International Journal of Contemporary Dental and Medical Reviews (2014), Article ID 111214, 3 Pages

REVIEW ARTICLE

Low-level laser therapy in dentistry: A review

Shahab Saquib1, Varsha Jadhav1, N. Priyanka1, Nitesh Perla2
1
Department of Periodontics, Yogita Dental College and Hospital, Ratnagiri, Maharashtra, India, 2Consultant Oral Pathologist, Smile Dental Clinic and Research
Centre, Mumbai, Maharashtra, India

Correspondence
Dr. Shahab Saquib, Department of
Periodontics, Yogita Dental College and
Hospital, Khed, Ratnagiri, Maharashtra, India.
Phone: +91-9765831201.
E-mail: drsaquib24@gmail.com
Received 26 December 2014;
Accepted 27 January 2015
Abstract
Laser is an acronym for “light amplification by stimulated emission of radiation.” Laser
has a wide range of application in medical and dental field. High dose of laser has certain
limitation and side-effects on the dental tissue. To overcome these issues extensive
research is going on low-level laser therapy (LLLT). LLLT is also known as “soft laser
therapy” and bio-stimulation. The use of LLLT in health care has been documented in
the literature for more than three decades. Numerous studies have documented that
LLLT is effective for some specific applications in dentistry.

doi: 10.15713/ins.ijcdmr.24 Keywords: Dentistry, hard tissue, low-level laser therapy, soft tissue

How to cite the article:

Shahab Saquib, Varsha Jadhav, N. Priyanka,
Nitesh Perla, “Low level laser therapy in
dentistry: A review,” Int J Contemp Dent
Med Rev, vol. 2014, Article ID 111214,
doi: 10.15713/ins.ijcdmr.24

Introduction Basic Principles and Mechanism of Action of LLLT

Lasers have been used widely in medicine and dentistry since
its development by Maiman in 1960. Laser is an acronym for
“light amplification by stimulated emission of radiation.”
The name of the low-level laser is an abbreviation of its active
medium such as gallium, aluminum and arsenide (GaAlAs)
or helium and neon laser. Low-level laser therapy (LLLT) is
also known as “soft laser therapy” and bio-stimulation. The
use of LLLT has been documented in the literature for more
than 30 years. Numerous research studies have demonstrated
that LLLT is effective for some specific applications in
dentistry.[1]
The use of LLLT has been shown to have a beneficial effect
on pain relief,[2] wounds,[3] and nerve injury.[4] Endre Mester in
Budapest in the late 1960’s pioneered the biostimulatory effect
of low-level laser, who demonstrated an increase in collagen
synthesis in skin wounds.[5]
The mechanisms of LLLT are complex, but essentially rely
upon the absorption of particular visible red and near infrared
wavelengths in photoreceptors within electron transport
(respiratory) chain within the membranes of mitochondria.[6]
Absorption of LLLT by mitochondria will cause activation of the
adenosine triphosphate (ATP) that is the main energy source for
the stimulation of normal cell function.
The simplest way to categorize these lasers is according to their
wavelength. Several parameters characterize LLLT. These are as
follows;
1. Laser power: Ranges from 10−3 to 10−1 W
2. Wavelength: Ranges from 300 to 10,600 nm
3. Pulse rate: Range from 0 to 5000 Hz
4. Intensity: Ranging from 10−2 to 102 J/cm2
5. Electromagnetic spectrum: Therapeutic lasers are within
visible red to near visible red ranging from 630 to 980 nm.
Biostimulation is supposed to be the main mechanism of
action for LLLT, and it was introduced more than 20 years back
when LLLT was used in dermatology for wound healing. There
are various mode of action of LLLT has been proposed, some of
them which are accepted explained here; Biological effects caused
due to the deposition of low energy into tissues where deposited
energy results in therapeutic effects. This results in the analgesic
and anti-inflammatory effects as well as shows improvement in
healing.[7] According to some investigator if the stimulation is to
weak, no effect is seen. Increased stimulation and optimal dose
lead to the optimal effect; while, further dose increase leads to
a decreased effect. Other propose that LLLT can act analgesic
since they cause the release of endorphin and therefore inhibit
nociceptive signals and control pain mediators in the nerves.[8]

