Canker sore treatment; also, using your laser to the fullest

I know we spent a lot of time talking about using laser for some very serious medical conditions, like neuropathy, traumatic brain injury with cognition and mood stabilization, sleep quality, addiction, fracture healing, and other serious conditions that affect patient's quality of life to a major degree. But I think it's easy to lose focus on how beneficial laser can be in practice, because I get a lot of questions from doctors all the time saying, "well, I want to get laser so that I can treat traumatic brain injury, or osteoarthritis, or neuropathy," and that's fine, that's great to go ahead and have a target to start with, but once you have laser therapy in your office, I think it's easy as a clinician to almost forget all the different ways that laser therapy can be utilized to help all of your patients. And so, when I saw this study, I thought, you know what? This is a great break that we can take from these serious health conditions and from the science of how laser therapy works.


Canker sore and laser study

Let me go ahead and give you the title of this study. It is Photobiomodulation therapy for the management of recurrent aphthous stomatitis in children: clinical effectiveness and parental satisfaction. This is an Italian study published in July 2020 in an Italian journal, which translates to "Oral medicine, oral pathology, and oral surgery." And let me clarify before I go any further that we're talking about using laser for canker sores, recurrent canker sores, not cold sores. These are the small, shallow white sores that you can get inside the mouth, not on the lips. The researchers are actually talking about these recurrent multiple sores in children that can actually affect nutrition, because it is painful to eat. It becomes painful to talk, so it can affect mood, social interaction, and schooling. These are self-limiting, they do get better on their own, but it's a little bit stressful on the parents, it's not fun for the kids. And the third or fourth time an episode hits it's kind of frustrating.

And so, this is a little bit less of a serious condition than somebody who might be having to have their foot amputated because their diabetic wound isn't healing. But still, we're talking about improving quality of life for some kids and parents so it's worth looking into, and

I think once we get done going through this, you'll have a little bit of a renewed interest in using your laser to help even minor conditions like this in practice.


There are some options out there right now for these kind of self-limiting small ulcers, which includes things like, topical anesthetics, mouth washes, immunomodulating drugs, and some herbal remedies too. When these sores start interfering with eating swallowing and speaking, that just makes things a little bit more miserable and children in particular are more prone to superinfections and hypersalivation. If you've got a kid that's in school and they're dealing with sores plus stress, and they're not feeling like eating, they're going to have a hard time concentrating, maybe anxious, and having a harder time in school. It's worth going ahead and finding a good way to try and reduce the pain and shorten up this disease process.


There's a lot of factors that can start these episodes. It can be immune system dysfunction, genetics, food allergens and food sensitivities, nutritional deficiencies, hormonal shifts and simple stress. Our kids these days have a lot of stress. Kids right now are going through so much, and school isn't even a stable factor for them really anymore with schools that are shut down, schools have gone to partially online or all online, maybe they've been quarantined a couple of times already. I mean, this was a stressful time for kids just as it is for parents. And that can even produce more of these attacks of the small ulcerations in the mouth. It just adds to the burden that these, these kids have to go through.


Laser therapy for canker sores

The Italian researchers that wrote this paper said, okay, looking at some of the past research, we've seen, some research on this particular problem with different colors of laser, including blue light at 450 nanometers, visible red at 645 nanometers, but also infrared at 808 and 2940. The biggest response in this previous study was seen to this visible red light at 645 nanometers. And so these researchers said, all right, let's take this visible red laser and see if we can help with not only pain relief, but also the size of these ulcerations. And then also, is it a tolerable procedure for the parents?


So, the researchers applied this visible red laser for three days in a row and assessed pain on day four and then one week, and then a week and a half later. They were using a 645 nanometer visible red laser at 100 milliwatts with a one-centimeter square spot size and spent 30 seconds per spot with an energy density of 10 joules per centimeter squared.

And it was continuous. It was not pulsed. Concurrently, they did a sham treatment that was the same setup just with the laser deactivated so that they would be able to compare active treatment versus a placebo effect. When they evaluated the results, it was very, very clear that the group that received this red laser treatment got quite a bit better results on pain, as well as the size of these ulcerations. And I'll give you a quote from the article. They say, "even if the exact mechanisms through which the laser induces pain relief are still not clear, it has been demonstrated that laser light has three main effects; analgesia, anti-inflammation, and promotion of wound healing." And when you're talking about these recurrent ulcerations inside the mouth, if you can get the pain down, you can get them to close up quicker, that is going to definitely increase quality of life for these patients.


Again, this is not saving lives necessarily, but still to these kids and their parents, it was important to get them feeling better. And when you have this tool in your office, you might as well be using it. I guarantee if you look back over the last year, if you treat any kids at all, you've definitely had kids come through your practice that had this going on. They might not have talked to you about it, but if you know that laser can be a solution for this problem, well, you might start noticing more of those patients and being able to help them out. Just a couple of treatments can make a big difference.


How many treatments will it take?

One of the criticisms that I've seen in other papers about laser therapy is that it requires multiple treatments and that that's inconvenient and it raises the cost of the treatment. Well, these researchers looked at how problematic the treatments being done were for the parents, not just the patient, you know, the child, but also for the parents. How inconvenient was it? Were they dissatisfied with the length of time that the treatment took or having to come in three days in a row? Turns out the parents were very satisfied and really had no problems with coming in for those treatments, whether it was a sham treatment or a actual laser treatment.


We had a patient just the other day who happened to mention it kind of offhand. "Oh, I've got these, these little canker sores coming up. This happens every now and then that I get these sores and I know the next week is just going to be terrible." And we said, well, hold up. Why don't you let us go ahead and do some laser treatment on there and see if we can help with the pain? And it was, she said, amazing. The pain went down almost immediately. Two days later, she had no ulcers in the mouth. And she was so happy, and she wasn't even here for that. She was here to have us work on her neck pain and her arthritic changes going on in the neck. But being able to include that treatment really helped her. She was much more comfortable being on the phone the next day at work. It was easier for her to eat and to converse, and she was just really blown away at how quickly the laser addressed the pain.


Get more out of your laser

I would encourage you get a little bit creative with your laser treatment. Remember that it's a great tool and you can use it for many different conditions in practice. You need to do the very best you can for your patients, and in this case, using more laser for conditions like aphthous stomatitis will not only make your patients happy, but will also help you use your laser more frequently and improve your revenue stream.


If you have questions about how to make the most out of your investment, please contact us anytime. We can set you and your staff up with excellent training and clinical support and make this a rewarding modality for your practice!