- Frequent Questions
Frequent Questions
What is LLLT?
LLLT is a treatment in which a laser beam at an energy level of between 1 and 16 J is applied at specific points directly to the skin or the mucous membrane, where it spreads to the underlying structures. The energy is distributed over an area so large that little or no sensation is felt by the patient during treatment as no thermal effect is transferred.
What happens?
LLLT has been shown to have a number of effects at the cellular level which would be far too extensive to describe in detail here. A list of studies and results can be found here. The practical clinical effects can be described as follows:
| Clinical Effect | Dose | Effect (Latent Period) | Effect (Duration) |
|
Analgesic |
low to moderate, 2-4 J | inmediate/minutes | hours/days |
| Muscle relaxing | moderate, 4-6 J | inmediate/minutes | hours/days |
| Promoted healing | low, 1-2 J | hours/days | days/weeks |
| Increased circulation | low to moderate, 2-4 J | inmediate/minutes | hours/days |
| Anti inflamatory | high, 8-16 J | hours/days | days/weeks |
A typical question is whether LLLT is a symptomatic or curative?
To give a satisfactory answer, we must first discuss the principles behind LLLT.
The most important clinical result is the anti-inflammatory effect. The onset is rapid (minutes/hours) and the effect is local. It is much more impressive, when you consider that there are no side-effects from the treatment. To compare with steroid injections is not quite fair, as LLLT has much more to offer. However, it is still a useful mental image to have. The anti-inflammatory effect is unspecific and can be used in all stages from an acute inflammatory response to trauma, i.e. distortion of a joint, burn on the skin etc., to chronic inflammatory conditions.
Depending on the fundamental problem, the LLLT will be curative or symptomatic. In cases of repetitive stress syndrome caused by excessive unilateral work-load, the inflammation can be treated successfully, the pain relieved, swelling reduced, etc. However, if incorrect working or training routines are not changed, the symptoms will reappear.
One of the typical indications for LLLT is osteoarthritis. It is absolutely incredible to see how soon and how effective you can alleviate the pain. However, as the joint in question becomes structurally damaged, the inflammation of ligaments causing the pain will return. Additional LLLT treatments can control this pain. After an initial treatment series (6-10 treatments twice a week), a single treatment can control the inflammation and, thereby, the pain, from a month to 6 months.
Increased blood-flow
The increased blood-flow is very much felt by the patients, especially if they have reduced local blood-circulation, or a chronic inflammatory disease. A typical example of the former could be an ischemic ulcer, where the increased circulation can cause temporary pain after the first few treatments. Compare this with the sensation of returning blood-circulation to the fingers and toes subjected to hypothermia.
A very interesting finding we made some years ago is the specific vascular effect on the pulp of a tooth. Again there is only a noticeable effect if there is a problem. You will have to direct the laser beam to the apical region of the tooth in question. If treating a healthy pulp, the patient will not feel any pain at all. If, on the other hand, there is a hyperaemia of the pulp, the laser light will initiate a “needle-prick” kind of pain after some seconds. The sooner the pain arises, the more severe the hyperaemia. Interestingly enough, reversible cases of hyperaemia can be treated this way with just one application. Again, if the cause is not removed (i.e. profound caries), the problem will reappear.
Pain relief
In most cases, pain relief is linked to the anti-inflammatory effect. However, there is an immediate result most likely caused by a direct effect on the nerve cell membrane – much the same as with local anaesthetics. You see this effect most clearly when treating various neuralgia. In best cases, you see almost immediate pain relief. Another typical example is hypersensitive dentine, which almost always is a good case for a hands-on demonstration. First you demonstrate the hypersensitive dentine with cold water, ice or similar. Then you treat the sensitive area of the dentine and at the apex of the tooth. 60 seconds later the patient cannot feel any hypersensitivity whatsoever.
Muscle relaxation
The muscle relaxation effect is a variation of the direct effect on the nerve cell membrane. The effect is instantaneous and, in some cases, also contributes to the overall sensation of pain relief and relaxation (locally).
Tissue stimulation
Tissue stimulation, especially healing of ulcers, was one of the first clinical effects of LLLT that was observed. Again, the effects are varied depending on the circumstances. There is a definitive “growth factor stimulus” by the LLLT. However for chronic ischemic ulcers, the most important effect is probably the increased blood-circulation. The tissue stimulation is exceptionally spectacular when cases of local sensory dysfunction, such as hypo- and dysaesthesia caused by trauma to the peripheral nerve. Typical cases are injuries to the mandibular nerve in connection with 3rd molar (wisdom tooth) extraction. You can take almost any case, no matter how old or how “stable” the sensory dysfunction is, and make an improvement within a week. Significant or full recovery of sensation within a month can be expected. Admittedly, this is the one clinical LLLT effect we have been most sceptical about. Primarily because it is the most difficult to explain. But it works.
List of indications for LLLT
Odontological conditions
- Dentine hyperaesthesia
- Hyperaemia pulpae
- Gingivitis and periodontis
- Extractions and surgery (promoting tissue healing, reduce post surgery swelling/pain)
Herpes - TMJ ailments
- Promoted healing after surgical procedures and extractions
- Reduced post-operative pain and swelling after endodontic procedures, surgical procedures, extractions, etc.
- Toothache due to hypersensitive dentine or hyperaemia pulpae
- Minor pain (and bleeding) during the procedure
- TMJ pain/problems
- Neuralgiform facial pain