1
Low level laser therapy
LLLT also has a stimulatory effect on stimulate lymphocytes,
macrophages, activate mast cells, and increase production
of ATP in the mitochondria and proliferation of various cell
types, which are anti-inflammatory agents.[8] LLLT also has the
effect on the microcirculation that will reduce the edema by
changing hydrostatic pressure of the capillary. Optimum dose
of LLLT leads to the formation of new endothelium and new
blood vessels that will help in formation granulation tissue and
accelerated healing. LLLT lead to the relaxation of the smooth
muscles of the various system, which decreases pain and spasm
on the affected muscles.[8]
Use of laser is contraindicated in a certain condition like;
coagulation disorders because they interfere with blood
circulation in a way still unknown. Presences of malignant disease
as well as precancerous lesions because LLLT stimulates cell
growth. During pregnancy, menstrual cycle, febrile conditions
the use of lasers is contra-indicated. Therapeutic lasers weaker
than 500 mW are considered to be devices of low risk, but
naturally, the use of protective glasses both for the patient and
the clinician is a must.
Application of LLLT in Dentistry
LLLT has a range of dental, medical, physiotherapy applications.
Low-level laser applications in dentistry include the promotion
of wound healing in a range of tissues and lesions.
Soft tissue application
1. Aphthous ulcers: Various studies stated that; the patients
reported significantly less pain as well as less functional
complications after LLLT therapy. Furthermore, they stated
that they experienced faster healing compared with the usual
medication therapy.[9,10] There is no adverse effect reported
on the cells of the epithelium.
2. Herpes simplex infections: Results of the studies have shown
that LLLT has a beneficial effect on the healing of Herpes
simplex infections. In one of the studies patients were given
LLLT therapy every day for 2 weeks for the treatment of
Herpes simplex infections. The average interval without
herpes lesions was 37.5 weeks in patients who received laser
therapy and 3 weeks in patients who received placebo, and
the difference was significant.[11] It has also been concluded
that it not only increase healing but also will prevent the
recurrence of the lesion.
3. Oral lichen planus: Studies have concluded that treatment
of oral lichen planus by LLLT shows reduction in pain and
a significant decrease in the size of the lesions. Laser was
equally effective in the treatment of oral lichen planus as was
topically applied corticosteroids, and that is also without any
side-effects.[12]
4. Xerostomia: Use of infrared laser shows a significant
increase in salivary flow in cases of xerostomia. When a
laser with wavelength 904 nm applied to the both parotid
and submandibular glands, then the result showed that it
2
Saquib, et al.
was efficient in reducing xerostomia by stimulating these
glands.[13]
5. Mucositis: Mucositis is common finding in the patients
who were exposed to chemotherapy and radiotherapy for
the treatment of malignancy. When LLLT was applied daily
within the oral cavity, it showed significantly decreased
in the findings of oral mucositis as well as daily mucositis
index. It also resulted in decreased pain scores and decreased
xerostomia symptoms whereas their swallowing abilities were
improved as compared with non-laser therapy patient.[14,15]
6. Paresthesia: In dentistry paresthesia is one of the
complications of surgical treatment, most commonly seen
after the surgical extraction of third molars. Investigators
based on their study concluded that there was a significant
improvement in the mechanoreceptive perception in
the damaged alveolar nerve when GaAlAs diode laser of
wavelength 820-830 nm was used during every treatment for
90 s in 20 applications.[16]
7. Periodontitis: It is one of the most common diseases of the
attachment apparatus of the tooth. It is the major cause of tooth
loss in the later part of life. Study conducted by Obradović
et al.[17] showed that when the patients of periodontal disease
treated with LLLT (670 nm) together with conventional
periodontal treatment healing was improved as well as there
was improvement in collagenization and homogenization
in gingival lamina propria on the basis of histopathological
findings.
Theodoro et al.[18] used photodynamic therapy by use of
LLLT in patients with chronic periodontitis. They concluded
that there was a significant difference in periodontal pathogens
in patients treated with conventional periodontal therapy as well
as with laser as compared to only conventional therapy. Other
investigators concluded that LLLT is a potent additional therapy
to non-surgical periodontal treatments because it enhances
periodontal healing.
Hard tissue application
1. Dentinal hypersensitivity (DH): DH is one of the most
common causes of dental pain. Use of LLLT to reduce
hypersensitivity relies upon laser-induced changes to neural
transmission networks within the dental pulp. Most studies
to treat DH have used GaAlAs laser treatment and have
demonstrated desensitization of hypersensitive cervical
dentine, with an efficacy rate of approximately 90%.[19]
2. Temporomandibular disorders: Patients with myofascial
pain dysfunction syndrome showed significant improvement
in mandibular movement when treated with LLLT
(820 nm).[20] It has also been reported that active and passive
mouth opening as well as right and left lateral movements
were improved after LLLT.
3. Pain during orthodontic tooth movement: Studies have
shown that LLLT is beneficial in controlling orthodontic
post-adjustment pain. Investigations have shown that LLLT
reduces secretion of highly pro-inflammatory molecules
Saquib, et al.
prostaglandin E2 and interleukin-1 from fibroblast cells that
reduced pain after orthodontic tooth movement.[21]
4. Sterilization of hard tissue: High-power lasers are well
recognized for their destructive effects on bacteria. In
contrast, if low power laser energy is coupled with dyes into
the bacterial cell wall, the energy required for destruction of
bacteria would be quite small and would prevent damage
to the dentin, pulp and periodontal ligament. Lethal laser
photosensitization (LLP) is a term which denotes a process
of laser radiation emission from a low power laser device
and activation of dye which in turn exerts a lethal effect on
particular cells, such as bacteria. These LLP have the potential
role in the sterilization of root canal and management of
dental caries.
5. Bone implant interphase: Bone implant interphase is a topic
of concern to the clinician because success of the implant
completely depends on osseo-integration. Khadra et al. from
their study concluded that LLLT might have a favorable
effect on healing and attachment of titanium implants with
the alveolar bone.[22]
6. Lasers in orthodontics: LLLT currently being followed
in all the specialties including orthodontics, wherein it
has resulted in a better and patient satisfaction practice,
including decreased treatment timings and better results
along with pain reduction procedures. It helps in etching,
contouring of the soft tissue, curing, laser holography and
laser welding.[23]
Conclusion
LLLT is useful adjunctive treatment modality in various field of
dentistry. It has a beneficial effect on both hard tissue and soft
tissue of the oral cavity with less adverse effect. Future trials of
LLLT applications in dentistry should make use of standardized,
validated outcomes. Effectiveness of the LLLT should also be
explored depending on wavelength, treatment duration, dosage,
and the site of application.
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