Cunha, C. B., Eduardo, F. P., Zezell, D. M., Bezinelli, L. M., Shitara, P. P., & Correa, L. (2012). Effect of irradiation with red and infrared laser in the treatment of oral mucositis: A pilot study with patients undergoing chemotherapy with 5-FU. Lasers in Medical Science 27(6), 1233-40.

To verify the efficacy of 660 nm laser associated with 780 nm laser in reducing the severity of oral mucositis (OM)

Investigators conducted two interviews before beginning treatment for OM and one interview after the therapies. In the first interview, patients were asked about demographics, medical and laboratory data, and types of food ingested. Oral health status was evaluated, and the oral cavity was examined. Oral hygiene was reviewed.

Following the first interview, participants were divided into one of three groups.

• Group 1 was the control group (CG), which received no laser therapy. The CG used chlorhexidine mouthwashes twice per day for 5 days. 
• Group 2 was irradiated with laser-emitting light in the red region, 660 nm for the treatment of OM. Group 2 received five daily sessions of low-level laser irradiation. 
• Group 3 received five daily laser treatments of laser irradiation with two wavelengths. These patients were irradiated with laser-emitting light in the red region and immediately afterward with laser-emitting light in the infrared region, 660 nm laser with a sequential phase of 780 nm laser.

• The sample consisted of 18 patients ranging in age from 41–90 years.
• The sample was 66.7% male and 33.3% female.
• No significant differences existed between groups.
• All participants were receiving 5-fluorouracil (5-FU) not in combination of other agents.
• Cancer diagnoses were oropharyngeal (n = 8), gastric (n = 3), esophageal (n = 2), maxillary sinus (n = 1), colon (n = 1), colorectal (n = 1), rectal (n = 1), and breast (n = 1).
• Periodontal disease, dental caries, and hematological data (total leukocytes and platelets) were not significantly different among groups.
• In terms of smoking and alcohol use, 13 of 18 participants were smokers or ex-smokers and 15 of 18 participants did not drink alcohol.

This study was conducted in Brazil. The site and setting type were not specified.

• Patients were undergoing the active treatment phase of care.
• This study has clinical applicability for palliative care.

This was a pilot study, prospective trial.

Symptoms of OM were classified according to a system validated by Monopoli et al. and applied by Vera-Llonch et al. The name of the tool was not given. Assessment was performed by a dental surgeon. This system was based on a grading system with the following grades.

• 0 = absence of sites with erythema, ulceration, or pseudomembranes
• 1 = presence of erythema and absence of ulceration
• 2 = presence of erythema, ulceration, or pseudomembrane affecting only one site
• 3 = presence of erythema, ulceration, or pseudomembrane affecting two sites
• 4 = presence of erythema, ulceration, or pseudomembrane affecting three sites
• 5 = presence of erythema, ulceration, or pseudomembrane affecting more than three sites.  

A faces visual scale was used to assess satisfaction with the results of treatment with a happy face meaning \"satisfied\" (i.e., I feel no pain, I am able to eat better, I can speak better, I am satisfied, I like the treatment) and a sad face meaning “dissatisfied\" (i.e., I feel pain, I cannot eat, I cannot speak, I am not satisfied, I don’t like the treatment).

Consistency of food eaten was measured; however, no tool was specified.

The red laser group (Group 2) and the red laser plus infrared laser group (Group 3) had statistically significant differences in comparison to the CG group (Group 1) (p = 0.0190).

Statistically significant changes were found in the consistency of the foods ingested, favoring Group 3 (p < 0.001).

Satisfaction with oral condition was significantly different from the initial to the final evaluation with regard to Groups 1 and 2 (p < 0.001). No statistical difference was found in Group 3 from the initial to the final evaluation (p = 0.491).

A statistically significant difference was found between the CG and the red laser groups in OM scores but not necessarily in the severity of the OM lesions. The addition of laser light emission in the red region with infrared emission was found to be advantageous for the treatment of OM. The study provided support for the use of good oral hygiene alone in reducing the grade of OM.

• The sample size was small, with fewer than 30 patients.
• Even though it was described as a blinded study, it clearly was not.
• The study only included adults and patients receiving 5-FU.
• Information regarding how data was collected, especially in regard to the tools, was lacking.
• The article did not describe how patients were assigned to groups, which was apparently not random.
• Frequency of oral assessment was not described, and values used in the analysis were unclear.

Using good oral hygiene alone is still the cornerstone of OM prevention and treatment. The addition of laser therapy may be helpful. Laser therapy may not be available in all settings. This study did not substantially add to evidence in this area. This study was too small to make definitive decisions regarding laser therapy, but it provides promising results.