Treatment of halitosis with photodynamic therapy in older adults with complete dentures: A randomized, controlled, clinical trial

Effect of Antimicrobial Photodynamic Therapy on the Tongue Dorsum on Reducing Halitosis and the Duration of the Effect: A Randomized Clinical Trial

Antimicrobial photodynamic therapy (PDT) is a treatment that is gaining popularity in modern clinical medicine. However, little is known about the effect of PDT alone on reducing oral halitosis and the duration of the effect. This trial examined the effect of PDT on the tongue dorsum on reducing oral halitosis and the duration of the effect. This study was approved by the Ethics Committee of Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, and Okayama University Hospital (CRB20-015), and it was registered in the Japan Registry of Clinical Trials (jRCTs061200060). Twenty-two participants were randomly assigned to two groups: an intervention group and control group. PDT was performed in the intervention group using red laser emission and methylene blue gel on the middle and posterior area of the tongue dorsum. The concentration of volatile sulfur compounds, bacterial count on the tongue dorsum, probing pocket depth, bleeding on probing, and simplified oral debris index score were determined before and 1 week after PDT. The Mann-Whitney U test was used to assess the significance of the differences in each parameter between the two groups. We found that the hydrogen sulfide concentration and bacterial count on the tongue dorsum were decreased in the intervention group, but there was no statistically significant difference between the two groups. These results indicated that performing only PDT on the tongue dorsum may not contribute to reducing halitosis.

Halitosis and Pain Threshold of Peri-Implant Tissues: An Observational Cohort Study

In this study, we aimed to evaluate the halitosis and pain threshold of the peri-implant soft tissues in individuals rehabilitated with implant-supported prostheses. Forty-eight subjects were divided into four groups (n = 12) according to their prosthetic rehabilitation: single-tooth fixed prosthesis, multi-tooth fixed prosthesis, overdentures, and the Brånemark protocol. Halitosis was measured using a halimeter, whereas the pain threshold was measured using Von Frey monofilaments. Measurements were taken before (t0) and 30 days after (t1) placement of healing caps, and at the time of (t2) and 30 days after (t3) prosthetic placement. Halitosis data were analyzed using the chi-square test and Bonferroni correction (p < 0.05). Two-way ANOVA and Tukey's test (p < 0.05) were used to analyze pain threshold data. We noted an association between halitosis and time for the Brånemark protocol [X2(6) = 18.471; p = 0.005] and overdenture groups [X2(6) = 17.732; p = 0.007], and between halitosis and type of prosthesis only at t0 [X2(6) = 12.894; p = 0.045]. The interaction between time and the type of prosthesis significantly interfered with the mean pain threshold values (p = 0.001). At most time points, the majority of participants in each group had clinically unacceptable halitosis. After 30 days of using the prostheses, the overdenture group had a lower pain threshold compared to the Brånemark protocol group.

Application of Photodynamic Therapy in Pediatric Dentistry: Literature Review

Microbiological control of dental pathologies presents a significant clinical challenge for dental surgeons, particularly considering drug-resistant microorganisms. To address this issue, Antimicrobial Photodynamic Therapy (PDT) has emerged as an effective and complementary technique for microbial reduction. This therapy involves the application of a photosensitizer dye (PS) either topically or systemically, followed by exposure to low-power lasers with appropriate visible light wavelengths. PDT has found a valuable place in dentistry across various specialties, including surgery, periodontics, endodontics, dentistry, implantology, orthodontics, and pediatrics. In the realm of pediatric dentistry, managing microorganisms during dental treatments has become a major challenge. Considering its promising results and ease of application, Photodynamic Therapy presents an interesting alternative for clinical practice. However, it is important to note that specific protocols must be followed for each application, encompassing the type of photosensitizer, concentration, pre-irradiation time, light type, wavelength, energy, power, and mode of light delivery. Researchers have been steadily refining these protocols to facilitate PDT's integration into clinical practice. The objective of this review is to describe in which procedures and oral health problems in children PDT can be applied. In this sense, we list what the literature brings about the possibilities of applying PDT in a pediatric dentistry clinic.

