Introduction
Materials and methods
Focused question
Protocol
Eligibility criteria
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Use of a lasers or aPDT
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Number of patients not less than 10 per group
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Randomized clinical trial
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Clinical trial
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Laser treatment of halitosis in generally healthy subjects
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The effect of the laser on the bacterial flora in the oral cavity
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A minimum of one week of observation after laser/aPDT use
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The use of various photosensitizers in aPDT
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In vivo studies
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Non-randomized studies
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Examinations of patients after laser treatment with general diseases, except for MS (multiple sclerosis)
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Number of patients less than 10 per group
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Patients age less than 12 years
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Laser treatment of advanced periodontal diseases and other oral diseases
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Change of the bacterial flora in the oral cavity without the use of a laser
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Duplicated articles
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No use of a laser
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In vitro studies
Search strategy
Information sources, search strategy, and study selection
Quality assessment
Risk of bias
Results
Study selection
No | Laser type | Wavelength (nm) | Power (W) | Laser therapy | Reference number |
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1 | Diode laser | 660 | 0.1 | aPDT | Costa da Mota et al. [16] |
2 | Diode laser | 395–480 | 0.48 | aPDT | Goncalves et al. [23] |
3 | Diode laser | 660 | 0.1 | aPDT | Llanos do Vale et al. [17] |
4 | Diode laser | 660 | 0.1 | aPDT | Romero et al. [18] |
5 | Diode laser | 660 | 0.4 | aPDT | Ciarcia et al. [19] |
6 | Diode laser | 660 | 0.1 | aPDT | Goncalves et al. [24] |
7 | Diode laser | 660 | 0.1 | aPDT | Lopes et al. [20] |
8 | Diode laser | 660 | 0.1 | aPDT | Labban et al. [21] |
9 | Er,Cr:YSGG laser | 2780 | 4 | Vaporization/debridement | Krespi et al. [22] |
Results of individual studies
Authors | Study type/number of patients/level of VSC | Groups | Laser (nm) + photosensitizer | Protocol aPDT | Study observation—time | Results |
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1. Costa da Mota et al. [16] | RCT 46 patients | G1-aPDT (n = 15), G2- tongue scraper (n = 15) G3 (n = 16) | 660 nm + methylene blue MB (0.05 mg/ml) | P = 100 mW, E = 9 J, t = 90 s per point, density P = 3.5 W/cm2, density E = 320 J/cm2, 6 points, applicator 0.028 cm2, BM- incubation 5 min, irradiation distance: 1 cm from tongue | 1 session, 1 week, the treatment microbiological analysis before and immediately after | G3—highest reduction in VSC, G2- lowest reduction in VSC After 1 week, there were no significant differences in quantity of VSC in particular groups. No significant differences in the microbiological analysis |
2. Goncalves et al. [23] | RCT 44 patients | G1 = 15, G2 = 14, G3 = 15 G1 = aPDT + BO (bixa orellana) G2 = tongue scraper G3 = aPDT + scraper | 395–480 nm BO (bixa orellana), 20% solution | P = 480 mW, E = 9.6 J, t = 20 s/per point, density P = 153 mW/cm2, density E = 6.37 J/cm2, applicator 3.14 cm2, irradiation points = 6, contact method, incubation on the tongue for 2 min | 1 session, immediately after the treatment, 1 week | Quantity of VSC diminished in all groups. There were no significant differences in G1 and G3 groups. One week after the treatment, no significant differences were noticed with respect to the level of VSC |
