Quinn - Oral Mucositis Academy of Laser Dentistry 2016 View it on YouTube
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