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The effect of nono on the healing of soft tissue lesions in the oral cavity-A pilot study     


By Jonathan Mann, D.M.D., M.Sc. and Ayala Stabholz, D.M.D. - School of Dental Medicine Department of Community Dentistry Hebrew University Hadassah.

Article Sections :
Abstract introduction Herpes Labialis Apthous Ulcer Material and Methods Results Discussion and Conclusion.



ABSTRACT
Sixteen patients suffering from various oral lesions, gingivitis, herpes simplex and apthous ulcers were selectd for a pilot study designed to evaluate the effectiveness of 660 nm low level Narrow Band light phototherapy on the course of these lesions. Each patient was given a device that combined two light sources. The patient was instructed to use it three times daily for a duration of 3 minutes and was asked to return for an evaluation.

  • Of 7 cases of gingival inflammation 6 showed improvement whereas one case showed no change.
  • Four cases of apthous ulcers showed dramatic improvement within 1-3 days.
  • Two cases of herpes simplex showed complete healing within 3 days.
  • One case of acute periodontal abcess showed complete healing within 3 days.
  • One case of erythematous hyperplasia following a crown lengthening procedure showed complete healing, whereas the second showed only slight improvement.
  • No side effects werw reported or observed at any time during the use of the device.


These preliminary results show that the 660 nm low level Narrow Band light phototherapy is effective and safe in treatment of various oral lesions.

INTRODUCTION
Gingival inflammation develops within a couple of days of undisturbed bacterial growth on the cervical portion of the tooth surface. In most cases if the microbial plaque is removed at this stage and effective plaque control measures institute, the inflammatory alterations soon disappear. Restorations and crowns with overhanging margins as well as anatomical abbretions of the hard and soft tissues and secondary etiological factors of gingival inflammation by facilitating plaque accumulation along the gingival marigin. In addition it has been shown that mouth breathers develop chronic gingivitis as well.

Conventional treatment includes the elimination of those secondary etiological factors and the instituion of optimal plaque removal. In sonic instances this treatment does riot result ill complete healing. Hyperplastic gingival inflammation can b observed as well during tile healing phase of crown lengthening procedures, despite optimal plaque removal by the patient.

HERPES LABIALIS
The recurrent attacks are as secondary herpetic stomatitis, recurrent habitual aphthae or recurrent herpetic stomatitis. The individual lesions which occur on the lips ar commonly referred to as “cold sores” while those within the mouth are called “canker sores”. The lip lesions (herpes labialis or “cold sores”) occur most often oil the vermilion border but may occur oil the circumoral skin They begin with a burning sensation and swelling of the lip which is rapidly followed by all aggregate of small vesicles which have a tendency to coalesce the rupture and exude serum which forms an abundent yellowish crust. The lesiosns may crack with the movement of the lip causing hemorrhage and the crust becomes black in color. Herpes labialis usually heal in two or three weeks without residual scar. The lesions may recur at varying intervals, frequently ill the same location – Following the initial infection the virus is residual in the tissue and may be activated by anything, which lowers the resistance of the tissue. Some patients develop lesion following exposure to sunlight. They are associated with upper respiratory infection or other disease processes attended by fever and for this reason the lesions are referred to his fever blisters. Some patients associate them with gastrointestinal upsets in which case they are often due to food allergies. They may be associated with the onset of menstrual periods. Treatment is symptomatic as the lesions heal spontaneously. The lesions should be kept soft by the application of cold cream, petroleum jelly or an ointment with a lanolin base.

APTHOUS ULCER
The canker sore (apthous ulcer, herpetic ulcer) is a recurrent herpetic lesion involving mucous membrane. They occur in vestibular and buccal mucosa, floor of the mouth, the gingiva, and on the tongue. Those which occur in the mucobuccal fold are linear in shape and are called aphthous fissuratum, while those in other areas are round or oval and are called canker sores. The initial symptoms are not as pronounced as the lesions on the lip and the patient.

As on the Up, the lesion arises as a vesicle but due to its location on a moist non-keratinized surface, the vesicle ruptures easily and is, therefore, present for only a very short time and the vesicular state is not recognized by the patient. After the vesicle ruptures a shallow ulcer develops which is rapidly covered by a yellowish fibrionous membrane and is surrounded by an intense real zone 1 or 1.5 nun in width.

The ulcer becomes very painful, especially hen it is located in the areas where the the the tissue is movable. The lesions may be single or multiple and of variable size, some reaching 5 to 7 mm in diameter.

The pain is usually more intense when the lesions are large and multiple. The lesions heal spontaneously in seven fourteen days. Treatment is of value only to relieve pain and will not enhance healing. Pain may be relieved by the application of Xylocaine (viscous) for a short period to permit the patient to eat more comfortably – Very painful ulcers may be relieved by chemical cautery of the base of the lesion. The lesions may be initiated by menstruation, food allergies, local trauma, and upper respiratory infection. They may be prevented by the use of immune gamma blobulin scrum, small pox vaccine, and other means associated with a specific predisposing factors such as menstruation, and emotional.

