nano-oral medicine indirect effect: biostimulation no fda ... · get rid of numbing more quickly)...

Using Photobiomodulating lasers in Children

Lawrence Kotlow 2012

Nano-oral medicine

Therapeutic biomodulating

laser care

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Lawrence Kotlow DDS 12

In the USA:Off label use

Low Level lasers are considered by the FDA as NSR medical device that poses

NONSIGNIFICANT RISK (NSF) to patients

No FDA -IRB (Institutional Review Board) review is required if the off label use is used to treat patients and is not part of a research project involving humans


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The use of low level lasers remains under the radar screen for the present time, especially in the USA, except for the use of the 680nm red light in caries detection. In the fields of post trauma, oncology, neural pain pathology, and musculo-skeletal management their use is growing.

!Indirect effect: Biostimulation !Non-Surgical: does not produce heat!Visible and non-visible wavelengths!Continuous & gated pulse!Rigid tips!Hand held units :very portable!Painless!Reduced use of drugs for pain control

Photobiomodulation (LLLT) in a Pediatric Dental Practice

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Everyday examples of light therapy

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" Jaundice is common in premature infants. Phototherapy acts on unconjugated bilirubin to a depth of 2 mm from the epidermis. Phototherapy changes the bilirubin through structural photoisomerization into water-soluble lumirubin that is excreted in the urine.

"Photosynthesis is the process by which plants, some bacteria use light energy from sunlight to produce sugar, which cellular respiration converts into ATP, the "fuel" used by all living things.

5Clinical everyday uses

analgesia

traumatic injuries

gag reflex

oral lesions

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!Aculaser :Laserex technologies

!Q1000

!Diobeam 830

!Medx health unit

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1. Lasers that operate using energy densities below the threshold where irreversible changes in cells occur.2. *Stimulates natural biological processes preventing cells from operating in an acidic(redox) state to an alkaline state to perform optimally.

*Jan Tuner DDS Low Level lasers in dentistry pg. 263 principles & practice of laser dentistry Convissar 2010For additional peer reviewed articles

8612009 different references in the text book written by Jan

Turner & Lars Hode“Laser Therapy : Clinical Practice and Scientific

Background (2002)-WWW.Prima –Books.com

Lawrence Kotlow DDS

PBM

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!Reducing nausea!Controls gag reflex !Reduces the need for numbing!Improved numbing when local is used!Maintaining tooth vitality after trauma!Reduces post-traumatic swelling!Improves soft tissue healing!Treatment of herpes & herpes type lesions!TMJ discomfort!Muscle trismis : releases tight muscles!Reduction in bleeding

Procedures completed in my office using photobiostimulation


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Chinese Name: Hegu (English translation: Joining Valley)Location: On the dorsum of the hand, between the 1st and 2nd metacarpal bones, in the middle of the 2nd metacarpal bone on the radial side.

Classification: Yuan-Source point of the Large Intestine MeridianCommand Point of the head and face

Hegu- acupunture point

Diseases of the head and face: i.e. external pathogenic headache ,congestion, swelling and nasosinusitis, toothache in the lower jaw, trismus , swelling of the face, facial paralysis

• 4-8 Joules• Between thumb and first finger• This is the main switching point for acupuncture system

Migraine headaches

and treating nausea


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Acupunture + Photobiomodulating laser treatment

P6 (Nei guan meridian point)=reduce gag reflex

!"# Agarwal MD et al Acupuncture and ondansetron for postoperative nausea & vomiting after laparoscopic cholecystectomy Canadian Journal of Anesthesia June 1, 2002 49:554-560

$"# Dundee JW; Yang J Jr Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy Soc Med (England) June 1990, 83(6) 360-362!"#

%"Schlager A. et al. Laser stimulation of the acupuncture point p6 reduces post operative vomiting in children undergoing strabismus surgery, BR.J Anaesth 1998;81:529-32

Salt NACL P6- Acupressure Point is located in adults on the anterior surface of the forearm, approximately three finger widths down from the first wrist crease.(children about two+ fingers)

660nm probe,3-4 joules one

minute at the P.6 point reduces gag

reflex in many patients

Isolite placed onpatient with

gag reflex problem.

Lawrence Kotlow DDS

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The gagger !

Lawrence Kotlow DDS14

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! A photobiostimulating effect!Reduced local anesthetic requirements!Allows for using High Speed handpiece!Success rate 80-90 percent of the patients

30 seconds to 2 minutesNon-contactNon-thermal

DEFUSED LASER ENERGY

Creating laser initiated hard tissue analgesia with hot lasers

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! Using hot (surgical) lasers to produce photobiostimulating effects


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Lawrence Kotlow DDS

Response of one child

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Reduction in the need for a mandibular block

Increased uptake of anesthetic agent (can also be used to get rid of numbing more quickly) Reduction of swelling if you injure a blood vessel during

injection

Effective patient management

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!Mode 3-one minute each cheek, intraorally 660nm probe 30 seconds on large lesions

!Parent said excellent relief that night

!4 days later returned almost lesion free

Viral & herpes like lesions

!"#Watanabe f, et al Usefulness of Low-Level Laser for Control of Painful Stomatitis in Patients with Hand-Foot-and-Mouth Disease Journal of Clinical Laser Medicine & Surgery. Dec 2003, Vol. 21, No. 6: 363-367

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Lawrence Kotlow DDS

Facial trauma Q1000 mode 1 three minutes & 660nm one minute

Initial injuryexternal

48 hours later internal28

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Trauma to upper anterior teeth

660 nm laser probe for 2 minutes

Dental and soft tissue trauma benefits

!"# Erickson F; ASCD J Dent Child. 1995 july-Aug; 62(4) 256-261

Anterior tooth trauma in the primary dentition: incidence, classification, treatment methods, and sequelae: a review of the literature.

$"#Andreasen JO : Endod Dent Traum, 1998;Feb;14(1) 31-44 Sequelae of trauma to primary incisors.I.Complications in the primary dentition

Lawrence Kotlow DDS

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Trauma to upper anterior teeth , partially extruded

2/15/ 2006

3/10/ 2006 5/15/ 2006

1/28/2008

660 nm laser probe for 2 minutes

1 month3 months

2 years

Lawrence Kotlow DDS

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5 days post trauma

9 mo post trauma

Initial trauma

2 years post 2 months post trauma

! Traumatic injury to primary teeth! In many cases normal effect of trauma causes primary

teeth to devitalize in 2-6 weeks after traumatic injury.! Laser 1 minute (day 1 and day 3) = vitality remains

Maintain tooth vitality(660nm)

Lawrence Kotlow DDS

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14 month old infant 11/3/10

Partial avulsion of lower central incisors and fracture of buccal plate of bone

11/3/10 11/3/10

11/3/10

11/3/10

11/5/10

11/5/10

660 nm4 j/minute

lingual & buccal

11/24/2010

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Lawrence Kotlow DDS

Tooth had 660nm laser placed for 2 minutes on partially avulsed left central incisor. This was repeated on day 4 and day

14( 4.4j)

Week sixWeek two 17 months

Partial avulsion of maxillary central incisor

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Mode 1, three minutes; 660 probe intraorally 1 minute

TMJ pain & long appointments

intraorallyDirectly over TMJ area

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Reduction of muscle trismis and edema (swelling)

Stimulates the immune system and brings neutrophils to site of infection for faster healing– Apply 8J to submandibular lymph

nodes

Laser Application will not preclude use of antibiotics in most cases but will stimulate the effect of the antibiotic by stimulating lymphatic system Mode 3, one minute

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Thank you for you interest and time today

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