Effects of Photobiomodulation on Burning Mouth Syndrome: A Systematic Review and Meta-Analysis

IF 4 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Journal of oral rehabilitation Pub Date : 2025-01-28 DOI:10.1111/joor.13931

Monica Reiko Okuhara, Virgínia Fernandes Moça Trevisani, Cristiane Rufino Macedo

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Abstract

Objective

The objective of this research is to evaluate the effectiveness and safety of photobiomodulation or low-level laser therapy on burning mouth syndrome compared to placebo, no-laser, clonazepam and alpha-lipoic acid.

Methods

A systematic review of randomised clinical trials was performed. The databases consulted were MEDLINE, CENTRAL, LILACS, EMBASE and clinical trial registries ClincalTrial.org and WHO-ICTRP, to retrieve citations published until April 4, 2023. In addition, we consulted the grey literature for unpublished studies. There were no restrictions on language, publication status and publication date. Outcomes included pain relief, change in oral health quality of life, adverse effects and change in the quality of life concerning anxiety and depression. Two independent authors performed the study selection, and the risk of bias was assessed using the Cochrane collaboration tool. The random effect was calculated with a 95% confidence interval to calculate the relative risk. We performed heterogeneity by I² and subgroup analysis. For all calculations, we used Review Manager 5.4.1 software.

Results

In total, 528 references were located, and 13 studies were included, with 503 participants. Seven studies were evaluated qualitatively, and six were grouped for data meta-analysis according to the type of laser used, red or infrared. The following comparisons were evaluated: laser versus placebo, laser versus clonazepam and laser versus alpha-lipoic acid. Less pain was reported with the use of a laser, with low quality of evidence, in the comparisons: red laser versus placebo with a weighted mean difference (WMD) of −1.18; 95% CI [−2.16 to −0.19]; I² = 61%; N = 58; 2 RCTs; infrared laser versus placebo with WMD = −1.34; 95% CI [−1.86 to −0.82]; I² = 14%; N = 87; 3 RCTs; laser versus clonazepam with mean difference (MD) of −1.66; 95% CI [−3.17 to −0.15]; I² = 0%; N = 33; 1 RCT. Oral health quality of life was better with the use of the laser, with very low quality of evidence, in the comparisons: red laser versus placebo with WMD = −1.08; 95% CI [−1.49 to −0.66]; I² = 0%; N = 105; 2 RCTs; infrared laser versus placebo with WMD = −0.46; 95% CI [−1.70 to 0.78]; I² = 86%; N = 85; 3 RCTs; laser versus clonazepam with MD = −19.65; 95% CI [−45.97 to 6.67]; N = 33; 1 RCT. For anxiety and depression, there was no significant difference between the groups, with very low quality of evidence, in the comparisons: infrared laser versus placebo, for anxiety with MD = 0.11; 95% CI [−2.64 to 2.86]; N = 28; 1 RCT; and for depression with MD = −0.66; 95% CI [−3.56 to 3.44]; N = 28; 1 RCT. Likewise, the comparison of laser versus clonazepam for anxiety and depression with MD = 1.05; 95% CI [−2.83 to 4.93]; N = 33; 1 RCT.

Conclusion

Pain was less common, and quality of life was better when using a low-level laser than placebo and clonazepam. The certainty of the evidence obtained was low and very low, respectively, meaning that the true effect may differ substantially from the effect estimate. Further well-conducted RCTs are needed to increase the degree of certainty of the evidence obtained.

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光生物调节对灼口综合征的影响：系统综述和荟萃分析。

目的：本研究的目的是评价光生物调节或低水平激光治疗灼口综合征的有效性和安全性，并与安慰剂、无激光、氯硝西泮和α硫辛酸进行比较。方法：对随机临床试验进行系统评价。查阅的数据库包括MEDLINE、CENTRAL、LILACS、EMBASE以及临床试验注册中心clinaltrial.org和WHO-ICTRP，检索到2023年4月4日前发表的引文。此外，我们还查阅了未发表研究的灰色文献。对语文、出版地位和出版日期没有限制。结果包括疼痛缓解、口腔健康生活质量的改变、与焦虑和抑郁有关的不良反应和生活质量的改变。两位独立作者进行了研究选择，并使用Cochrane协作工具评估偏倚风险。随机效应以95%置信区间计算，以计算相对风险。我们通过I2和亚组分析进行异质性分析。对于所有的计算，我们使用Review Manager 5.4.1软件。结果：共检索到文献528篇，纳入13项研究，受试者503人。7项研究进行了定性评估，6项研究根据使用的激光类型（红色或红外线）分组进行数据荟萃分析。评估了以下比较：激光与安慰剂，激光与氯硝西泮，激光与α硫辛酸。在比较中，使用激光治疗的疼痛较少，证据质量较低：红色激光与安慰剂的加权平均差（WMD）为-1.18；95% CI [-2.16 ~ -0.19]；i2 = 61%；n = 58；2相关的;红外激光与安慰剂相比，WMD = -1.34；95% CI [-1.86 ~ -0.82]；i2 = 14%；n = 87；3相关;激光与氯硝西泮的平均差（MD）为-1.66；95% CI [-3.17 ~ -0.15]；i2 = 0%；n = 33；1个随机对照试验。在比较中，使用激光治疗的患者口腔健康生活质量更好，证据质量很低：红色激光治疗与安慰剂相比，WMD = -1.08；95% CI [-1.49 ~ -0.66]；i2 = 0%；n = 105；2相关的;红外激光vs安慰剂，WMD = -0.46；95% CI [-1.70 ~ 0.78]；i2 = 86%；n = 85；3相关;激光对比氯硝西泮，MD = -19.65；95% CI [-45.97 ~ 6.67]；n = 33；1个随机对照试验。对于焦虑和抑郁，两组之间没有显著差异，证据质量非常低：红外激光治疗与安慰剂治疗，焦虑的MD = 0.11；95% CI [-2.64 ~ 2.86]；n = 28；1个随机对照试验;抑郁症的MD = -0.66；95% CI [-3.56 ~ 3.44]；n = 28；1个随机对照试验。同样，激光与氯硝西泮治疗焦虑和抑郁的比较，MD = 1.05；95% CI [-2.83 ~ 4.93]；n = 33；1个随机对照试验。结论：与安慰剂和氯硝西泮相比，低强度激光治疗组疼痛发生率较低，生活质量较好。获得的证据的确定性分别为低和非常低，这意味着真实效果可能与效果估计有很大差异。需要进一步实施良好的随机对照试验来提高所获得证据的确定性程度。

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来源期刊

Journal of oral rehabilitation 医学-牙科与口腔外科

CiteScore

5.60

自引率

10.30%

发文量

116

审稿时长

4-8 weeks

期刊介绍： Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function. Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology. The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.