MATERIAL AND METHODS
Sixteen patients suffering from oral lesions of the soft tissue werw selected for the study. Seven patients had gingival information that showed limited response to conventional periodontal treatment. Four patients suffered from aphthous ulcers, two casea had herpes simplex labialis, one case had an acute periodontal abscess and two cases of rythematous hyperplasia following crown lengthening.

All the patients were given a “No – No” device with two light sources which convert to from one beam. The device resembies a toothbrush and can reach easilly all sites in the oral cavity.

Patients were instructed to use the device three times daily for three minutes each time, and return for an evaluation of the three and six days later. Some were re-examined 24 hours after the initiation of the device.

RESULTS
Of the sixteen patients examined cases of gingival inflammation showed improvement and only one case showed no change – of these, 4 cases showed improvement within 24 hours and the other two within 3 days. Improvement was considered to be so when the color of the gingiva changed from red and spontaneous bleeding to a brighter normal color with no bleeding.

Four cases of aphthous ulcers showed improvement. Those lesions which had been a longer period in the mouth showed a slower recovery. A 1 – to 3 day range was found sufficient for recovery.

The two cases of herpes simplex an immediate cases in the development of the lesion and total cure within 2 days. An acute periodontal abscess showed a complete healing within 3 days combined with convtional treatment.

DISCUSSION AND CONCLUTION
This pilot study presents a description of various lesions in the oral cavity of which most were affected dramatically by the use of the “No-No”.
The “No – No” 660 produces low level band light at 660 nm wavelengh with a Beam area focus at 2 cm2 other technical specification include :

Continuous Wave (CW)
Power at focus (typical) 18mw
Maximun power density 15mw / CM2

Pulse Wave
Peak power at focus (typical) 75mw
Frequency (typical) 100 HZ
Duty ratio (typical) 10%
Average power (typical) 7.5mw

The apparatuse is intended for self application. It was interesting to note that in some of the lesions that werw found next to restoration with overhanging margins, the use of the beam results in absolute cure, whereas other lesions did not respond to the treatment. However, those lesions that disappeared following the beam use reappeared within a short period after cessation of its use. One of such cases showed a significant improvement, following a combined (conventional and beam) treatment. This gingival lesion did not reappear. Consequently, it might be suggested that the beam treatmentthat includes removal of the obvious etiological factors of the lesion.

The effect of nono on the healing of soft tissue lesions in the oral cavity-A pilot study     


By Jonathan Mann, D.M.D., M.Sc. and Ayala Stabholz, D.M.D. - School of Dental Medicine Department of Community Dentistry Hebrew University Hadassah.

Article Sections :
Abstract introduction Herpes Labialis Apthous Ulcer Material and Methods Results Discussion and Conclusion.



ABSTRACT
Sixteen patients suffering from various oral lesions, gingivitis, herpes simplex and apthous ulcers were selectd for a pilot study designed to evaluate the effectiveness of 660 nm low level Narrow Band light phototherapy on the course of these lesions. Each patient was given a device that combined two light sources. The patient was instructed to use it three times daily for a duration of 3 minutes and was asked to return for an evaluation.

  • Of 7 cases of gingival inflammation 6 showed improvement whereas one case showed no change.
  • Four cases of apthous ulcers showed dramatic improvement within 1-3 days.
  • Two cases of herpes simplex showed complete healing within 3 days.
  • One case of acute periodontal abcess showed complete healing within 3 days.
  • One case of erythematous hyperplasia following a crown lengthening procedure showed complete healing, whereas the second showed only slight improvement.
  • No side effects werw reported or observed at any time during the use of the device.


These preliminary results show that the 660 nm low level Narrow Band light phototherapy is effective and safe in treatment of various oral lesions.

INTRODUCTION
Gingival inflammation develops within a couple of days of undisturbed bacterial growth on the cervical portion of the tooth surface. In most cases if the microbial plaque is removed at this stage and effective plaque control measures institute, the inflammatory alterations soon disappear. Restorations and crowns with overhanging margins as well as anatomical abbretions of the hard and soft tissues and secondary etiological factors of gingival inflammation by facilitating plaque accumulation along the gingival marigin. In addition it has been shown that mouth breathers develop chronic gingivitis as well.

Conventional treatment includes the elimination of those secondary etiological factors and the instituion of optimal plaque removal. In sonic instances this treatment does riot result ill complete healing. Hyperplastic gingival inflammation can b observed as well during tile healing phase of crown lengthening procedures, despite optimal plaque removal by the patient.

