CATEGORY 68 AUSTRALASIAN DENTIST CLINICAL While lasers and LEDs are widely used, the term “photobiomodulation” is rarely recognized outside of laser-based healthcare professions. Although it is frequently employed by veterinarians, chiropractors, and physiotherapists, many dentists still view it as science fiction. Even among experienced practitioners and researchers, misconceptions and misuse of terminology persist. This brief article aims to promote the use of accurate terminology within our profession, fostering greater understanding and broader adoption of this important and effective therapy. Light therapy is a recent discovery – FALSE u Niels Ryberg Finsen was awarded a Nobel Prize in 1903 for his phototherapy work using sunlight1. He treated lupus vulgaris with intense focused sunlight u Blue light is used to treat neonatal jaundice in the NICU to help break down the buildup of bilirubin pigment in the blood2,3. UVB is essential for production of Vitamin D3 and is an effective treatment to stop or slow the progression of active vitiligo and helpful with improving psoriasis4 (Fig. 1). Red and blue light combined can be effective for inflammatory acne and broad-spectrum light can help reset circadian rhythms and reduce depressive symptoms5 u Endre Mester’s work showing healing with lasers in 1967 kickstarted modern research6,7. The hair on shaved mice grew more quickly when exposed to the laser energy u There are different forms of light treatments that can vary in dose, manner of use (eg. combined with exogenous chromophores), desired biological and clinical therapeutic outcome Photobiomodulation is just a heat treatment – FALSE u PBM is a non-surgical, non-ablative, non-thermal process causing photophysical and photochemical events at various biological scales8 u It is a form of light therapy that has been known by many terms including low-level laser (or light) therapy (LLLT), low-intensity laser therapy, low-power laser therapy, cold laser, soft laser, photostimulation and photobiotherapy u Photobiomodulation (PBM) is the accepted terminology and became a medical subject heading by the National Library of Medicine in 2016 which distinguishes it from therapies relying on thermal effects8 u Lower power is used for stimulation, healing and reduction of inflammation while higher power and higher frequencies are used for neural blockade9–11 u PBM is used to accelerate wound healing and tissue regeneration, increase circulation, reduce acute inflammation, reduce acute and chronic pain and help restore normal cellular function u Wavelengths between ~600 to 1100 nm are less strongly absorbed by melanin, hemoglobin and water allowing penetration without heat generation12 Photobiomodulation is a pseudoscience – FALSE u Nearly 800 human Randomized Control Trials, and some 7000 basic and clinical, animal and human studies have been done. Around 100 articles per month are being published on PBM u The main mechanism by which PBM works is light absorption in the mitochondria within cells. This photochemical reaction increases ATP production, transiently increases reactive oxygen species (ROS) and releases mitochondrial nitric oxide. This causes a cascade of growth factors, increasing cell signalling, gene transcription and cell metabolism13,14 (Fig. 2) u Other PBM mechanisms include modulation of membrane receptors/ transporters and ion channels (opsins, AHR, TRPV1) and induction of extracellular growth factors such as TGF-β115 u At the tissue level this leads to vasodilation, improved lymphatic drainage, reduced pain, less trismus, improved range of motion and less nerve and cellular tissue death16,17 u PBM is used to treat dental and nondental conditions across the whole body18,19. Many painful and previously poorly managed conditions such as ulcers, burning mouth syndrome, oral mucositis, and post-herpetic neuralgia can experience immediate pain relief20–25 u Dental conditions treated with PBM include dental sensitivity26, accelerating wound healing and reducing graft pain16, minimising pain and swelling postextraction27, improving orthodontic tooth movement28, overcoming nerve Photobiomodulation: Myths and facts On the pathway to becoming mainstream By Dr Jason Pang BDS, BSc, MSc (Laser Dentistry) Fig. 1 UV phototherapy for psoriasis Dr Jason Pang Fig. 2 Mechanism of action of photobiomodulation
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