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ePaper created 2016-01-08, 09:25:11 | version 1.38.0
research I ation of distal radius fractures.5 Intravenous regional anaesthesia was used. The need for painkillers was less in patients having LPT immediately before sur- gery. The study by Santos aimed to evaluate the ef- fects of LPT immediately before tetanic contractions in skeletal muscle fatigue development and possible tissuedamage.6 OptimaldosesofLPTsignificantlyde- layed the development of skeletal muscle perform- ance and protected skeletal muscle tissue against damage. Thus, it is suggested that LPT could be used priortosurgicalinterventiontoreducepostoperative discomfort. The fact that LPT can be useful even in healthy tis- sue was suggested already in 1999 by Schindl.7 The study showed that patients with recurrent HSV-1 at- tacks could be successfully treated with LPT even in the “silent” period in-between outbreaks. Dentists could therefore, at advantage, treat known HSV-1 prone patients with LPT even if there is no clinical ev- idence of an outbreak. The importance of this possi- bility is underlined by two recent studies where pa- tients with recurrent HSV-1 turned out to have a greaterriskofdevelopingAlzheimer’sdiseaselateron in life.8,9 The connection is unknown, but if patients withrecurrentHSV-1aretreatedwithLPTatconven- tional dental sessions, the risks may be reduced. Alzheimer’s disease is far from dentistry, but cer- tainly there is a connection between the oral cavity and general medicine. A further example is Burning Mouth Syndrome [BMS]. This is in the oral cavity but consideredtobeamedicalproblem.LPThasbeentried without success in early studies. However, the origin of BMS is unknown. Two more recent studies used high energies and the outcome was successful.10,11 Thus, the effect behind the pain relieving result ap- pearstobeinhibitionofaxonalflow,asdemonstrated by Chow.12 LPT then could not cure these patients, as withanyothertherapy,butatleastserveasapainre- lieving therapy, open for dentists. Diabetes is another non-dental pathology with a deep impact in dentistry. The laser dentist cannot do anything about the pathology itself, but the advan- tagesoftreatingthesideeffectsofdiabetesareobvi- ous. This is among other things demonstrated in the healing process after surgery and periodontal ther- apy. An animal study by al-Watban showed that woundsinthegeneticallydiabeticanimalshealedjust as fine as for the non-diabetic animals.13 The positive effect in periodontal therapy is confirmed by Obradovic.14 Wecanthereforeexpectimprovedheal- ing after scaling, extraction and minor surgery if LPT as applied in diabetic patients. Lichen planus is treated by specialists in the den- tal field and the general dentist often refers these cases to a specialist or to a medical doctor. A recent study by Dillenburg showed a better result from LPT than for the traditional clobetasol.15 Pemphigus vul- garis is yet another autoimmune condition where steroids can be replaced by LPT.16,17 TMDisindeedadentalindication,butbeingmulti- factorial,itborderstopsychologyandmedicine.Each profession can do its own part. A more holistic atti- tudeisrequiredtocuresomeofthesepatientsandthe muscular problems are often not only related to the masticatorysystembuttoneckandshouldersaswell. A laser dentist can make these areas a dental interest and expand the therapeutic possibilities. From a strictly scientific point of view, LPT for TMD is not sci- entifically proven. This is because even with more than50clinicalstudies,theparametersdifferalot,the laser parameters as well as the therapeutic ap- proaches.ShouldthelackofCochrane-styleevidence be applied to this treatment, we should be aware of thefactthatendodonticsisanotherareawherethere is no scientific evidence, according to an evaluation by SBU—Swedish Council on Health Technology As- sessment.18 The lack of evidence stems from the use ofdifferentmaterialsandmethods.Thousandsofpa- pers cannot rectify this judgement. Of course, we knowthatendodontictreatmentworkswell,butwe cannot prove it. The same goes for LPT and TMD, for the time being. In fact, SBU has a more positive evaluation of the use of LPT for neck pain.19 Figs. 2 & 3_Non-healing wound, having been unsuccessfully treated for four months. Initial situation before LPT on January 5 on the right; situation on January 16 on the left. A home care laser device was used. I 07laser4_2015 Fig. 3Fig. 2 [PICTURE: ©ETIAMMOS]