This document summarizes the current state and future prospects of dental laser phototherapy (LPT). It notes that while over 3,500 studies on LPT now exist on PubMed, protocols vary widely between studies and the field lacks standardized guidelines. However, LPT is gaining acceptance in dentistry, with manufacturers now offering LPT options on dental laser equipment. While higher quality studies are still needed to establish evidence for most applications, LPT has been shown to be effective for over 100 conditions with few side effects, representing an attractive alternative or supplement to pharmaceuticals. Continued development of LPT protocols and education initiatives are encouraged to help integrate this modality more fully into evidence-based dental practice.

1. Guest Editorial
Dental Laser Phototherapy
Jan Tune´r, DDS
In a survey of the literature up to the year 2001,1
353 studies on laser phototherapy (LPT) with a dental
connection were identified, and 94% of these reported a
positive effect. A total of 98 dental institutions in 38 countries
were identified in this survey. That would appear to be a good
base for an acceptance of a comparatively new treatment
modality. In contrast, however, < 12 dental studies were
found on PubMed, suggesting a different story. Only early
adapters were using LPT in their clinical everyday practice
and ‘‘biostimulation’’ was considered to be alternative
medicine.
Thirteen years later, the situation is different. With *3500
PubMed abstracts, many of these being dentally oriented,
LPT is gradually being implemented in the dental profession.
Manufacturers of ‘‘hard dental lasers’’ have realized the shift
and are often offering LPT options in their equipment via
separate handpieces. With this positive change at hand, it
could be a good time to consider the future development of
dental LPT, and to further discuss steps necessary to embrace
this treatment modality.
The literature is ambiguous when it comes to the proto-
cols, and meta-analyses are hard to evaluate, either because
of the lack of reporting of the full parameters or the varia-
tion in treatment protocols, for example, in the case of
temporomandibular disorder (TMD), for which the diversity
of protocols makes a strict scientific evaluation impos-
sible.2,3
However, this problem is not typical of LPT. It also
applies to endodontics, in which there is no evidence-based
science, in spite of the fact that it is widely used and quite
successful.4
In addition, there appears to be a lack of qual-
ified reviewers in the area of LPT. Studies with incomplete
or incorrect reporting of parameters slip through the re-
viewing process all too often and there is apparently a lack
of understanding of the therapeutic windows when it comes
to meta-analyses. Reviewing focuses too much on method-
ology and the use of unlikely laser parameters is not well
considered. Even qualified reviewers call for improvement
in LPT parameter reporting.5
The World Association for
Laser Therapy has published dosage guidelines for muscu-
loskeletal indications,6
but so far not for dental applications.
Scientific journals could require a higher reviewing stan-
dard, and even specialized laser journals do not require full
reporting of the parameters used.
‘‘Laser dentistry’’ in the past generally meant drilling,
cutting, and vaporizing, but there is now an understanding of
the fact that even a ‘‘surgical’’ laser produces some degree
of LPT. There is also a growing awareness among manu-
facturers that LPT is an attractive accessory to their tradi-
tional lasers. Diode lasers are easily fitted with a reduced
power LPT headpiece, and Nd:YAG manufacturers recom-
mend the bleaching array as a way of performing LPT. This
progress is positive, although the therapist has little control
of the parameters, unless the average output in milliwatts
and aperture size are accounted for. From manufacturers
specializing in LPT, products have emerged in which a
single portable probe contains two wavelengths and/or the
ability to change the power. This makes these products more
versatile. Holding a laser pen and aiming at selected targets
is the most common treatment procedure. This is suitable in
several situations, but there is a need for development of
more convenient and time-saving procedures; for example,
an impression tray-like design with a red light in periodontal
therapy and orthodontics, a mask covering the involved
muscles in TMD, or extraoral wraps for mucositis patients.
Meanwhile, parts of the industry offer pseudoscientific
explanations, which confuse and delay the full recognition
of LPT. Another problem is that some manufacturers rec-
ommend LPT in the watt range and speak about kiloJoules.
High energies are fine for temporary pain reduction, but
certainly not for stimulation.