Clinical applications of antimicrobial photodynamic therapy in dentistry

Given the emergence of resistant bacterial strains and novel microorganisms that globally threaten human life, moving toward new treatment modalities for microbial infections has become a priority more than ever. Antimicrobial photodynamic therapy (aPDT) has been introduced as a promising and non-invasive local and adjuvant treatment in several oral infectious diseases. Its efficacy for elimination of bacterial, fungal, and viral infections and key pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Candida albicans, and Enterococcus faecalis have been investigated by many invitro and clinical studies. Researchers have also investigated methods of increasing the efficacy of such treatment modalities by amazing developments in the production of natural, nano based, and targeted photosensitizers. As clinical studies have an important role in paving the way towards evidence-based applications in oral infection treatment by this method, the current review aimed to provide an overall view of potential clinical applications in this field and summarize the data of available randomized controlled clinical studies conducted on the applications of aPDT in dentistry and investigate its future horizons in the dental practice. Four databases including PubMed (Medline), Web of Science, Scopus and Embase were searched up to September 2022 to retrieve related clinical studies. There are several clinical studies reporting aPDT as an effective adjunctive treatment modality capable of reducing pathogenic bacterial loads in periodontal and peri-implant, and persistent endodontic infections. Clinical evidence also reveals a therapeutic potential for aPDT in prevention and reduction of cariogenic organisms and treatment of infections with fungal or viral origins, however, the number of randomized clinical studies in these groups are much less. Altogether, various photosensitizers have been used and it is still not possible to recommend specific irradiation parameters due to heterogenicity among studies. Reaching effective clinical protocols and parameters of this treatment is difficult and requires further high quality randomized controlled trials focusing on specific PS and irradiation parameters that have shown to have clinical efficacy and are able to reduce pathogenic bacterial loads with sufficient follow-up periods.

Clinical efficacy of photodynamic therapy on halitosis: a systematic review and meta-analysis

Halitosis is a widespread health problem with complex factors, and therapeutic effects sometimes are unsatisfactory. Plenty of clinical trials have tried to prove the effectiveness of photodynamic therapy (PDT), but the results are indeterminate. This study aimed to evaluate the clinical efficacy of PDT on halitosis. We searched PubMed, Cochrane Library, Embase, Web of Science, and Scopus from inception to August 10, 2022, and only studies about the PDT on halitosis were included. The criteria for meta-analysis comprised randomized controlled trials (RCTs) comparing the treatment of PDT with tongue scraper (TS) immediately after the halitosis therapy and during a 7-, 14-, 30-, and 90-day follow-up. Eight eligible studies involving 345 patients were included in this study. It was shown that PDT (MD =  - 34.49, 95% CI [- 66.34, - 2.64], P = 0.03) or PDT + TS (MD =  - 67.72, 95% CI [- 101.17, - 34.28], P < 0.001) had better efficacy than TS on the H2S concentration reduction immediately after the halitosis therapy. No significant differences were observed in reducing the H2S among TS, PDT alone, and PDT + TS at the follow-up. Besides, no difference between PDT and TS was found in the reduction of CH3SCH3 and CH3SH. Based on the current evidence, PDT and PDT + TS demonstrate efficacy in the treatment of halitosis in the short term, and PDT was shown to be a beneficial and promising therapeutic method.

Effectiveness of lasers and aPDT in elimination of intraoral halitosis: a systematic review based on clinical trials

In recent years, there has been increasing interest in research showing positive results in antimicrobial photodynamic therapy (aPDT) and laser therapy (LT) in dentistry. The authors of this review tried to answer the question: “Is the effectiveness of lasers and aPDT in the elimination of intraoral halitosis possible?” For this purpose, the electronic database of PubMed and Cochrane Library were searched until September 2021 using a combination of different keywords: (bad breath OR fetor ex ore OR halitosis OR oral malodor) AND (laser OR PDT OR PACT OR photodynamic inactivation OR photodynamic therapy OR photodynamic antimicrobial chemotherapy). Initially, 83 studies were identified. A total of 9 articles were qualified after the application of the eligibility criteria. Eight works concerned aPDT treatment, and only one dedicated to the Er,Cr:YSGG laser. A significant reduction in halitosis occurred immediately after both LT and aPDT. The review found the confirmation of the effectiveness of laser therapy in reducing the number of volatile sulfur compounds (VSC) and the amount of anaerobic bacteria responsible for VSC formation. In most studies, a positive effect was observed for a 1-week follow-up. Laser therapy (aPDT, Er,Cr:YSGG) effectively eliminates microorganisms that produce volatile compounds and can effectively eliminate bad breath for the longer period of time than traditional methods of combatting this ailment.

