# A Review of CO\({}_{2}\) Laser-Mediated Therapy for Oral Mucosal Lesions
###### Abstract  
(1) Background: Several studies investigating the clinical outcomes of potentially premalignant oral epithelial lesions treated with CO\({}_{2}\) lasers have been published over the last decades. (2) Methods: A systematic research review was performed for studies published between 2011 and 2021 in the PubMed, Science Direct, and Google Scholar databases. (3) Results: Initially, the search identified 52 relevant articles. The primary analysis of the titles and abstracts eliminated 22 articles, leaving 30 articles whose full texts were examined. A total of 22 articles met the inclusion criteria. The studies were classified into 3 categories. (4) Conclusions: After evaluating the results of all the studies included in this review, an initial general statement can be made, namely that CO\({}_{2}\) lasers are a treatment option worth taking into consideration when approaching oral mucosal lesions. When compared to other types of lasers used in dental practice, the CO\({}_{2}\) laser stands out due to its many advantages. CO\({}_{2}\) laser; oral leukoplakia; oral erythroplakia; oral lichen planus; oral dysplasia  
1  
11  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
1  
lower risk of turning into a malignant lesion, and (b) non-homogeneous leukoplakia, which can be identified by thick, hardened, raised surface with red spots, and compared to the homogeneous counterpart, presents a high risk of becoming malignant. Homogeneous leukoplakia usually appears as a white or grey lesion with a uniform aspect and well-defined margins, and it is most frequently located on the jugal, palatal, and lingual mucosa. Non-homogeneous leukoplakia can be subdivided into verrucous, proliferative, nodular, and erythroplakia [3,4]. Oral erythroplakia (OE) has a clinical aspect of a red, velvety plaque or patch that cannot be attributed to any other pathophysiologic process. In some cases, it is associated with oral leukoplakia (erythroleukoplakia). Although the incidence and prevalence of OE are inferior compared to those of OL, the histologic analysis of biopsied homogenous OE lesions showed 51% invasive carcinoma, 40% carcinoma in situ, and 9% mild or moderate dysplasia [1,5]. Oral lichen planus (OLP) is considered a systemic mucocutaneous disease, affecting the oral mucosa, as well as the skin, nails, the scalp, or the vaginal mucosa, with a female predilection [1,6]. Intraorally, the most common sites are the buccal mucosa, gingiva, and tongue, often situated bilaterally and symmetrically, while the most frequent morphologic forms of the disease are the reticular, papular, plaque-like, bullous, atrophic, or erosive forms [7]. Oral submuc fibrosis predominantly affects individuals living in the Southeast Asian countries and, while multiple etiologic factors have been linked to this pathology, it seems that the use of area nut and its derived products (including betel quid ad gutkha) is the most predominant factor [8,9]. Local symptoms vary from sudden intolerance to spicy foods, associated with the formation of vesicles and ulcers, to xerostomia, restriction of the tongue's range of motion, and a progressive reduction in the elasticity of the oral mucosa [10]. Oral epithelial dysplasia is defined by WHO as a precancerous lesion of stratified squamous epithelium characterized by cellular atypia associated with abnormal maturation and stratification [1,11]. There are several treatment options available in the case of oral leukoplakia, such as drug therapy, surgical excision, freezing, or laser [5,12,13]. The excision of tumorous/pigmented tissue is so far considered to be the best possible solution for obtaining healthy surrounding tissue [3,4]. The classical surgical treatment of tumors is usually considerably invasive, although often a mandatory procedure.