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Efficacy of Low Level Laser Therapy in Oral Mucositis

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Efficacy of Low Level Laser Therapy in Oral Mucositis Mini Review JOJ Nurse Health Care Volume 9 Issue 5 - November 2018 Copyright © All rights are reserved by Clélea de Oliveira Calvet DOI: 10.19080/JOJNHC.2018.09.555774 Efficacy of Low Level Laser Therapy in Oral Mucositis Graça Maria Lopes Mattos¹, Cayara Mattos Costa²and Clélea de Oliveira Calvet3* 1CEUMA University, Brazil ²Federal University of Maranhão, Brazil 3Integrated Clinic Hospital, Brazil Submission: November 02, 2018; Published: November 30, 2018 *Corresponding author: Clélea de Oliveira Calvet , Integrated Clinic Hospital, Maranhão, Brazil Abstract Patients submitted to radiotherapy or chemotherapy induced antineoplastic therapy have as their sequel oral mucositis, which is the main complication arising from the treatment. Laser therapy is a modality that has grown in recent years, with evidences of significant improvements thein the lesion. prevention A literature and treatment review was of oralconducted mucositis. with This seven study publications aims to show in Portuguese the benefits and of low-level English in laser PubMed therapy and application SciELO databases, in patients from submitted 2008 to to antineoplastic therapy and present oral mucositis by means of an integrative literature review on the use of low-level laser to prevent and treat effects.2018 and a summary table was prepared. It was observed that low-level laser therapy is an effective tool in the prevention and treatment of oral mucositis in cancer patients, bringing benefits such as: reduction of pain and severity of the lesion and anti-inflammatory, analgesic and healing Keywords: Laser Therapy; Oral Mucositides; Cancer patients Abbreviations: OM: Oral Mucositis; LLLT : Low level Laser Therapy Introduction Through radiotherapy or chemotherapy, the antineoplastic etoposide, mitoxantrane and cytarabine are the most common treatment can cause cellular damage to the oral epithelium and And 5-fluorouracil, methotrexate, melafalan, cyclophosphamide, salivary glands, as well as changing its functions and causing methotrexate and cyclophosphamide are the most related to the lesions, such as oral mucositis [1]. chemotherapy drugs [6,7]. Amoung these drugs, 5-fluorouracil, appearance of OM [3,6] in patients undergoing antineoplastic treatment. oral mucosa, which becomes swollen and erythematous and may Oral Mucositis (OM) is an inflammation and ulceration of the The main clinical diagnosis of the severity of the OM is lead to the formation of large ulcers covered by pseudomembrane. indicated by World Health Organization in scales varying from This lesion is extremely painful and causes discomfort, dysphagia and systemic weakness, as well as being the most common cause grade 0 to grade 4, respectively: normal mucosa; erythematous presence of extensive ulcer and feeding of liquid consistency mucosa; ulcer involvement and difficulty in solid feeding; of pain in the mouth in cancer patients [2-4]. [8]. In 2014, the Multinational Association of Support Care in from OM can increase the risk of local and systemic infection and Cancer/International Society of Oral Oncology (MASCC/ISOO) has Due to difficult feeding and speech, the ulcerations resulting can compromise oral function and interfere with antineoplastic treatment. It also may increase hospitalization stays time and form of OM prevention in patients who has received hematopoietic recommended low-level laser therapy because of its benefits as a stem cells [9]. around 7 to 10 days after chemotherapy and generally from the influence the nutritional status of the patients. Lesions appear second week of radiotherapy[3,5,6]. laser therapy (LLLT), has been used in prevention and treatment Some chemotherapy drugs are used alone or associated The photodynamic laser therapy, more specifically low-level with radiotherapy in the hospital scope are responsible for the has biological effects through photophysical and biochemical of OM in recent years [10-12].The application of LLLT on OM appearance of OM lesions, because they act mainly on tumor processes, increasing the cellular metabolism by stimulating cells and affect the tissues of oral mucosa that result from immunosuppression. And due to the great sensitivity of the oral analgesic and cicatrizator effect of lesions in the mucos [13] and mitochondrial activity. The result is an anti-inflammatory, tissues and toxic effects of the chemotherapy drugs, lesions in collagen and elastin production, contraction of the wound and oral cavity are the most common arise from chemotherapy [3]. acceleration of healing, keeping the integrity of the mucosa [1]. JOJ Nurse Health Care 9(5): JOJNHC.MS.ID.555774 (2018) 001 JOJ Nursing & Health Care an ideal dose, and present as an