Differences between low level laser therapy and triamcinolone acetonide kenalog on healing of recurrent aphthous ulceration

Aim of the Study: The Expected benefit is comparison between new high technical arena low level laser (LLLT) and conventional treatment (triamcinolone acetonide kenalog) and select the most effective and faster method for treatment by assessing clinically the effect of these two methods on healing process of recurrent aphthous ulceration. Subjects, materials and methods: A prospective study of 34 patients, age range 11-45 years, with RAU lesions were divided into: Control group: RAU patients without any treatment. Group I: RAU irradiated with 1.5 Joule laser into two doses (in alternative day). Group II: RAU given triamcinolone acetonide kenalog in orabase daily in two doses. The results obtained account for duration of lesions, size measurement, pain symptoms, and presence of erythema in three visits. Results: Clinically the mean duration of ulcers healing did not differ widely from control group. The pain sensation of RAU that was treated decreased. Statistically, there is no significant difference in the healing process of RAU treated by LLLT and treated by triamcinolone acetonide kenalog. Conclusion: low level laser therapy is biomodulation (biostimulation and bioinhibition). Topical triamcinolone is a glucorticoid that has anti-inflammatory and anti proliferative effects. Clinically they slightly decreased the normal time of healing of this immune dysregulating lesion, but there is no superior difference in clinical effects between these two methods. ةصلاخلا : يريرسلا مييقتلل تصصخ ةساردلا هذه نإ يجوم لوطب ةقاطلا ئطاولا لصوملا هبش يئانث رزيللا عاعشإ ريثأتل ٩٠٤ و ةرركتملا ةيعلاقلا تاحرقتلا ءافش ىلع ةرمتسم ةمزح وذ ، رتيمونان نولونيسمايارتلا جلاع ىلع ىضرملا عم اهتنراقم يعضوملا كولانيآ ديانوتسا . تسأ دقل مدخ ) ٣٤ ( رمعب ضيرم ) ١١ ٤٥ ( اوضرع و ةنس عاعشلإ نيتعرج لكش ىلع رزيللا يلاتلاآ عيماجم لكش ىلع اومسق دق و ،رخآ و موي نيب : ةطباضلا ةعومجملا : نم يناعت ىضرملا ةعومجم يه و جلاع يأ اهئاطعإ نودب ةرركتملا ةيعلاقلا تاحرقتلا . ىلولأا ةعومجملا : ناعت يتلا و ىضرملا ةعومجم تاحرقتلا نم ي ل تضرعو ،ةرركتملا ةيومفلا ) ٥ ر ١ ( رزيللا عاعشإ نم لوج . ةيناثلا ةعومجملا : : نم يناعت يتلا و ىضرملا ةعومجم ةرركتملا ةيومفلا تاحرقتلا دقو تيطعأ عقوم ىلع يعضوم حسم كولانيآ ديانوتسا نولونيسمايارتلا ةباصلإا . جئاتنلا : تاحرقتلا ةدم ةفرعم قيرط نع تذخأ مللأاب ساسحلإا دوجو و ،اهمجح سايق و ،اهروهظ خيرات ءدب نم رخآ و موي نيب ضيرملل تارايز ثلاث يف كلذ و حرقتلا لوح رارمحلاا دوجو و ،اهل بحاصملا . ةرركتملا ةيعلاقلا ةيومفلا تاحرقتلل ماتلا ءافشلا ةيلمع ىلع فلاتخا دجوي لا هنأ ايريرس ةساردلا هذه ترهظأ نيب نيتقيرطلا . ضرعتلا دعب ةرشابم لوزي حرقتلل بحاصملا مللأا ناف كلذل ةفاضلإاب عاعشلإ ةليلق ةجردب دوعي هنا وأ رزيللا . جاتنتسلاا : رزيللا مادختسا نيب قرف دجويلا ئطاولا جلاع يف يعضوملا كولانيآ ديانوتسا نولونيسمايارتلا و ةقاطلا ةيعلاقلا ةيومفلا تاحرقتلا . Annals of the College of Medicine Vol. 34 No 1, 2008 © 2008 Mosul College of Medicine 36 phthae typically are small, round or ovoid ulcers with a circumscribed margin, erythematous halo and yellow or grey floor . Aphthous ulcers are among the most common oral lesions in general practice with a frequency of up to 20% and recurrence rates as high as 50%, with higher prevalence in high socio-economic classes. The ulcers, which usually occur on non keratinized oral mucosa, can cause considerable pain and may interfere with eating, speaking and swallowing. The lesions are confined to the oral mucosa and begin with prodromal burning any time from 2 to 48 hours before an ulcer appears. During this initial period a localized area of erythema