Randomized and Controlled Clinical Studies on Antibacterial Photodynamic Therapy: An Overview

The emergence of drug-resistant bacteria is considered a critical public health problem. The need to establish alternative approaches to countering resistant microorganisms is unquestionable in overcoming this problem. Among emerging alternatives, antimicrobial photodynamic therapy (aPDT) has become promising to control infectious diseases. aPDT is based on the activation of a photosensitizer (PS) by a particular wavelength of light followed by generation of the reactive oxygen. These interactions result in the production of reactive oxygen species, which are lethal to bacteria. Several types of research have shown that aPDT has been successfully studied in in vitro, in vivo, and randomized clinical trials (RCT). Considering the lack of reviews of RCTs studies with aPDT applied in bacteria in the literature, we performed a systematic review of aPDT randomized clinical trials for the treatment of bacteria-related diseases. According to the literature published from 2008 to 2022, the RCT study of aPDT was mostly performed for periodontal disease, followed by halitosis, dental infection, peri-implantitis, oral decontamination, and skin ulcers. A variety of PSs, light sources, and protocols were efficiently used, and the treatment did not cause any side effects for the individuals.

Effect of Photodynamic Therapy on Halitosis: A Systematic Review of Randomized Controlled Trials

BACKGROUND

This systematic review aimed to assess the effectiveness and safety of aPDT for the treatment of halitosis.

METHODS

Search strategies were conducted in October 2021 without language or data restrictions, on the following databases: MEDLINE, EMBASE, CENTRAL, LILACS and BBO, as well as a manual search. Randomized clinical trials (RCTs) with parallel design were considered for inclusion, assessing individuals (adolescents and adults) with a clinical diagnosis of halitosis treated with photodynamic therapy (aPDT). Primary outcomes assessed were halitosis measurements, adverse events and quality of life. The risk of bias for each included study was evaluated with the Cochrane Risk of Bias tool and the certainty of the body of the evidence was assessed with the GRADe approach.

RESULTS

Six RCTs (total of 225 participants) were included and due to clinical diversities it was not possible to group the outcome data in meta-analyses. Based on very low-certainty evidence (GRADE) the results showed that, when compared to tongue scraper, aPDT seems to promote a little to no difference in reducing halitosis and in the microbiological analysis. No adverse events were reported. Considering aPDT combined with tongue scraper, better outcome results were observed when compared to tongue scraper alone.

CONCLUSIONS

Based on very low-certainty evidence, the findings of this review are uncertain about the effects of aPDT for halitosis control. Further RCTs with higher number of participants and long term assessments need to be conducted to support the use of this intervention. The protocol was registered in the PROSPERO database (number: CRD42020215319) on 19 November 2020-retrospectively registered.

The Problem of Halitosis in Prosthetic Dentistry, and New Approaches to Its Treatment: A Literature Review

The aim of this work is a review of recent scientific literature about intra-oral halitosis among patients using dentures. Halitosis is a condition in which an unpleasant smell comes out of the oral cavity, which is caused mainly by volatile sulfur and non-sulfured compounds. The etiology of halitosis may be intra- or extra-oral; in most patients, however, it is due to the activity of microorganisms in the oral cavity. The problem of the occurrence of intra-oral halitosis has accompanied patients for many years. In dental prosthetics, the problem of halitosis occurs in patients using removable or fixed dentures. In both cases, new niches for the development of microorganisms may be created, including those related to intra-oral halitosis. It should be noted that dentures—both fixed and removable—are a foreign body placed in the patient’s oral cavity which, in case of insufficient hygiene, may constitute a reservoir of microorganisms, causing this unpleasant condition. Conventional treatment of intraoral halitosis reduces microbial activity via chemical and/or mechanical action. Currently, the search for new strategies in the treatment of halitosis is in progress. One idea is to use photodynamic therapy, while another is to modify poly(methyl methacrylate) (PMMA) with silver and graphene nanoparticles. Additionally, attempts have been made to combine those two methods. Another unconventional method of treating halitosis is the use of probiotics.