accessible possibility for the tratment of OM induced by antineoplastic therapy. The authors A systematic review and meta-analysis [14] has showed and infrared laser therapy, which had the potential to partially still revealed that there is a possibility of LLLT become a part of a strong association in the treatment of OM by low-level red suppress the development of the OM induced by antineoplastic the regular oral care in treatment of cancer. Thus, this study aims duration of symptoms. Although laser therapy is demonstrating that present OM, through an integrative review of literature about therapy and significantly reduced pain, severity of the lesion and to show the benefits of the application of LLLT in cancer patients the use of this laser as an preventive measure and OM treatment. patients undergoing antineoplastic therapy [12,15,16] there are a considerable level of efficacy in reducing the grade of OM in still no established protocols for the treatment of OM in cancer Materials and Methods patients [17]. Nevertheless, studies have suggested that laser The integrative review is a descriptive research method therapy could be used as a form of prevention and treatment of where it can search, critically evaluate and synthesize the the OM lesions induced by the treatment of cancer [13,18,19]. available evidences about the theme, in order to show the current knowledge of the subject investigated, to intervene effectively in That way, Bensadoun and Nair [19] proved that there are health care and to reduce costs, to identify gaps directed to the consistent and favourable evidences to LLLT, as long as from development of future research [20]. Table 1: Summary of articles included in this review. No Authors Title Objective Results This study aimed to compare the There was a reduction in frequency and severity of oral Use of therapeutic frequency and the Evolution of oral mucositis with the use of laser. The results suggested Khouri et al. laser for prevention 1 mucositis among patients submitted that the therapeutic laser could be used in both cases [18] and treatment of oral to therapeutic laser and conventional as a new form of prevention and treatment of oral mucositis therapy. mucositis. A systematic review This study aimed to review the and infrared laser therapy may partially inhibit Therethe development are consistent of evidences oral mucositis that low-levelinduced by red 2 Bjordal et al. the prevention and treatment of oral laserand meta-analysistherapy in cancer of mucositiseffects of low-levelinduced by laser antineoplastic therapy in the effect of low-level the pain, severity and duration of the lesion symptoms therapy. mucositis. antineoplasticcaused therapy, by as oral well mucositis. as significantly reduce therapy-induced oral in the prevention and This study aimed to discuss the Low-leveltreatment laser of cancer therapy Bensadoun Nair 3 laser therapy for preventive and [19] Notherapy adverse are effects recommended of low-level to laser prevention therapy and were treatmentpromising of oral state mucositis of low-level induced oftherapy-induced the art based on reported. treatmentThus, low-level of oral red mucositis. and infrared laser antineoplastic therapy. mucositis:literature review 2012 state and Systematicmeta-analysis. review This study aimed to review the of laser and other Migliorati et al., light therapy for the clinical practices for the use of laser Two new guidelines were created in favor of increasing 4 [19] management of oral andavailable other photodynamicliterature and totherapies define mucositis in cancer for the prevention and treatment of patients. oral mucositis evidences of the efficiency of low-level laser therapy. This study aimed to conduct a of seven of these concluded that laser therapy in Laser therapy in oral Figueiredo et patientsTwelve undergoing studies were oncotherapy included. The is about meta-analysis nine times 5 of the effectiveness of laser therapy al., [13] more effective in the prevention of oral mucositis insystematic the prevention review of and oral meta-analysis mucositis in grade greater than 3 than in patients without laser mucositis control: a patients undergoing oncotherapy. meta-analysis. treatment. Effect of prophylactic This study aimed to determine Eighteen randomized clinical trials showed risk 6 Oberoi et al. therapy reduces the risk of severe reduction of severe mucositis, as well as reduced low-levelsystematic laser review therapy and whethermucositis prophylactic as compared low-level to placebo laser or outcomes when compared with placebo or no therapy. on oral mucositis: a no therapy. A systematicmeta-analysis. review This study aims to synthesize the available clinical evidences on the and severe mucositis and decreases the average andlaser meta-analysis therapy (LLLT) of 7 HE et al., 2018 Prophylacticseverity
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