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laser - international magazine of laser dentistry No. 2, 2017

potential for infection on contact. The blisters burst and form painful ulcers and oozing wounds in the ul- ceration phase. In the encrustation phase, crusts or scab form and are often accompanied by severe itch- ing. In the last phase, the reddish areas and swellings heal, usually without leaving any scar tissue. Severe symptoms can be prevented if herpes labi- alis is treated by an antiviral cream up the beginning of the papula phase. Unfortunately, this disease often seems to break out abruptly without any previous symptoms, in which case the topical treatment with antiviral creams only helps alleviate the symptoms and reduce the risk of infection. A large portion of the population supposedly car- ries herpes simplex virus type 1. Often, acute epi- sodes of herpes occur when the immune system is weekend or in phases of severe stress, but also under strong sun exposure. Once manifested, herpes labia- lis may co-occur with bacterial superinfections which can affect both clinical symptoms and pain. The HSV-1 virus is easily transferred via saliva or smear infection. Multiple relapses occur mostly in young adults, often at the vermillion border (Fig. 1). These are the patients who usually present at the dermatologist or dentist. The herpes virus often de- velops a resistance against antiviral creams and does not respond to the treatment. Allergies, burning or itching sensations or headaches (in oral therapy) are common side effects of these medicines. As they are potential mutagens, their application is not recom- mended during pregnancy. Fortunately, these patients can be helped in find- ing alleviation and fast recovery by laser therapy. However, the soft laser—which is usually recom- mended for these purposes—alone may lead to frustrating results, as it accelerates the healing pro- cess, but this is often neither noticed nor honoured by the patient, who will leave the dental practice with the same results as when he entered it. For this rea- son, the author has developed a modified treatment protocol in his practice, which leads to an instant pain relief of at least 90 % and a Wow-moment for the patient. For this purpose, we use the programme „Soothing of the pockets” of our elexxion claros laser and the soft-laser handpiece T4 with a diameter of 4 mm. A pulse power of 1.5 W and a frequency of 1,500 Hz as well as a pulse duration of 444 µS result in an average performance of 1 W (Fig. 2). As a first step, we inform the patient that treatment may result in a light warming of the tissues, asking him to give notice when the sensation should become too hot. Then, we decrease the distance to the source of infection under continuous suction, starting from 1 cm and up to 0.2 to 0.5 cm, and palpating it follow- ing a grit pattern under constant movement for 30 seconds. Afterwards, we check with the patient and inspect the treated tissue areas. After treatment, the skin may not exhibit any damages caused by laser and the patient should report an unsuspicious tempera- ture sensation. If these standards are not met—in our experience, this happens in approx. 5 % of the pa- tients, please reduce the pulse performance to a level the patient can accept and prolong the treatment time accordingly. Afterwards, you can ask the patient to describe the intensity of his complaints compared to his original complaints on a scale from 1 to 10. This way, we continue therapy until we achieve a pain re- duction of 90 % or often 100 % which corresponds to a 0 or 1 on the pain scale. This may lead to a treatment time of up to three minutes. In about 15 % of the cases, increasing the pulse performance to 1.95 W may be recommended. This should be done when the patient does not report any improvements of the symptoms after one minute of treatment time. After- wards, we use the soft laser with the programme “Wound Healing” of our laser or at 100 mW for at least one minute. When doing this, an energy level of 5 to 7 Joules should be applied to the tissue. On the next day, the patient will present at our practice for his check-up (Fig. 3) and another soft-laser therapy Fig. 1 Fig. 2 Fig. 3 industry | Fig. 1: The HSV-1 virus is easily transferred via saliva or smear infection. Multiple relapses occur mostly in young adults, often at the vermillion border. Fig. 2: A pulse power of 1.5 W and a frequency of 1,500 Hz as well as a pulse duration of 444 µS result in an average performance of 1 W. Fig. 3: Check-up after 24 hours. The patient is free from pain. laser 2 2017 23

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