Allen – Great questions. To the best of my knowledge this was an aphthous ulcer, so I treated it as such. The fashion in which I treated the lesion was based on research I have read supporting the biostimulatory effect of lasers. Most of my information comes from the text by Jan Tuner and Lars Hode: “Laser Therapy”.
I actually used the Nd:YAG in a defocused manner, approx. 1cm away from the lesion. The patient noted no discomfort, heat or any other symptoms. Quoting from their text regarding aphthous ulcers: “…The sypmtoms of most patients can be alleviated by laser treatment, and the healing period can be reduced. Carbon dioxide, Er:YAG and Nd:YAG lasers can also alleviate symptoms if a defocused beam is used. The dosage is determined by the patient’s response to pain relief. When the patient feels a distinct reduction in pain, you are on the way to the ‘right’ dosage. Several treatment sessions are often necessary to prevent any discomfort to the patient until the aphthae have disappeared. 4-6J is a good ‘starting point’.”

Some literature they quoted from:

Fagoni V et al. Use of HeNe soft-laser in 32 cases of mouth aphthae. Laser Abstracts (Rivista Europea di Laser Terapia Medica e Chirurgia). 2 (2): 25-29

Takashi K. Clinical evaluation of a GaAlAs semiconductor unilaser irradiation on solitary aphthae erosion and hypersensitive dentine. Shikwa Gauko. 1987; 87 (2): 295-.

Colvard M, Kuo P. Managing aphthous ulcers: laser treatment applied. J Am Dent Assoc. 1991; 122 (7): 51-53.

Howell R M et al. The use of low energy laser therapy to treat aphtous ulcers. Ann Dent. 1988; 47 (2): 16-18.

There are more articles, but you get the drift, I’m sure.

To answer you question with regards to any theories being proposed on mechanisms by which this effect takes place: There appears to be two ways that low level laser therapy affects the tissue to which it is being appied.

First, there are certain cell functions which are stimulated locally (where the light hits the tissue – “primary response”). It is known that chromophores in the form of e.g. porphyrins, play an important role.

Secondly, there is a systemic effect, well shown through the use of CO2 lasers as biostimulators. Since the wavelength of CO2 lasers cannot penetrate tissue more than a fraction of a millimeter, there is no primary response outside of the outer part of the dermis. The stimulative effect, therefore, must therefore work through a secondary response.

Chapter 11 in Tuner & Hodes’ text goes greatly into the theory of biostimulation. They talk about how laser therapy is not based on heat development but on photochemical and photobiological effects in cells and tissue.

The Pulsemaster 600 is/was made by ADT. I can’t say that I was terribly impressed with their company – I got very little support, but it was the first laser I bought and I didn’t know any better. I do like the laser, however.
Unfortunately, I do not have the ability to affect the pulse duration on my laser. I can only change the Hz and the mJ. I wish I had known more about other companies and their products prior to my purchasing this Nd:YAG. Perhaps I would have purchased one that was more adjustable. I have owned this laser for just over one year.

I hope this helps. I can’t say enough about the Tuner and Hodes text. They have a few different texts out. I’ll try to find their website and post it.

Have a great Memorial weekend.

Kelly.

Thanks to Ron and Bob for the great input.

This lesion may have resolved so quickly since the patient had had it for almost a week as it was. Hard to say.

My thinking when treating this lesion was that, regardless of the etiology, I wanted to stimulate all the cells in the area to get into a “healing mode”. I know it sound kookie, but a lot of the research I have been doing with regards to biostimulation suggests just that.

I do agree that treating the surface with the Erbium would have helped with the immediate pain relief.

Whatever the case, the patient healed quickly and is one happy camper.

Thanks again for the great input.

Kelly