Laser therapy


What is the role of low-level laser in the treatment of dentine hypersensitivity and how the applications should be made?

Analgesic and anti-inflammatory - 3 sessions and wait 30 days.

It is necessary to clean the tip of the active low-intensity laser? Some protection method can be used? What are the dangers for the patient?

Disinfection with alcohol.

Using PVC film (magipack).

Low level laser eye protection only.

There are contraindications to the use of low-intensity lasers?

I do not believe in contraindications of laser therapy because there is no scientific studies that point damage to tissues. However, we observe some situations where the use of laser therapy to be more careful. Among these are:

1. Patients with disorders of the thyroid gland: Avoid radiate directly on the gland;

2. Pregnant patients: Although there is no record of harmful effects on the mother should avoid radiate directly on the fetus. In any event, any procedure that is not extremely necessary to be performed in the pregnant woman should be avoided, particularly in the first and last trimester of pregnancy.

3. Patients with malignant tumors of the oral cavity: radiation should be avoided in areas occupied by tumor cells because studies have pointed to the Laser stimulation of cell growth.

Being a form of laser light radiation that operates at ranges of wavelength harmless to cells, having no ionizing action, the most important is that the professional knows to apply it in appropriate doses in each case, not forgetting to apply biosafety standards.

What efficiency assisted mode present in some equipment of low intensity lasers available on the market?

Every professional who wants to make use of laser therapy effectively and prudently, in search of satisfactory results with their patients, he should be in possession of knowledge about radiation Laser, their application forms and irradiation parameters. This is only possible through personal efforts and dedication to study.

The achievement of good courses and reading certainly will make you more apt to use the Laser therapy safely and field. If the trader thinks he can treat their patients following certain protocols for equipment manufacturers, will certainly be one of those who buy a Laser and maintains equipment, after a short time of use, in his case, because they cannot find any satisfactory result in Lasertherapy . There are no "recipes" in Laser Therapy. It is important that the practitioner knows safe dose ranges and power, and, furthermore, get knowledge of pathology, dental anatomy and to have criteria for use in therapy, knowing what the application points, and any number of sessions variations in dose during treatment, because these issues are essential to success in the use of laser therapy exist nowhere ASSISTED MODE of whatever equipment Lasertherapy.

It is necessary that the equipment be subjected to safety tests?

Certainly all opto-electronic equipment, such as laser therapy equipment and Led therapy must be subjected to safety tests, because this is the guarantee that the trader is using a machine that besides issuing Light is that nature is the will efficiently and stable. Not just the equipment emit laser or LED, but the other components that make up the equipment, such as electrical and electronic devices, the housing, the diodes, the handpieces, etc., are in a state minimum efficiency and quality. The safety tests allow certify the quality of equipment and of all its components. Hence, the importance of professional check, from the manufacturer of the equipment that you own or want to purchase, if the same holds certifications for safety, such as the certification of Inmetro.

Profº Drº Francisco de Assis Limeira Junior Limeira

The treatment of a herpes should be made according to the phase which is the lesion?

The primary oral infection with herpes simplex virus (HSV) typically occur early in life, are asymptomatic and not associated with significant morbidity. A minority of the population develops a symptomatic primary infection characterized by acute infection with rupture of vesicles that quickly collapses to form areas of erythema and ulceration. The perioral region tends to be the most affected. After primary HSV infection can persist latently in the trigeminal ganglia and sporadic reactivations appear as cold sores.

The triggers include viral manifestation of ultraviolet radiation (exposure to the sun), stress, trauma, fatigue, and menstrual period for women. Statistics made in the United States believe that between 15% to 45% of the U.S. population (approximately 43 to 100 million people) are affected by cold sores.

The classical manifestation is local irritation with subsequent formation of a "cluster" of small vesicles marked by well-defined erythema and edema in the adjacent region. Subsequently occurs rupture of vesicles, ulcer and sloughing. The spontaneous healing occurs in a period of two weeks. In immunocompetent patients with herpes labialis no risk of major complications, but they suffer from pain, swelling and the esthetic derived from the clinical picture, which generates social discomfort during periods of manifestation.

The conventional treatment may include the use of topical or systemic antiviral agents intended to decrease the clinical manifestations. The use of systemic agents should be reserved for cases of immunocompromised patients.