develops. Within hours, a small white papule forms, ulcerates, and gradually enlarges over the next 48 to 72 hours. (2) . Recurrent aphthous ulcer (RAU) is classified on the basis of ulcer size and number as minor, major and herpitiform. The cause of RAU is idiopathic in most patients. The most likely precipitating factors are local trauma and stress; Other associated factors include nutritional deficiencies, food allergies, genetic predisposition, immune disorders, use of certain medications, HIV infection and systemic diseases (2, . Histologically, aphthae are mucosal ulcerations with a mixed inflammatory infiltrate . Numerous studies have been conducted on the immunopathogenesis of RAU and there is good evidence of immune dysregulation. It has been postulated that, in the presence of a local or systemic stimulus, the epithelial cells become targets for the cytotoxic action of lymphocytes and are subsequently destroyed. Current evidence would suggest that RAU is not an autoimmune disease. The immunopathogenesis of this common disorder, however, is yet to be elucidated (3. The primary goals of therapy of RAU are relief of pain, reduction of ulcer duration and restoration of normal function. Current treatments are palliative and focus on pain reduction and acceleration of healing process (2, . Topical corticosteroids such as hydrocortisone hemisuccinate, triamcinolone acetonide paste and beclomethasone dipropionate are effective and have two modes of action; anti inflammatory action and specific blocking effect of T-lymphocyteepithelial cell interaction. Most steroids will provide short term pain relief, and some have the problem of being prescription medications, being costly and having the potential for significant side effects and systemic implications (7. Low level laser therapy (LLLT) is based on the concept that certain low level doses of specific coherent wavelengths can turn on off certain cellular components or functions. Dentists have been administering LLLT to their patients as an aid in healing, reducing pain and swelling, and controlling oral infections for at least the past three decades. The oral aphthous ulceration is one of these mucous membrane diseases that was treated by LLLT and many attempts were done to show the efficacy of certain doses of soft laser on the healing process without any side effect (10. Other researchers claimed that low level laser A Annals of the College of Medicine Vol. 34 No 1, 2008 © 2008 Mosul College of Medicine 37 produced rapid reduction of lesion size with resolution of edema and erythema . Subjects, Materials and Methods: Subjects: thirty four Iraqi patients have RAU only, they were otherwise healthy. These patients were requested to refrain from the use of any medicaments throughout the trial. They were divided into: Control group: were 12 patients with RAU only and should not have other systemic disease in which RAU is a part of its findings. The study samples consist of: • Group I: included 11 patients suffering from RAU only, they were irradiated by1.5 Joule continuous mode laser (time of exposure: 5 min). • Group II: included 11 patients suffering from RAU only, they were given triamciolone acetonide kenalog in orabase. Materials: Laser apparatus a 904 nanometer GalliumArsenide diode laser, the emission used is continuous mode, the average power in optic fiber is 5 milli watts, thus dose measurement in each session was 1.5 joule according to equation: Energy (Joule) = average power (Watt) × time of radiation (second) E = 0.005 W × 300 sec = 1.5 J • Triamcinolone acetonide kenalog in orabase 1 mg (0.1%) dental past.