Laser Biostimulation of Oral Ulcers in Children International Journal of Laser Dentistry, May-August 2012;2(2):59-62 59 IJOLD Laser Biostimulation of Oral Ulcers in Children Jatinder Kaur Dhillon, Gauri Kalra, Vijay Prakash Mathur CASE REPORT ABSTRACT Oral ulcers in children are a frequent complaint of patients reporting to a dental professional. These can be very painful and may cause difficulty during eating, speaking and brushing. Several modalities have been proposed for management of oral ulcers, such as topical anesthetics, antiseptic mouthwashes, etc. However, these have not been proven very efficacious. Low level laser therapy (LLLT) has been suggested as a means of accelerating healing of oral ulcers. This case report presents a case of two painful aphthous ulcers in a 13-year-old child treated with LLLT using soft tissue diode laser. Immediately after the laser therapy, the pain reduced significantly and the healing occured substantially in 72 hours. Keywords: Children, Diode, Laser, LLLT, Oral, Ulcer. How to cite this article: Dhillon JK, Kalra G, Mathur VP. Laser Biostimulation of Oral Ulcers in Children. Int J Laser Dent 2012;2(2):59-62. Source of support: Nil Conflict of interest: None INTRODUCTION Oral ulcers can be very painful and debilitating lesions in children. An ulcer is a well-circumscribed depressed lesion over which the epidermal layer has been lost. 1 They may be classified on the basis of their number (single or multiple), the duration of the ulcer (acute or chronic) and occurrence of the disease in the past (primary or recurrent). Most common causes of oral ulcers are trauma, recurrent aphthous stomatitis, microbial infections, mucocutaneous disease, systemic disorders and drug therapy. 2 Recurrent aphthous ulcers (canker sores) and herpes-induced stomatitis are the most commonly occurring ulcerative conditions in children. Recurrent aphthous ulcers present as painful, solitary or multiple ulcerations of the oral mucosa. Other symptoms include paresthesia, malaise, low-grade fever, localized lymphadenopathy, loss of appetite and mucus-containing vesicular lesions. It is mostly associated with severe pain lasting up to 6 or more days. There is no specific etiology for aphthous ulcers. However, they may precipitate due to trauma, stress, hormonal changes, microorganisms and vitamin and trace element deficiencies. 3 Systemic conditions include genetic predisposition, immunodeficiency and family history. Prevalence of recurrent aphthous ulceration was reported in Third National Health and Nutrition Examination Survey, 1988 to 1994 (NHANES III) to be 1.64% in a sample of children aged 2 to 17 years of the United States. 4 Various treatment modalities have been 10.5005/jp-journals-10022-1020 suggested for oral ulcers. The treatment is mainly focussed on palliative care till it heals by itself. However, natural healing may take up to 2 weeks which can cause major distress for children. The effect of low levels of laser energy was first discovered by Dr Endre Mester in 1967. 5 Since then it has been used for various applications in the field of medicine and dentistry and is broadly termed ‘low level laser therapy’ (LLLT) or ‘biostimulation’ or ‘phototherapy’. It is defined as a ‘non-thermal’ laser light application using photons (light energy) from the visible and infrared spectrum for tissue healing and pain reduction (North American Association of Laser Therapy–NAALT). 6 Several in vitro studies 7,8 have demonstrated that the effects of laser light on wound healing are much greater than obtained with light from other sources, such as light-emitting diodes (LEDs). The proposed mechanism of LLLT is as follows: 9-11 1. It acts on mitochondria to cause increased ATP production which increases oxygen consumption on the cellular level which promotes tissue repair. 2. It stimulates the release of serotonin and endorphins which produces an analgesic effect. 3. It reduces prostaglandin synthesis which produces anti- inflammatory effects. 4. Improved blood circulation to the skin and mucosa. 5. It causes hyperpolarization by decreasing permeability of the membrane of the nerve cells for Na/K. 6. It decreases edema by increasing the lymphatic flow. The major advantage of LLLT is that the effect is localized, resulting in no harm to adjacent structures. It also produces immediate pain relief. This is attributed to the disruption in the action of Na-K pump in the cell membrane and serotonin release. There have been numerous studies on the effect of LLLT on pain which demonstrates that after LLLT the urinary excretion of 5-hydroxyindoleacetic acid, the degradation product of serotonin increases significantly. 11,12 CASE REPORT A 13-year-old male child reported to the Pedodontics OPD at CDER, AIIMS with the complaint of pain and burning sensation on eating for last 2 days. On clinical examination it was found that the patient had two shallow non-indurated ulcers with an erythematous border. One of the ulcers was located in the buccal-attached gingival region of the left upper premolars measuring about 1.5 cm at its maximum