## 4 Discussion
They also concluded that irradiation exposure of the denture base and soft tissue with 10 J of energy should be directly applied without the use of a methylene blue photosensitizer at a concentration of 450 ug/mL [25]. Contrary to these studies, some researchers have stated that _candida albicans_ cells are resistant to radiation wavelengths and are not affected by PBM [25; 28]. To serve this purpose, target microorganisms should be sensitized first by the application of dyes. The reactive oxygen components produced accelerated the perforation of the cell membrane, fastening the translocation of photosensitizer molecules into the cell and causing photodamage to the internal cell organelles [25]. It is also reported that the dyes might be lethal to the microorganisms even in the absence of irradiation [29]. However, clinical and laboratory trials have described different results. For instance, [PERSON] et al. [30] investigated the effect of PBM at various wavelengths in a clinical study with and without \"erythrosine, curcumin, and toluidine blue\" dyes at 405, 532, and 650 wavelengths on fungi. They reported that PBM with erythrosine and curcumin with blue laser light alters the molecules intracellularly, which decreases the antifungal activity of low-level laser therapy. However, [PERSON] et al. [31] claimed that laser irradiation at 808 nm with indocyanine green dye potentially reduces the growth of _Candida albicans_. These findings are in accordance with the current study, where the fungicidal activity of PBM is substantiated by the prior application of a methylene blue photosensitizer at a concentration of 450 ug/mL for 10 min. [PERSON] et al. [32] analyzed the clinical outcome and mycological effectiveness of PBM and nystain in denture stomatitis patients. The study revealed no difference in the antifungal activity of both Nyatatin and PBM. [PERSON] et al. [28], with a similar methodology to our study, applied PBM with methylene blue and miconazole to dentures and soft tissues to manage DS. The methods of [PERSON] et al. [28] were different from those of [PERSON] et al. [32]. The former study used methylene blue dye in the first appointment, whereas the other sessions were solely conducted with only PBM. However, [PERSON] et al. [32] applied PBM with a photosensitizer agent three times a week for 15 days, with six sessions overall. [PERSON] et al. [28] reported a 40% decrease in _Candida albicans_ from a palatal mucosal smear with PBM, while, on the other hand, the clinical signs and symptoms were improved by 80% in the miconazole group. Additionally, in the miconazole group, the recurrence was lower at 12.5% compared to the PBM group at 25%. The findings of this study revealed that the application of PMB drastically improves stomatitis in denture wearers. Furthermore, PBM therapy also improves the OHRQoL in such patients. However, the outcome needs further clarity, for which additional investigations with trials are needed to compare the clinical efficacy of PBM with the _Candida albicans_ reduction count. We assume that since PBM affects the cell membrane of microorganisms, the modification of the membrane in response to environmental stimuli may alter it and reduce the sensitivity of fungi to the laser treatment. Furthermore, as proven, the fungi keep an extracellular biofilm as a mechanical barrier to chemical agents, which may substantiate the microorganisms defense against any antifungal agents. This study, with a strong methodology and a focus on patient perception, outlines the importance of PBM in DS treatment, but despite its strengths, we met some limitations. The study outcome was based on a laboratory analysis of the CFU counts of _Candida albicans_ only, which does not provide a clinical correlation or focus on the risks or side effects of PBM, which may appear in the long run. Furthermore, the PBM could not be compared with other chemical or antifungal agents to produce an unbiased outcome. The use of PBM could produce radiation.