ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Non-ablative Laser Treatment of Minor Aphthous Ulcers Reduces Pain and Healing Time Equally Compared to Topical Steroids and Better Compared to Placebos
Clinical Question In patients with recurrent minor aphthous ulcers, does non-ablative laser treatment of the ulcer reduce the pain and healing time compared to other treatment options?
Clinical Bottom Line Non-ablative laser treatment of minor aphthous ulcers appears to reduces pain and healing time equally compared to topical steroids and better than placebos.
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) 23622766Prasad/2013Adults with Minor Recurrent Aphthous StomatitisRandomized Controlled Trial
Key resultsPatients reported reduced pain immediately following and 24 hours after laser treatment compared to the placebo group (p ≤ 0.001). Healing durations were significantly decreased to 4.08 ± 0.81 days in the laser treatment group compared to the placebo group which took 7.84 ± 0.84 days for total regression (p ≤ 0.001).
#2) 20950190De Souza/2010Minor Recurrent Aphthous StomatitisRandomized Controlled Trial
Key resultsThere was no difference between the two groups (laser vs topical steroid treatment) in regression time of lesions (p = 0.4345) or reduction in pain (p value not reported). Patients overall in both groups reported decreased pain and had healing time ranging from 4-7 days.
Evidence Search ("stomatitis, aphthous"[MeSH Terms] OR ("stomatitis"[All Fields] AND "aphthous"[All Fields]) OR "aphthous stomatitis"[All Fields] OR ("aphthous"[All Fields] AND "ulcer"[All Fields]) OR "aphthous ulcer"[All Fields]) AND ("lasers"[MeSH Terms] OR "lasers"[All Fields] OR "laser"[All Fields])
Comments on
The Evidence
Validity: Both studies had similar groups at the start who were treated the in the same manner, had adequate follow up with acceptable compliance, and recall bias was unlikely. There were also not any competing interests. Both surveys did have lower than 80% completion rates. Prasad (2013) had the patients blinded to the treatments but the clinicians were not blinded in either study. Perspective: Further studies would be beneficial to evaluate the efficacy of the different types of lasers (“cold” vs “hot”) and the settings of laser intensity and duration. The exact mechanism of healing following laser treatment is currently not fully understood and further research in this area is warranted. There are multiple different treatments for aphthous ulcers currently available, yet none have absolute superiority over another. Evaluation of pain is highly subjective and the possibility of placebo effect cannot be entirely excluded. Also, the degree of pain and the duration of healing in recurrent aphthous ulcers are typically highly variable and this could have effected results.
Applicability With the low potential risk of harm to patients and the potential for relieving pain while possibly decreasing healing time, it is reasonable to use non-ablative lasers on patients in appropriate clinical setting for minor recurrent aphthous stomatitis. The subjects in these studies were generally healthy besides having minor RAS and had been screened for systemic (endocrine-metabolic) diseases along with pregnancy. Laser treatment does not require any anesthetic prior to the treatment and relieves pain immediately with lasting pain relief along with decreasing healing time. Laser treatment also offers an acceptable alternative to other current ulcer treatments with lasers only requiring a single application, low toxicity, and slight to no discomfort to the patient. No cost analysis has been done. The effectiveness of laser therapy for patients with greater than 10 ulcers, frequent recurrences, major aphthae, herpertiform aphthae, and associated systemic disease is undetermined.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry)
Keywords Aphthous Stomatitis Ulcers; Laser; Topical Steroid
ID# 2614
Date of submission: 02/13/2014spacer
E-mail SchweersBC@livemail.uthscsa.edu
Author Brian Schweers
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Howard McGuff, DDS
Faculty mentor/Co-author e-mail mcguff@uthscsa.edu
Basic Science Rationale
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