HERPES LABIALIS
The recurrent attacks are as secondary herpetic stomatitis, recurrent habitual aphthae or recurrent herpetic stomatitis. The individual lesions which occur on the lips ar commonly referred to as “cold sores” while those within the mouth are called “canker sores”. The lip lesions (herpes labialis or “cold sores”) occur most often oil the vermilion border but may occur oil the circumoral skin They begin with a burning sensation and swelling of the lip which is rapidly followed by all aggregate of small vesicles which have a tendency to coalesce the rupture and exude serum which forms an abundent yellowish crust. The lesiosns may crack with the movement of the lip causing hemorrhage and the crust becomes black in color. Herpes labialis usually heal in two or three weeks without residual scar. The lesions may recur at varying intervals, frequently ill the same location – Following the initial infection the virus is residual in the tissue and may be activated by anything, which lowers the resistance of the tissue. Some patients develop lesion following exposure to sunlight. They are associated with upper respiratory infection or other disease processes attended by fever and for this reason the lesions are referred to his fever blisters. Some patients associate them with gastrointestinal upsets in which case they are often due to food allergies. They may be associated with the onset of menstrual periods. Treatment is symptomatic as the lesions heal spontaneously. The lesions should be kept soft by the application of cold cream, petroleum jelly or an ointment with a lanolin base.

APTHOUS ULCER
The canker sore (apthous ulcer, herpetic ulcer) is a recurrent herpetic lesion involving mucous membrane. They occur in vestibular and buccal mucosa, floor of the mouth, the gingiva, and on the tongue. Those which occur in the mucobuccal fold are linear in shape and are called aphthous fissuratum, while those in other areas are round or oval and are called canker sores. The initial symptoms are not as pronounced as the lesions on the lip and the patient.

As on the Up, the lesion arises as a vesicle but due to its location on a moist non-keratinized surface, the vesicle ruptures easily and is, therefore, present for only a very short time and the vesicular state is not recognized by the patient. After the vesicle ruptures a shallow ulcer develops which is rapidly covered by a yellowish fibrionous membrane and is surrounded by an intense real zone 1 or 1.5 nun in width.

The ulcer becomes very painful, especially hen it is located in the areas where the the the tissue is movable. The lesions may be single or multiple and of variable size, some reaching 5 to 7 mm in diameter.

The pain is usually more intense when the lesions are large and multiple. The lesions heal spontaneously in seven fourteen days. Treatment is of value only to relieve pain and will not enhance healing. Pain may be relieved by the application of Xylocaine (viscous) for a short period to permit the patient to eat more comfortably – Very painful ulcers may be relieved by chemical cautery of the base of the lesion. The lesions may be initiated by menstruation, food allergies, local trauma, and upper respiratory infection. They may be prevented by the use of immune gamma blobulin scrum, small pox vaccine, and other means associated with a specific predisposing factors such as menstruation, and emotional.

MATERIAL AND METHODS
Sixteen patients suffering from oral lesions of the soft tissue werw selected for the study. Seven patients had gingival information that showed limited response to conventional periodontal treatment. Four patients suffered from aphthous ulcers, two casea had herpes simplex labialis, one case had an acute periodontal abscess and two cases of rythematous hyperplasia following crown lengthening.

All the patients were given a “No – No” device with two light sources which convert to from one beam. The device resembies a toothbrush and can reach easilly all sites in the oral cavity.

Patients were instructed to use the device three times daily for three minutes each time, and return for an evaluation of the three and six days later. Some were re-examined 24 hours after the initiation of the device.

RESULTS
Of the sixteen patients examined cases of gingival inflammation showed improvement and only one case showed no change – of these, 4 cases showed improvement within 24 hours and the other two within 3 days. Improvement was considered to be so when the color of the gingiva changed from red and spontaneous bleeding to a brighter normal color with no bleeding.

Four cases of aphthous ulcers showed improvement. Those lesions which had been a longer period in the mouth showed a slower recovery. A 1 – to 3 day range was found sufficient for recovery.

The two cases of herpes simplex an immediate cases in the development of the lesion and total cure within 2 days. An acute periodontal abscess showed a complete healing within 3 days combined with convtional treatment.

DISCUSSION AND CONCLUTION
This pilot study presents a description of various lesions in the oral cavity of which most were affected dramatically by the use of the “No-No”.
The “No – No” 660 produces low level band light at 660 nm wavelengh with a Beam area focus at 2 cm2 other technical specification include :

Continuous Wave (CW)
Power at focus (typical) 18mw
Maximun power density 15mw / CM2

Pulse Wave
Peak power at focus (typical) 75mw
Frequency (typical) 100 HZ
Duty ratio (typical) 10%
Average power (typical) 7.5mw

The apparatuse is intended for self application. It was interesting to note that in some of the lesions that werw found next to restoration with overhanging margins, the use of the beam results in absolute cure, whereas other lesions did not respond to the treatment. However, those lesions that disappeared following the beam use reappeared within a short period after cessation of its use. One of such cases showed a significant improvement, following a combined (conventional and beam) treatment. This gingival lesion did not reappear. Consequently, it might be suggested that the beam treatmentthat includes removal of the obvious etiological factors of the lesion.