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Review Article

The Role of the Near-Infrared Light-Emitting Diode in Dental and Oral Surgery

Erin Morency1, Manuel Dujovny2*, Onyekachi Ibe3, Pablo Sosa4, Fabian Cremaschi4, Lori Burkow-Heikkinen5

1School of Nursing, Oakland University, Human Health Building, Rochester MI, USA.
2Department of Neurosurgery, Wayne State University, Detroit MI, USA.
3College of Engineering & Information Science, DeVry University, Southfield, MI, USA.
4Department of Neuroscience, Clinical and Surgical Neurology, School of Medicine, National University of Cuyo, Centro Universidad,
Mendoza, Argentina.
5American College of Sports Medicine, Indianapolis, IN, USA

*Corresponding author: Dr. Manuel Dujovny, 1906 Long Lake Shore Drive, Bloomfield Hills, Michigan 48386, Tel: 248 760-4108; Email: manueldujovny@hotmail.com

Submitted: 08-25-2015 Accepted: 09-16-2015 Published: 09-23-2015

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Article



Abstract

Background: Dental caries and periodontal disease are leading reasons for patients to seek dental and oral care.

Objective: To evaluate the effects of the near infrared light emitting diode on wound healing, inflammation, bacteria, osteointegration, and pain.

Material and Method: This article investigates the role of the near infrared light emitting diode on oral and dental disease. A
thorough review of books, journals, PubMed, and social media, and an anecdotic case are discussed

Discussion: Using the infrared light emitting diode, wound healing rates can be increased and inflammation can be decreased. Also bone regeneration and bacterial control can be improved after exposure to the infrared spectrum. Many dental procedures result in pain and the use of the near infrared light emitting diode helps to minimize pain. The near infrared light emitting diode gallium arsenide can be used as an adjunctive therapy for dental procedures that produce inflammation and pain.

Keywords: Biostimulation; extraction; near infrared light emitting diode; low level laser therapy; gingivitis; periodontitis; wound healing; oral surgery

Abbreviations:

NIR: Near Infrared;
LLLT: low level laser therapy;
LED: Light Emitting Diode;
GaAs: Gallium Arsenide;
PMN: Polymorphonuclear Leukocyte;
VEGF: Vascular Endothelial Growth Factor;
FGF: Fibroblast GrowthFactor;
TNF: Tumor Necrotic Factor;
Cox: Cytochrome Coxidase;
NO: Nitric Oxide

Introduction

Since the discovery of the first working laser in the 1960’s,  special emphasis has been placed on the development and use of low level laser therapy in medical treatment. Many forms of therapy using the NIR-LED GaAs for the treatment of pain, wound healing and tendon inflammation have been documented. Near infrared is one of three forms of infrared radiation within the electromagnetic spectrum, ranging from about 630 nm to 1100 nm. The discovery of radiation is credited to William Herschel during the early 1800s, but its industrial use was not developed until the 1950s when near infrared was used as an add-on unit to other optical devices with different wavelengths, such as ultraviolet spectrometers.[1] Einstein’s electromagnetic wave theory was used to identify near infrared light emitting diodes as a useful type of phototherapy.[2]

With improvements of the light emitting diode at the end of the 20th century, the construction, production, and commercial use of the near infrared light emitting diodes resulted in its use in space research which showed plant growth as well as wound healing are affected by the NIR spectrum. The main components inside today’s LED’s are GaAs, gallium phosphide, gallium nitride, or gallium arsenide phosphide. Table 1 highlights important historical dates associated with the development of the NIR LED.

NIR-LEDGaAs and low level lasers are similar in their production of near infrared light, with similar biological outcomes[2], but differ in economical affordability, mobility, and difficulty of use by the general public without specialized technical training. The main difference is that light emitting diodes are monochromatic and noncoherent and the equipment is smaller and reduced in weight and is portable. The NIR-LED obviates some of the problems associated with the laser generation of the wavelength. NIR-LED therapy can allow the patient to be in their own home during the course of treatment, resulting in better patient response and satisfaction. Due to the size and portability of the NIR-LED device , it can be used immediately after an incident or accident. The NIR-LED can decrease patient pain and limit the effects of inflammation.

Examples of common devices that use near infrared radiation are night vision goggles, digital cameras, and remote controls. New devices available also include arms that can attach to a dentist chair and arc over the patient’s mouth, illuminating the oral cavity. Today, near infrared has gone beyond industrial use and is used in a variety of clinical and medical applications such as oxygen spectroscopy, imaging, photodynamic therapy, optic thermography, photobiomodulation, remote monitoring, thermal radiation (heat) and other optical devices.