3. Llanos do Vale et al. [17] | RCT 45 patients | G1 = 22 G2 = 23 G1- tongue scraper G2- aPDT | 660 nm, methylene blue—MB (0.005%) | P = 100 mW, E = 9 J, t = 90 s, density P = 35,368 mW/cm2, density E = 3183 J/cm2, 6 points irradiated with a contact method, applicator = 0.00287 cm2, MB—5 min on the tongue and rinsed with saline | 1 session 1 week (VSC level) | aPDT significantly lowered levels of VSC |
4. Romero et al. [18] | RCT 40 patients Single-blind trial | G1 = 20 G2 = 20 G1- aPDT G2- tongue scraper | 660 nm methylene blue 0,005% | P = 100 mW E = 9 J per point t = 1 min density P = 3537 mW/cm2 density E = 318 J/cm2 6 points | 1 session, results immediately after the treatment 1 week 90 days (VSC measurement) | The VSC values were 2 (scraper) or 3 (aPDT) times lower than the baseline value after 1 week and after 3 months. The most significant improvement immediately after the treatment was observed |
5. Ciarcia et al. [19] | RCT 39 patients | G1 = 13 G2 = 13 G3 = 13 G1-aPDT G2- tongue scraper G3- aPDT i scraper | 660 nm methylene blue 0,005% | P = 400 mW E = 36 J t = 90 s P = 1039.4 mW/cm2 density E = 93.5 J/cm2 4 irradiated points, distance: 2 cm, for 2 min | 1 session, immediately after the treatment 1 week 14 days 30 days (VSC level) | Directly after the treatment the significant reduction in VSC was observed No data available after 7, 14, and 30 days |
6. Goncalves et al. [24] | CT 60 patients | G1 = 20 G2 = 20 G1-with MS G2—healthy | 660 nm methylene blue 0.005% | P = 100 mW E = 9 J t = 90 s for a point density P = 3537 mW/cm2 density E = 320 J/cm2 applicator- 0.094 cm2 6 points irradiated with contact method MB on the tongue for 5 min | 1 session examination immediately after the treatment | Level of VSC diminished in both groups |
7. Lopes et al. [20] | RCT 45 patients | G1 = 16 G2 = 15 G3 = 14 G1-aPDT G2- tongue scraper G3- aPDT + scraper | 660 nm methylene blue 0.005% | P = 100 mW E = 9 J T = 90 s W/cm2 density E = 317.43 J/cm2 Applicator -0.02835 cm2 6 points separated by 1 cm were irradiated with the contact method, P = 3537 mW/cm2 Methylene blue 5 min. on the tongue | 1 session 1 h and 24 h after treatment (VSC level) | There was a significant reduction in VSC in all groups, the highest result of the reduction of VSC was shown in group G3 |
8. Labban et al. [21] | RCT 40 patients | G1 = 20 G2 = 20 G1- tongue scraper G2-scraper + aPDT | Laser 660 nm, methylene blue 0.005% | P = 100 mW, density P = 3527 mW/cm2, E = 9 J 6 points on the tongue and on the prosthesis, distance – 1 cm, MB – 5 min | 1 session, 5 days after, 15 days after, 30 days after treatment, the level of VSC was measured, microbiological test for the presence of Porphyromonas gingivalis was performed, OHIP-14 profile | Decrease in the level of H2S, which was sustained during the month of observation, decrease in the amount of P. gingivalis (highest after 5 days) |
9. Krespi et al. [22] | RCT 60 patients | G1 = 30 G2 = 30 G1- tongue scraper G2 laser | 2780 nm Er,Cr:YSGG | P = 4 W E = 100 mJ f = 40 Hz t = 60 s Pulse width—60 µs Air -10% Water—5% Tip—MC12 distance from the tongue 3 mm Density E = 3 J/cm2 10 passes | 1 session/1 month The level of VSC was measured; a microbiological test has been performed, the appearance of the tongue was assessed | Decrease in VSC and the number of anaerobic and aerobic bacteria, improvement in the appearance of the tongue, sustained throughout the observation period |
Quality assessment
Criteria | Authors | ||||||||
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Costa da Mota [16] | Goncalves [23] | Llanos do Vale [17] | Romero [18] | Ciarcia [19] | Goncalves [24] | Lopes [22] | Labban [21] | Krespi [22] | |
Randomization | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 |
Blinding | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 |
Sample size calculation | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Control group | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Laser parameters: (power, energy, density) applicator type | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Power meter use | 1 | 1 | 0 | 1 | 1 | 0 | 1 | 0 | 1 |
Laser type (wavelength) | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Detailed treatment protocol | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
At least 1-month follow-up | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | 1 |
Total score | 8 | 7 | 6 | 8 | 7 | 5 | 7 | 8 | 8 |
Risk of bias | low | low | medium | low | low | medium | low | low | low |