What is the Role of Photodynamic Therapy in Periodontics?

Periodontal disease is one of the most common dental issues faced by the majority of the population. Around 75% of all the Americans have been estimated to suffer from periodontal disease and associated health complications.

Periodontal disease is a form of gum inflammation that progresses to affect the bone, teeth, and surrounding oral tissues.

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Often, periodontal disease is painless, which is one of the prime reasons for ignorance of this condition. Accurate diagnosis and prompt treatment of the periodontal disease can help to save the integrity of tooth structure and the surrounding bone.

Among the several approaches, photodynamic therapy has recently gained attention. It has shown positive results in treating gum inflammations and periodontal issues.

Photodynamic therapy is a non-invasive photochemical approach that uses visible light, a photosensitizer, and oxygen to target the bacterial cells without potentially harming the host tissue. (1)

It is essential to note that photodynamic therapy is not considered as replacement therapy. Moreover, photodynamic treatment is effective in addition to conventional scaling and root planning.

Today’s article will highlight the working mechanism of photodynamic therapy and its role in treating periodontal diseases effectively.

What is photodynamic therapy?

Photodynamic therapy is a recent advancement in the field of dentistry. It is a non-invasive photochemical approach which is used for infection control in the affected site while causing no harm to the surrounding healthy tissue. (2)

Photodynamic therapy was first recognized and approved by the U.S Food and Drug Administration to treat pre-cancerous skin lesions of the scalp and face.

Recently, the application of photodynamic therapy on infected periodontal tissues showed excellent results and faster recovery as compared to conventional scaling and root planning.

What is periodontal disease?

Periodontal disease is one of the most common dental issues faced by a large number of population across the country. It is a type of gum inflammation which is mainly caused by excessive plaque and bacterial accumulation.

Typically, periodontal disease involves break down of bone and tissues in the infected site, which result in eventual tooth and bone loss.

Some of the common signs and symptoms of periodontal disease may include –

  • Bleeding, redness around the gums
  • Swelling or inflammation of the affected tissue
  • Formation of periodontal pockets
  • Tooth mobility
  • Receding gums and associated tooth sensitivity
  • Formation of an abscess around the teeth
  • Tooth loss

What is the role of photodynamic therapy in treating periodontal disease?

Treatment of the periodontal disease requires a breakdown of the bacterial biofilm. Unlike antimicrobial drug therapy, photodynamic therapy provides bacterial eradication by locally acting on the infected tissue in a much faster and effective way. (3)

Typically, photodynamic treatment consists of three essential non-toxic components –

A harmless low-intensity visible light

Usually, a low-intensity light is used in a range of lasers with varying wavelengths. For example, visible light to argon lasers and helium-neon laser to infra-red diode lasers.

The type of light and the dose depends on the depth of destruction and type of tissue involved. However, for the periodontal disease, a red light laser with a wavelength of 630-700nm is commonly used to activate the photosensitizer.

A photosensitizer

Photosensitizers are typically a dye substance that gets absorbed by the bacterial cell and infected tissue. Photosensitizers commonly used in periodontal treatments are toluidine blue O or methylene blue.

Usually, the laser light activates the photosensitizer and promotes it to bind with the bacterial membrane. This action increases the permeability of the dye and provides a visualization of the extent and severity of the infection.

Oxygen

Oxygen is the most crucial aspect of photodynamic therapy. It combines with the free radicals produced during photoactivation. Free radicals are highly reactive ions which interact with molecular oxygen to produce superoxides, hydroxyl radicals or hydrogen peroxide.

These chemical ions are destructive towards the bacterial cell membrane. Additionally, they do not cause harm to healthy tissue. This process is also referred o as the antimicrobial photodynamic oxidization. (4)

What are the advantages of photodynamic therapy?

Photodynamic therapy is a practical approach to reduce inflammation and change the local environment of the periodontal infection. Some of the advantages of photodynamic treatment include –

  • Photodynamic therapy is an ideal adjunct to conventional scaling and root planning.
  • It significantly reduces the treatment time
  • It is non-invasive local therapy and does not require anesthesia
  • It reduces the risk of bacteremia (5)
  • Improves tooth sensitivity
  • Does not affect the healthy host tissue
  • Allows faster healing

What is the cost of photodynamic therapy?

The cost of photodynamic treatment depends on the severity, depth of destruction, and the type of tissue involved. Location of the clinic and specialization of the dentist may also affect the final cost of the procedure. Typically, photodynamic therapy may cost around $100 – $400.

Take away message

Periodontal disease is a progressive form of gum disease which involves inflammation of the supporting tissue, including the teeth and the underlying bone.

Periodontal disease can quickly escalate from simple gum inflammation to aggressive destruction of the periodontal membrane. Some of the potential risk factors include excessive bacterial and plaque buildup and lack of maintenance of oral health.

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Photodynamic therapy is a non-invasive approach which uses a low-intensity laser, a photosensitizer, and oxygen.

These three components locally target the bacterial cells and reduce inflammation of the periodontium while maintaining the integrity of the healthy surrounding tissue.

Photodynamic therapy is FDA approved and holds a promising role as an antimicrobial substitute for treating periodontal and gum related issues.

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