The NIR-LED equipment is about the size of older model cellular telephones. The unit connects via a cord to the a standard electrical outlet, and the device comes with a specific adaptor. Some models can function with the use of single use or rechargeable AA or AAA batteries as well. The device has been miniaturized and battery powered, also now available in the size of a standard electric toothbrush. This reduced size configuration has allowed it to be used for root canal sterilization and dental curing. The significant reduction in size has facilitated the treatment of the oral mucosa damage which often occurs in preparation of treatment for bone marrow transplantation.[3,4] In this article we will discuss the physiopathology of wound healing and inflammation after tooth extraction.

Oral health care problems are prominent in all age groups. In the US children aged 5-17 are five times more likely to have dental caries than asthma. It is the most common chronic disease in this age group.[5] In many cases tooth extraction is recommended due to the extensive decay. Extraction is also necessary to create space for orthodontic treatment. Post extraction therapy usually involves an ice pack being applied to the area of the face, as well as the prescription of pain medications including anti-inflammatory and narcotics. The rate of oral diseases increases with age; these diseases include gingivitis, root inflammation/infection, and dental caries.[6] Along with these diseases the elderly are having more dental implants as technology improves. In this review we focus on a technique which we believe has been underutilized; the near infrared Light Emitting Diode gallium arsenide. We recognize the unique capabilities of this wavelength to accelerate wound healing and decrease inflammation of the surrounding tissues. We will address the physiological state of the sites treated by dental extraction.

Materials and Methods

Information was gathered from literature searches in books, PubMed, social media, and anecdotal cases on the use of near infrared light emitting diode gallium arsenide on the oral cavity.

Discussion

Most dental pathology can be helped with NIR light as an adjunctive therapy. In dentistry most of the pathology is associated with wound healing, inflammation, or both. Most frequently in children this is initiated by the extraction of a tooth due to dental caries, impaction (necessitated by orthodontic work), or sports related injuries (in particular hockey, boxing, football).[
2]

The repair process after any tissue disruption can be predicted and is reviewed as follows. Key characteristics of acute inflammation include increased vascular permeability, increased interleukin-1, histamine, tumor necrotic factor, and PMN migration. During this initial inflammation NIR light has been successful in decreasing levels of interleukin-1 and -6, as well as tumor necrotic factor.[7,8] NIR light and laser therapy have both been identified as being able to decrease histamine release by decreasing mast cell numbers.[9-10] Nitric oxide is known to maintain vascular tone and NIR stimulation has been observed to increase nitric oxide levels.[11-13]

Wound healing ends with completion of wound repair and tissue regeneration. The main reparative cell is the fibroblast. Whelan et al. compared the use of hyperbaric oxygen with NIRLED and found that fibroblast numbers increased 140-200% as well an increase of 155-171% in epithelial cells[14], similar to those of the oral mucosa. Fibroblasts are able to increase in number and activity with the use of near infrared light, because of the increase in mediators like transforming growth factor-beta and platelet-derived growth factor.[2,10,15] NIR treatments of 3 J/cm(2) resulted in increased fibroblast cell growth without affecting procollagen synthesis [16]Another integral component of tissue regeneration is stem cells; which have been observed to increase in number and activity via near infrared stimulation.[17-18].

Collagen is another important scaffold needed for wound healing, types I and III being prevalent. In a diabetic rat model, diabetic rats treated with low level laser therapy had collagen density and deposition more similar to those of the control, non-diabetic rats, than the diabetic rats who had not been treated.[19]

Metalloproteases are responsible for the remodeling of collagen and the composition of the extracellular matrix due to interaction with fibroblast growth factor. These enzymes create the balance of synthesis and degradation of appropriate molecules for effective regeneration for wound healing and tissue repair, and they can be improved by near infrared light.[20-21] Modulation of all of the wound healing and tissue repair and inflammation processes are accelerated by NIR LED.

Many growth factors play an important role in the tissue regeneration process. Epidermal growth factor and transforming growth factor beta are necessary for cell proliferation and differentiation. Platelet derived growth factor, fibroblast growth factor, and vascular endothelial growth factor are both involved in the process of angiogenesis; while keratinocyte growth factor helps with epitheliazation.[22] In our observations, the NIR-LED GaAs decreased inflammation, while also accelerated wound healing and tissue repair.

Cyclooxygenase-1 and cyclooxygenase -2 are mediators for prostanoid production, which are part of the recruitment of immune system cells to the area of injury and inflammation. [23] Along with maintaining vascular tone, NO is believed to be a competitive inhibitor of oxygen with Cox. It is believed that the addition of NIR light weakens the bond of NO with Cox and allows the binding of oxygen. When NO is unable to bind with Cox mitochondrial activity is increased and more energy is available for use [24].

NIR therapy increases osteoclast formation and bone regeneration. Low level laser therapy has been shown to potentially lower tooth relapse, with the thought being that bone formation occurred more efficiently because of greater osteoclast numbers.[25] El Bialy et al observed increased levels of mandibular growth stimulation on rats treated with NIR-LED over those that were treated with low level lasers [26]. The use of NIR light can help stimulate osteoblasts while minimizing swelling [2].

