ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Low-Level Laser Therapy Reduces The Frequency Of Radiotherapy-Induced Oral Mucositis Occurrences More Than Diligent Oral Hygiene Alone
Clinical Question Low-level laser therapy reduces the frequency of radiotherapy-induced oral mucositis occurrences more than diligent oral hygiene alone.
Clinical Bottom Line In patients with squamous cell carcinoma of the head and neck region, laser therapy is more effective than diligent oral hygiene alone in reducing outbreaks of oral mucositis. A randomized controlled trial with 60 patients showed that patients treated with laser therapy tolerated the side effects of radiotherapy better than those using diligent oral hygiene alone. Because laser therapy is a relatively new management for oral mucositis, it is uncertain whether this treatment is within the capabilities of a general practice, but patients will likely be receptive to this therapy.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21472883Oton-Leite/201260 patientsRCT
Key resultsLaser therapy showed a decrease in the frequency of occurrences of oral mucositis (p= 0.002) and subsequently, a reduction in radiotherapy interruptions (p < 0.001). Overall, the quality of life (QOL) scores showed a greater decrease in the placebo group than the laser therapy group (p < 0.001). At baseline, both groups reported similar QOL values. Mean differences from the baseline taken at intermediate and final periods showed lower results for the placebo group, especially in the areas of pain (p= 0.03), chewing (p= 0.004), and saliva production (p= 0.003). Any p value under 0.05 was considered to be statistically different between test groups.
Evidence Search "Radiotherapy"[Mesh] AND "Laser Therapy"[Mesh]) AND "Stomatitis"[Mesh]
Comments on
The Evidence
Validity: This randomized controlled trial is valid because it had a large patient pool, and the groups were similar at the start of the trial (p > 0.5). Both groups were given the same oral hygiene regimen, and both groups continued their scheduled radiotherapy. There was adequate follow-up, but it was a single blind study, not double blind. Compliance was adequate, and recall bias was unlikely. Perspective: There is a great unmet need to provide effective prevention and treatment of oral mucositis for oral cancer patients and patients undergoing chemotherapy and/or radiation therapy for other cancers such as colorectal cancer and hematological cancers. Clinically, patients suffering mucositis as a result of radiation therapy for oral squamous cell carcinoma (OSCC) experience a tremendous amount of pain and, in spite of our efforts, there are few treatment options to help alleviate this pain. Furthermore, head and neck cancer patients often have several, if not all, of their teeth extracted prior to initiation of cancer therapy and subsequently have difficulty eating and drinking. Moreover, many OSCC patients also experience xerostomia as a result of radiation therapy. The addition of mucositis can impede fabrication and utilization of prostheses such as dentures and exaserbate the patient’s ability to obtain good nutrition and overall health. Surprisingly, the efficacy of LEL was established in 1999 however it’s utilization to prevent mucositis has been minimal. Future evaluation of how to incorporate LEL into standard treatment for cancer patients is much needed.
Applicability The patients (mean age= 55.6 years, 81.6% male predominance) in this study were chosen based on their histological diagnoses of squamous cell carcinoma in the head and neck region. Laser therapy showed a lesser decrease in the quality of life of radiotherapy patients, with a marked decrease in acute oral complications.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery)
Keywords Head and Neck Cancer, Mucositis, Low-Energy Laser Therapy
ID# 2399
Date of submission: 02/27/2013spacer
E-mail wittenw@livemail.uthscsa.edu
Author Warrin Witten
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Cara Gonzales, DDS, PhD
Faculty mentor/Co-author e-mail gonzalesc5@uthscsa.edu
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