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ePaper created 2016-07-29, 16:53:04 | version 1.38.0
case report | 11 2 2016 laser theulcer.However,bothofthemhavenumerousside effects. Dental lasers have also been used for the treatment of RAS. It was found that laser irradiation accelerates wound healing, promotes pain relief and decreases recurrence of the lesions. There are three factors that accelerate wound healing: the increased production of ATP which results in greater tissue regeneration in thehealingprocess,increasedmicrocirculationwhich facilitatesthecellmultiplicationandtheformationof new vessels. The reason of pain reduction could be attributedtothereleaseofendogenouspainrelievers such as endorphins and encephalins, the increased production of serotonin and suppression of bradyki- nin activity. Case report A 63-year-old female patient presented with painful lesions in her mouth. The patient was diag- nosedwithrecurrentaphthousstomatitis.Theulcers were extremely painful and she had difficulties in eating, speaking and brushing her teeth. The patient had suffered from ulcers for several weeks and was extremelyanxiousandverysensitivetopain.Shehad triedtoreliefthepainbymanydifferenttopicalmed- ications,buttonoavail.Also,newlesionsdeveloped astheolderlesionsresolved.Thepatienthadnosys- temic disorders and was a non-smoker. Eight minor ulcers were found in her mouth (Fig. 1): One in the upper left lip (Fig. 1: lesion a1, Fig. 2), two ulcers in thepalate(Fig.1:lesionsa4anda5,Fig.3:lesiona4), two ulcers in the right buccal area (Fig. 1: lesions a2 anda3,Fig.3:lesiona2,Fig.4:lesiona3),twolesions in the lower lip (Fig. 1: lesions a6 and a7, Fig. 5:lesion a6)andoneminorulcerbelowthetongue(Fig.1:le- sion a8, Fig. 5). Laser therapy was selected for the treatment of recurrent aphthous stomatitis. The patient was treated by 915 nm diode laser. A 300 μm fibre was used with power settings of 2 W, cw and in non-contact mode. The tip was moved with circular movements of 1 mm/s in speed from the periphery towards the centre of the lesion. The tip was also moved gradually closer to the lesion from 10 mm to 1 mm distance. The irradiation time of each lesion was 30 s/cm2 . Consecutive to each ir- radiation, the patient was asked if she was still feel- ing pain. Most lesions were irradiated twice (Fig. 1: lesions a4, a5, a6, a7, a8) and the larger and painful lesions were irradiated thrice (Fig. 1: lesions a1, a2, a3).Attheendofthetreatment,thepatientreported that five ulcers were free of pain (Fig. 1: lesions a4, a5, a6, a7, a8) and three out of eight ulcers were mildly sensitive to the touch (Fig. 1: lesions a1, a2, a3). The patient was send home and instructions were given to avoid hard, acidic and salty foods. The patient was recalled a week later. She was content and she reported that eating was painless. She felt like the ulcers started healing earlier than the previous attacks. The patient was clinically ex- amined and it was found that five ulcers had com- pletelyhealed(Fig.6:lesionsa2,a4,a6,a7,a8,Figs. 9 and 10) and three ulcers out of eight were still sen- sitive to the touch (Fig, 6: lesions a1, a3, a5, Figs. 7 and 8). Additionally, two new painful ulcers were found:onebelowthetongue(Fig.6:lesionb2,Fig. 9) and the other on the palate (Fig. 6: lesion b1). The Fig. 2 Fig. 4 Fig. 3 Fig. 5 Fig. 1 Initial examination Fig. 1: Eight minor ulcers were found (a1–a8). Fig. 2: Ulcer in the upper left lip (a1). Fig. 3: Ulcer in the right buccal area (a2) and ulcer in the palate (a4). Fig. 4: Ulcer in the right buccal area (a3). Fig. 5: Ulcer in the lower lip (a6) and ulcer below the tongue (a8). 22016