LEDs have been suggested as a replacement for lasers, and
many studies have confirmed the efficacy of both light
sources. Some studies have compared the effects of lasers and
LEDs in dental applications and have confirmed the useful-
ness of both. However, the light parameters have been too
different to make any conclusions possible.7
It appears that
the effects of LEDs are more similar to lasers when used for
superficial structures, whereas lasers are more effective in the
treatment of bulk tissues.8
Dental LPT is on the threshold of entering from the
shadows and into the evidence-based light, but the lack of
easily accessible independent and unbiased education needs
to be resolved. Universities are called upon to take the lead
and not to let their students depend upon information from
the industry. Karu (unpublished observation) said that ‘‘we
can talk to the cells, but we need to learn their language.’’
For the time being we can only communicate via some kind
of pidgin, but that is still wonderful.
In conclusion, the scientific base and overall reputation of
dental LPT has improved considerably during the past 12
Private practice, Gra¨ngesberg, Sweden.
Photomedicine and Laser Surgery
Volume 32, Number 6, 2014
ª Mary Ann Liebert, Inc.
Pp. 313–314
DOI: 10.1089/pho.2014.9860
313

2. years. However, studies of higher quality are needed to
reach the evidence-based level for most of the indications.
LPT is a phenomenon that works for all cells containing
mitochondria, and the beauty of the treatment is that is works
for so many conditions. This has also become a problem from
a scientific point of view, as >100 different indications are
described in the literature, and very few have enough liter-
ature backing to be considered evidence based. But when
evaluating an indication, one should not only look at the
studies published for this particular indication. Rather, the
biological background of the pathology should be consid-
ered, and the global effects of LPT taken into account. And
the lack of side effects is a very important aspect, in a time
when overconsumption of nonsteroidal anti-inflammatory
drugs (NSAIDs) and steroids has become a serious health
problem. A recent survey of the literature revealed 23
studies in which LPT was nearly as effective or better than
the pharmaceuticals, or even better when used in combina-
tion with them.9
Dentists requiring more evidenced-based
science before introducing LPT might find the reference10
worthwhile reading.
References
1. Tune´r, J., and Hode, L. (2002). Laser therapy – clinical prac-
tice and scientific background. Gra¨ngesberg: Prima Books.
2. Petrucci, A., Sgolastra, F., Gatto, R., Mattei, A., and
Monaco, A. (2011). Effectiveness of low-level laser ther-
apy in temporomandibular disorders: a systematic review
and meta-analysis. J. Orofac. Pain 25, 298–307.
3. Herranz-Aparicio, J., Va´zquez-Delgado, E., Arnabat-
Domı´nguez, J., Espan˜a-Tost, A., and Gay-Escoda, C.
(2013). The use of low level laser therapy in the treatment
of temporomandibular joint disorders. Review of the liter-
ature. Med. Oral Patol. Oral Cir. Bucal. 18, e603–e612.
4. Tranaeus, S., et al. Swedish Council on Health Technology
Assessment. http://sbu.se/en/Published/Yellow/Methods-
of-Diagnosis-and-Treatment-in-Endodontics/ (Accessed
May 7, 2014).
5. He, W.L., Li, C.J., Liu, Z.P., Sun, J.F., Hu, Z.A., Yin, X.,
and Zou, S.J. (2013). Efficacy of low-level laser therapy in
the management of orthodontic pain: a systematic review
and meta-analysis. Lasers Med. Sci. 28, 1581–1589.
6. http://waltza.co.za/documentation-links/recommendations/
(Accessed May 7, 2014).
7. Esper, M.A., Nicolau, R.A., and Arisawa, A. (2011). The
effect of two phototherapy protocols on pain control in
orthodontic procedure - a preliminary clinical study. Lasers
Med. Sci. 26, 657–663.
8. Hode, T., Duncan, D., Kirkpatrick, S., Jenkins, P., and Hode,
L. (2009). The importance of coherence in phototherapy.
Proc. SPIE 7165, Mechanisms for Low-Light Therapy IV,
716507 (February 18, 2009); doi:10.1117/12.809563.
9. Tune´r, J. Diclofenac, dexamethasone or laser phototherapy.
Available at: http://www.laserannals.com/2013/10/26/
pills-or-lpt/ (Accessed May 7, 2014).
10. Smith, G.C.F., and Pell, J.P. (2003). Parachute use to pre-
vent death and major trauma related to gravitational chal-
lenge: systematic review of randomised controlled trials.
BMJ 327, 1459–1461.
Address correspondence to:
Jan Tune´r
Spjutva¨gen 9
772 32 Gra¨ngesberg
Sweden
E-mail: jan.tuner@swipnet.se
314 GUEST EDITORIAL