You are on page 1of 6

Journal of Cosmetic and Laser Therapy, 2010; 12: 77–80

CASE REPORT

Use of 532-nm Q-switched Nd:YAG laser for smoker’s gingival hyperpigmentation

SUNG BIN CHO1, JU HEE LEE1, WOONKYUNG SEO2 & DONGSIK BANG1
of Dermatology and Cutaneous Biology Research Institute,Yonsei University College of Medicine, Seoul, Korea and 2Department of Oromaxillofacial Surgery, Armed Forces Yangju Hospital,Yangju, Korea
Abstract Laser treatments using 532-/1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers are popular non-ablative and selective photothermolysis therapies for pigmentary disorders. We treated three male Korean patients (aged 23, 27 and 24 years) for smoker’s gingival hyperpigmentation using a 532-nm Q-switched Nd:YAG laser. At each treatment session, the laser was delivered at 1.2 J/cm2 with a 5-mm spot size and appropriate overlap. Clinical improvement as well as complete healing of the treated gingiva was noted within 2 weeks after each treatment. We also observed that the therapeutic effects lasted more than 6 months. Key words: Gingival hyperpigmentation, Nd:YAG laser, smoker
1Department

Introduction Oral mucosal pigmentation has been linked to several factors including population variation, drugs, active or second-hand smoking, heavy drinking, hormones, Addison’s disease, and malignancies (1–3). Physiologic changes of oral pigmentation are noted in individuals with a darker skin, pregnant women, and women with hormone replacement therapy. Patients with multiple labial melanotic macules should be ruled out of the possibly associated conditions such as Peutz-Jeghers syndrome, Carney complex, and Laugier-Hunziker syndrome, although lentigines commonly occur on the palate, gingiva, and lips. The noxious effects of cigarette smoking on the periodontium have been extensively reported; including the increased risks of periodontal destruction, alveolar bone loss, subgingival infection, gingival bleeding, gingivitis, and hyperpigmentation (4–7). Although the cessation of smoking can slow the disease progression of any smoking-related periodontal diseases, it is suggested that quitting smoking does not reverse the past effects of smoking on periodontal tissues (4). The present study describes the clinical effects and safety of 532-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser treatment, which is a non-ablative and selective

photothermolysis laser therapy, for the treatment of smoker’s gingival hyperpigmentation.

Case report We treated three male Korean patients (aged 23, 27 and 24 years) for smoker’s gingival hyperpigmentation using a 532-nm Q-switched Nd:YAG laser. The patients had no pertinent medical history other than a history of smoking (each patient had smoked approximately one pack/day for at least 3 years). The patients presented with varying degrees of diffuse brownish-pigmented patches on the upper and lower gingiva (Figures 1A, 2A, and 3A). The possibility of underlying disorders, including Addison’s disease, hemochromatosis, Wilson’s disease, and PeutzJeghers syndrome, had been ruled out through clinical manifestations and results of laboratory tests. After obtaining informed consent, the patients were treated with one to three sessions (patient 1: three sessions; patient 2: one session; patient 3: two sessions) of 532-nm Q-switched Nd:YAG laser therapy using a Spectra VRMIII™ apparatus (Lutronic, Goyang, Korea) at a month interval. The total number of treatment sessions was determined by clinical response and patient satisfaction. Laser

Correspondence: Dongsik Bang, Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 250 Seongsanno, Seodaemoon-Gu, Seoul 120-752, Korea. E-mail: dbang@yuhs.ac

(Received 25 September 2009; accepted 9 February 2010)
ISSN 1476-4172 print/ISSN 1476-4180 online © 2010 Informa UK Ltd. DOI: 10.3109/14764171003706174

B: immediately after the first treatment. Sweden).78 SB Cho et al. Patient 3 received a lidocaine nerve block injection (infiltration of 2% lidocaine mixed with 1:100 000 epinephrine) for precise anesthetic effects (Figure 3B and C). Figure 1. treatment was delivered to patients 1 and 2 after topical anesthesia via a 5-minute gargle with Xylocaine® Pump Spray (AstraZeneca AB. The laser was delivered at 1. Patient 1 with hyperpigmented gingiva treated with three sessions of 532-nm Q-switched Nd:YAG laser (A: before the treatment. C: 2 weeks after the final treatment. Saliva and the anesthetic gargle solution were gently removed using gauze just prior to the induction of laser therapy. Södertälje. All patients wore a mouthpiece to facilitate the procedure. Figure 2. D: 6 months after the final treatment). C: 2 weeks after the treatment. . B: immediately after the treatment. D: 6 months after the treatment). Patient 2 with hyperpigmented gingiva treated with one session of 532-nm Q-switched Nd:YAG laser (A: before the treatment.2 J/cm2 with a 5-mm spot size and appropriate overlap.