The symptoms of each phase are:
- Prodromal Phase: Itching, burning and slight redness may last from 12 to 36 hours.
- Bullous or vesicular Phase: Characterized by the appearance of vesicles with reddish edges and pain.
- Face ulcerative: Occurs vesicles rupture and break epithelium with formation of ulcers and crusts that subsequently follow to conventional healing.

The low power laser can be used in specific ways and with different targets in each phase of the disease.

In the first phase (prodromal) the target would activate the immune system of the patient locally to prevent development of the disease or reduce its intensity. All the affected area as well as outlying areas can be irradiated and higher doses of radiation may have better effects (40mW for 2 minutes with energy 4.8J). The wavelengths in both the red and infrared give good results. Higher doses should be kept within certain limits to avoid the worsening of symptoms due to excessive formation, for example, free radicals generated by radiation with worsening of clinical status. However, within the proposed doses usually has been reported significant worsening of symptoms. Immediately after the irradiation may be a "clinical worsening in" However, it is representative of acceleration in the natural course of the disease. Which means a reduction of time of cure.

In bullous or vesicular stage the aim is to improve local blood circulation, the arrival of defense cells and improvement of symptoms, especially pain. The irradiation should not be made on the vesicles, because this case is not observed improvement in symptoms and the risk of contamination is extremely high at this stage.

Since the virus does not absorb radiation at these wavelengths must not occur stimulation of viral replication, however, the absorption site under the vesicles is limited because the tissue beneath it lies in the degenerative process. Two clinical treatments can be offered here: In the first case the vesicles break up with curettage of internal content (in this procedure very carefully, because as stated earlier the risk of contamination is extremely high) and after careful cleaning of the area can be made local irradiations on the bloody area exposed at low energies (0.4 J per point [20mW - 20s]) and in the peripheral region of the vesicles with about 3J (40mW/75s or 75J/cm2).

In the ulcerative phase goal of treatment is to lesion healing. In this case doses around 1J 4J to have good effect (20mW 40mW 50s to 100s).

Neville BW. Herpes simplex virus. In: Oral and Maxillofacial Pathology. Philadelphia, Pa.: Saunders, 2002:213-20.
Worrall G. Herpes labialis. Clin Evid 2004;12:2312-20.
Schindl A, Neumann R. Low-intensity laser therapy is an effective treatment for recurrent herpes simplex infection. Results from a randomized double-blind placebo-controlled study. J Invest Dermatol. 1999, 113(2):221-3.
Tunér J, Hode L. The laser Therapy Handbook. Prima books, Suiça 2004.
Lizarelli RFZ. Dental Clinical Protocols, Use of Low-Power Laser, 2ed São Carlos, Brazil.

A low intensity laser can cause damage?

Like any therapeutic tool the low power laser displays appropriate indications for their use, as well as conditions for such application is made safely and efficiently.

The most common damage that can be caused by a low power laser is eye exposure. The high beam intensity promoted by focusing on the retina made can generate damage therein, therefore, the use of appropriate eye protection devices should be observed during the application of the therapy.

Some evidence points to the possibility of stimulation of neoplastic cells, therefore, to prevent the possibility of risk, the professional under any circumstances should radiate injuries cause and origin unknown or suspected malignancy.

The use of intensities (powers) can lead to very high risk of thermal damage, so the powers used as well as their respective intensities should be maintained within the standard therapy which is known for many low-level laser therapy, so the use of high potencies in very small areas to be avoided.

In epilepsy patients, high frequency pulsed light can trigger attacks. As low power lasers are used and the patient usually continuous turn, must be protected using appropriate ocular device this should not be a contraindication therapy.

Once therapy is local, so far, not been reported side effects in pregnant or lactating patients.

To prevent contamination, the rules of biosecurity should be maintained with proper sterilization of the devices used, as well as through mechanical barriers that reduce the risk of contamination.

Proper use of the laser depends on an accurate diagnosis and treatment of diseases. In many clinical conditions in which the low power laser has potential indications, he would work as an adjunct to conventional therapy, improving its result, leading to an increased comfort and quality of treatment offered to the patient. It is vital that the patient before receiving treatment, becomes aware of its advantages, disadvantages and risks and is in accordance with the same, expressing this through a formal agreement term inform consent.

The success of any therapy depends on appropriate use of the same by the professional.

Tunér J, Hode L. The laser Therapy Handbook. Prima books, Suiça 2004.
Lizarelli RFZ. Dental Clinical Protocols, Use of Low-Power Laser, 2ed São Carlos, Brazil.

Profª Drª Silvia Cristina Núñez

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