Photothermal Therapy, PDT and the Lumoral method in Dentistry
Light has been known to have a therapeutic effect for thousands of years, but Oscar Raab was the first person to scientifically study the subject in 1898. He was the first to document an antibacterial effect based on light activation. In those days, the widespread introduction of the method was prevented by the lack of suitable light sources.
The discovery of antibiotics for the treatment of bacterial infections in 1928 replaced the need for light-activated methods. Today, however, it has been found that systemically administered antibiotics widely interfere with the body's normal bacterial balance. Additionally, antibiotic resistance has become an ever-increasing threat to health care. In topical photoactivatable therapy, the antibacterial effect is directed only at the photoactivatable area and does not affect the normal flora of the body. There is also no resistance formation to photoactivatable methods.
The development of the photoactivable antibacterial method is well known. The photodynamic method requires light, a dye (the photosensitizer), and oxygen to work. Dyes have the ability to absorb a large amount of visible light. The dye must be able to absorb light energy in order to act as a sensitizer. In this case, the electron of the sensitizer molecule tunes to a higher energy level. This excited energy level is discharged either as a thermal vibration (photothermal effect) or further moving to the outermost electron circle of a nearby oxygen molecule (photodynamic effect). High-energy oxygen thus mediates the photodynamic effect.
Picture 2. Left: Porphyromonas gingivalis bacterial culture on a blood agar base. Right: A similar bacterial culture inactivated by the Lumoral method.
Bacteria have a weak ability to defend against the photodynamic and the photothermal method, unlike more advanced cells. Human cells are effectively protected against doses of oxygen radicals that are harmful to bacteria with enzymes developed for this purpose. Of all the medical professions, it is dentists who have embraced antibacterial photodynamic therapy. They have used the method specifically to treat periodontitis. These laser light treatments are most commonly used in Germany and the United States in support of other periodontitis treatments.
In periodontitis, the biggest problem is distorted bacterial flora that damages the tissue surrounding the teeth. Periodontitis is most often caused by poor dental hygiene. The disease is a form of bacterial infection not caused by a single bacterium but a large number of different bacteria working together. It should be noted that mild periodontitis affects about 70% of the Western adult population.
The use of photodynamic therapy in dental clinics is limited by the relatively high cost and amount of work involved in administering the treatment. Laser equipment increases the amount of work in clinical use, where light is delivered directly to the gingival pocket, separately for each tooth. This, of course, makes the treatment more effective and precise. Several studies have found that photodynamic therapy improves the bacterial flora and oral hygiene in general. However, in most studies, treatment has been administered remarkably infrequently, for example once every six months or once a year.1,2 In studies where dosing is more continuous, the results are significantly better. 3–5 Naturally.
Picture 3: Lumorinse technical mouth rinse is activated by the light of Lumoral light activator.
Lumoral’s photodynamic method is based on a new idea. The device enables regular use, and it can be used not only in the dental clinic but also at home. Lumorinse has been developed to easily attach to dental plaque. In this way, the antibacterial effect can be targeted to the desired area and the normal oral bacterial flora remains undisturbed. The antibacterial blue light of the device works in the same way as traditional photodynamic therapy, but it uses internal bacterial dyes, porphyrins and flavins as the photosensitizing molecules. The interaction between Lumoral's photodynamic therapy and antibacterial blue light has been shown to be very effective against harmful oral bacteria, and no bacterial resistance is developed against this interaction, even with repeated use.
- Birang R, Shahaboui M, Kiani S, Shadmehr E, Naghsh N. Effect of nonsurgical periodontal treatment combined with diode laser or photodynamic therapy on chronic periodontitis: A randomized controlled split-mouth clinical trial. J Lasers Med Sci. 2015;6(3):112-119. doi:10.15171/jlms.2015.04
- Srikanth K, Chandra RV, Reddy AA, Reddy BH, Reddy C, Naveen A. Effect of a single session of antimicrobial photodynamic therapy using indocyanine green in the treatment of chronic periodontitis: a randomized controlled pilot trial. Quintessence Int. 2015;46(5):391-400. doi:10.3290/j.qi.a33532
- Pessoa L, Galvão V, Damante C, Sant’Ana ACP. Removal of black stains from teeth by photodynamic therapy: clinical and microbiological analysis. BMJ Case Rep. 2015;2015. doi:10.1136/bcr-2015-212276
- Monzavi A, Chinipardaz Z, Mousavi M, et al. Antimicrobial photodynamic therapy using diode laser activated indocyanine green as an adjunct in the treatment of chronic periodontitis: A randomized clinical trial. Photodiagnosis Photodyn Ther. 2016. doi:10.1016/j.pdpdt.2016.02.007
- Giannelli M, Materassi F, Fossi T, Lorenzini L, Bani D. Treatment of severe periodontitis with a laser and light-emitting diode (LED) procedure adjunctive to scaling and root planing: a double-blind, randomized, single-center, split-mouth clinical trial investigating its efficacy and patient-reported outcomes . Lasers Med Sci. 2018. doi:10.1007/s10103-018-2441-9