patients were advised to avoid excessively long or vigorous tooth brushing. ablation of gingival epithelium. Laser treatments using 532-/1064-nm Q-switched Nd:YAG lasers are popular non-ablative and selective photothermolysis therapies for pigmentary disorders in dermatological practices. 2D. D: 6 months after the final treatment).Gingival hyperpigmentation 79 Figure 3. The erbium:YAG laser was approved by the US Food and Drug Administration for hard tissue treatment in dentistry and the laser has proven effective for the ablation of oral soft and hard tissue (11). However. In the interim. Various laser devices have been used in numerous periodontal procedures. is higher with carbon dioxide lasers because the thermal effects of carbon dioxide lasers on the perilesional tissues are greater compared with those of erbium:YAG lasers. Patients were prescribed mouth gargle (benzydamine chloride) for 3 days post-treatment and were advised to quit smoking. Immediately after the treatment. However. Nearly all of the post-therapy crusts spontaneously fell off within 5 days. Also. and 3D). Minimal posttherapy bleeding was noted. Patients generally experienced a prickling sensation for 1–3 days post-therapy without toothache. and implantation (8). infiltration of 2% lidocaine mixed with 1:100 000 epinephrine on the (B) upper and (C) lower gingival. include carbon dioxide. Discussion Lasers are very precise and selective treatment modalities. Patient 3 with gingival hyperpigmentation treated with two sessions of 532-nm Q-switched Nd:YAG laser (A: before the treatment. complete recovery of the full tissue thickness generally takes about 2–4 weeks (10). post-therapy frosts were observed (Figures 1B and 2B). Nd:YAG. and diode lasers (8). Until recently. possible side effects. which have been widely used for the treatment of oral cavity lesions. the main light-absorbing molecule of both carbon dioxide and erbium:YAG lasers. clinical effects can be expected with ablative laser therapies using 10 600-nm carbon dioxide or a 2940-nm erbium:YAG lasers. is water and these lasers can precisely vaporize the epidermis and upper dermis depending on the laser settings. frenectomy. All patients were satisfied with the treatment outcomes. although most of the gingiva epithelializes at 1 week after erbium:YAG treatment. and operators’ preferences. the risk of side effects. Clinical improvement as well as complete healing of the treated gingiva was noted within 2 weeks after each treatment (Figures 1C and 2C). such as gingivoplasty. A Q-switching technique . Chromophore. such as scarring and post-therapy dyschromias.11). excisional and incisional biopsies. ablative erbium:YAG lasers have been widely used for the removal of gingival melanin and discoloration (10. Choosing laser devices depends mainly on the characteristics of target lesions. and quickly subsided without intervention. laser types. erbium:YAG. Carbon dioxide lasers are one of the workhorse surgical lasers and can resurface lesions with little or no hemorrhage (9). we observed that the therapeutic effects lasted more than 6 months (Figures 1D. Because pathological studies have established that oral mucosal pigmentation is associated with basal hypermelanosis in cases of smoker’s melanosis (3). The laser devices.

However.101:181–7. Tobacco use and its effects on the periodontium and periodontal therapy. J Periodontal Res. Leffell DJ. Smokers’ melanosis in a Nigerian population: A preliminary study. . Declaration of interest: The authors report no conflicts of interest. Oral melanin pigmentation related to smoking in a Turkish population. References 1. Therefore. 7th ed. The authors alone are responsible for the content and writing of the paper. II. Koch G. Fitzpatrick’s dermatology in general medicine.9:97–107. Grossi SG.39:275–85.41:680–2. Dunford R. Wall T. Elhan AH. Golgberg MH.67:1050–4.78:2018–25. Paller AS. J Periodontol. 9. Sakamoto FH. With a concept of selective photothermolysis. Ho AW. Dunford R. 2008. light can project through skin without a pronounced effect on its barrier function and patients can be treated with minimal downtime. emits nanosecond laser pulses by sudden releasing of the excited-state energy from a laser medium (9). Zambon JJ. New York: McGraw-Hill. Potential applications of erbium:YAG laser in periodontics. Community Dent Oral Epidemiol. 1995. Alpha Omegan. Sahin M. Lasers and flashlamps in dermatology. Goldsmith LA. Anderson RR. 11.65: 260–7. 2007. Soykan E. Aoki A. Eduardo Cde P. Machtei EE. Owing to its penetration depth and laser tissue absorption spectrum. light can pass through the epithelial or dermal cells preserving the barrier functions and creating therapeutic effect only at certain targets. Ho AW. 3. Machtei EE.29:272–7. 2263–79. Ishikawa I. Risk indicators for alveolar bone loss. editors. Paksoy C. Acknowledgement The authors report no funding sources and declare no conflicts of interest. 5.80 SB Cho et al. Cigarette smoking increases the risk for subgingival infection with periodontal pathogens. 10. 2004. J Contemp Dent Pract. Aranha AC. 2. Winfunke-Savage K. Esthetic treatment of gingival melanin hyperpigmentation with Er:YAG laser: Short-term clinical observations and patient follow-up. Katz SI. J Periodontol. Aoki A. et al. Assessment of risk for periodontal disease. 2001. prospective studies should be conducted in the future to confirm our findings. Avram MM. 2008. Rosa DS. 8. Genco RJ. J Contemp Dent Pract. Laxman VK. Grossi SG. the 532-nm Q-switched Nd:YAG laser is used for various epidermal pigmented lesions. J Oral Maxillofac Surg.8:68–75. I. optimized. Annaji S. Jeboda SO. Machtei E. 2007. Chuong R. J Periodontol. Unsal E. J Periodontol. 7. 6.66: 23–9. Gilchrest BA. 2007. Coleton SH. In: Wolff K. Takasaki AA. Risk indicators for attachment loss. Assessment of risk for periodontal disease. 1996. Genco RJ. Grossi SG. 1983. Dunford R. 4. Nwhator SO. Zambon JJ. Genco RJ. The 532-/1064-nm Q-switched Nd:YAG laser has no specific light-absorbing factors on the epidermal architecture. The use of lasers in periodontal therapy. Case 47. p. 1994. part II: Oral hyperpigmentation associated with Addison’s disease. Ayanbadejo P. Ho AW.

Copyright of Journal of Cosmetic & Laser Therapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. download. However. or email articles for individual use. users may print. .

download.Copyright of Journal of Cosmetic & Laser Therapy is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However. users may print. . or email articles for individual use.