# A Review of CO\({}_{2}\) Laser-Mediated Therapy for Oral Mucosal Lesions
###### Abstract
As far as malignant lesions are concerned, it is generally acknowledged that their evolution is rapid, may or may not be symptomatic in the initial stages, and that they present unpredictable characteristics of size, appearance, morphology, limits, associated symptoms, and invasiveness in the neighboring tissues [3]. In the case of oral erythroplakia, due to the high risk of malignant transformation, the treatment protocol includes excision to the submucosal level (when the tongue is not involved) or to the superficial muscular level (when the tongue is involved) [1,14,15]. Primary treatment in the case of oral lichen planus includes local medical therapy, such as topical corticosteroids [16], while second-line therapy includes other topical agents (cyclosporine, retinoids, calcineurin inhibitors, etc.) and the use of photodynamic therapy [17]. The treatment protocol for oral submuc fibrosis consists of the removal of risk factors associated with conservative therapy (micronutrient supplementation, antioxidant therapy, enzymatic degradation, and physical rehabilitation) [9,15]. In some cases, surgical therapy is indicated in order to alleviate trismus through excision and the release of fibrotic tissues [8]. Contemporary therapy for oral epithelial dysplasia includes cold knife excision, CO\({}_{2}\) laser ablation, antioxidant therapy, immunomodulating treatment, or any combination of the above [18,19]. However, the risk of recurrence and malignant transformation is high in the case of oral dysplasia [20]. While the excision of tumorous/pigmented tissue is, so far, considered to be the best possible solution for obtaining healthy surrounding tissue [3,4], in the case of laser therapy,the radiation is absorbed by the water in the tissues and then converted into heat energy, by which the irradiated tissues are removed [21; 22]. When using the surgical approach, the aim is to achieve lesion-free margins in the healthy surrounding tissue. However, the consequences of this kind of therapy mainly refer to the loss of soft tissues in the affected area, as well as a complete or partial loss of function and sensitivity in the excised area. The circumferential safety margins that are employed will induce the loss of healthy tissue, the replacement of which is necessary with tissue reconstruction techniques [4]. Depending on the size of the excised area, healing through primary intention may occur when simple suturing techniques can be applied, with or without flap usage. For example, when the lesion excision involves the lingual, sublingual, and/or jugal mucosa, the most frequently used flap is the nasolabial flap [4]. In the case of CO\({}_{2}\) laser, the thermal effect of the laser is used in treating oral leukoplakia lesions. When a CO\({}_{2}\) laser with certain energy irradiates biological tissues, those absorb the laser's energy and transform it to heat energy [23; 24; 25]. Under this heat energy, the temperature inside the biological tissue rises rapidly (reaching hundreds of degrees) causing protein coagulation and necrosis [26; 27]. Medical professionals around the globe are constantly striving to find therapeutic methods that are as non-invasive as possible while providing more comfort for their patients, during and after the intervention. A laser-based approach appears to be a solution when it comes to the disadvantages of classical surgical therapy. The advantages of laser treatment include shorter operating times, less damage to surrounding tissues, less scarring, less postoperative pain, less swelling and additional intraoperative hemostasis, and surgical precision due to the focused light beam [28; 29; 30; 31]. The aim of this review was to investigate the latest outcomes regarding the effectiveness of the CO\({}_{2}\) laser therapy method in the case of potentially premalignant oral epithelial lesions compared with other therapeutic approaches.