The development of implant surgery has created a different need for wound healing; more efficient wound healing can lead to increases in implant success rates. Prostaglandin E2 values had a negative correlation with the stability of implants, leading researchers to find a positive correlation between NIRLED therapy and the osseointegration process.[27] Low level laser therapy promoted improved bone healing on rabbits who received titanium implants on their tibia, modeling dental implants, and were treated with a 830-nm laser for seven sessions at 48-h intervals. They postulated that the difference in the hydroxyapatite of calcium value was the reason for the difference.[28] Similarly, Brawn and Kwong-Hing observed accelerated bone healing after a socket graft with hydroxyapatite and 21 days of phototherapy treatment.[29] When using an 830nm laser at 20J/cm(2) Gomes et al found that low level laser therapy improved peri-implant bone repair by increasing stability, bone-implant contact, and bone regeneration.[30] Faria et al observed increased bone formation after implantation of mandibular bone defects in mongrel dogs with the aid of photosensitivity drugs treated by NIR LED [31].

The mouth is a unique environment, significantly colonized by bacteria, increasing the risk for extended inflammation. Common
diseases in humans include gingivitis and periodontitis; the prevalence of these diseases is increased in individuals with lowered immune systems such as diabetes. Along with the healing mechanisms found with LLLT, there is also a microbial inhibitory effect that would be extremely beneficial for decreasing the risk of infection. Obradović et al observed a positive result, with the use of 670 nm NIR- LLLT, on diabetic patients with periodontitis [32]. NIR LLLT has also showed promising results in inhibiting periodontopathogens in adolescents with chronic gingivitis.[33] A study of Porphyromonas gingivalis infected immortalized gingival fibroblasts showed decreased levels of prostaglandin E2 and increased production of antimicrobial peptides.[34] Ricatto et al. observed bacteriostatic properties of NIR lasers and NIR-LED on two different cariogenic bacteria.[35] Gingival recession was treated with connective tissue grafts and either introduced to low level laser therapy or were part of the control group. Those who had the low level laser therapy showed greater root coverage.[36] Guided tissue regeneration of periodontal intrabony defects also resulted in lower levels of gingival recession when treated with low level laser therapy [37].

Pain occurs soon after dental trauma including extraction. Current methods of pain control include ice packs, moist heat, anti-inflammatories and narcotics. Barretto et al observed anti- nociceptive responses after stimulation with NIR low level laser therapy.[38] Vinck et al completed a study using a NIRLED and concluded that the effects on pain were most likely a result of localized effects of the ability of the nerves to conduct signals.[39] After removal of a tooth, the dentist commonly recommends an ice pack to apply to the area. It is the experience of one author that NIR-LED application two to three times a day post removal, at ten minutes per session, for the next seven days, resulted in a significant reduction of pain and inflammation as well as increased gumtition of the socket of the tooth. The pain was relieved without the need of narcotics or other palliative therapies (ice packs). Esper et al. observed a greater reduction of pain sensitivity and orthodontic tooth movement with the use of a NIR-LED(640 nm with 40 nm full-bandwidth at half maximum, 4J/cm (2), 0.10 W, 70 s) compared to a control group.[40] NIR low level laser therapy after supernumerary tooth surgical removal and frenectomy resulted in lower levels of pain.[41] Whelan et al reported the use of NIR-LED decreased pain in children with oral mucositis by 47 percent.[14] After surgical removal of impacted third molars, Batinjan et al used near infrared low level laser therapy to treat wound swelling and temperature changes. The results showed that both swelling and temperature in the wound area were decreased. [42] A double blind study showed that there was a decrease in pain and discomfort after dental flap surgery with the use of 660 nm near infrared laser irradiation (biomodulation).[43]

Both light emitting diodes and low level lasers produce the same effects via NIR stimulation of tissue. As reported, the effects
reduce inflammation, increase wound healing activity, and lower pain. Near infrared low level laser therapy, known more commonly as biomodulation in the dental community, has been a more frequent coadjutant therapy than NIR-LED therapy. Outcomes for these two NIR therapies are similar and should not be used in place of other forms of treatment. NIR LLLT is large, needs training to use, and the laser is expensive. In comparison, NIR-LED can be portable, used with minimal training, and are more affordable. With the improvements in NIR-LED technology they are becoming more economically viable. The NIR NIRLED does not require the patient to sit in the dentist’s chair for treatment and a prescription is not needed to buy a NIR LED. The benefits of NIR-LED therapy are greater than those with LLLT and the current results are comparable, creating the need for further research, including randomized double blind studies, in the area of NIR-LED effects on dental care.

Otolaryn table 18.1

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Cite this article: Dujovny M. The Role of the Near-Infrared Light-Emitting Diode in Dental and Oral Surgery. J J Otolaryn. 2015, 1(4): 018.

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