Through laser treatments, patients may also find relief from cold sores and pain in the temporomandibular joints. Additionally, lasers have proven useful for reshaping gum tissue and correcting restrictive frenulums in children. Authentic Smiles uses the Summus Horizon Laser for the treatment of TMD and many other conditions. The Summus Horizon Laser is regenerative, non-invasive, and offers pain management through photobiomodulation.
Lasers and Photobiomodulation
Photobiomodulation (PBM) is a red and near infra-red light therapy that induces photochemical reactions in the body on the molecular and cellular levels. Laser light in the red and near-infrared spectrum reduces inflammation, provides analgesia, and most importantly, enhances the repair/remodeling/regeneration of tissue. Wavelengths between 600nm and 1100nm are used in laser therapy.
Photobiomodulation describes how red and near-infrared light treatment can impact cells and tissue that are either over or under-active in a stressed state regardless of the cause. Photobiomodulation was established as the proper descriptive terminology by the North American Association for Light Therapy and the World Association for Laser Therapy in 2014. Prior to that, the most frequently used term was low-level laser therapy (LLLT). However, there are photobiomodulation devices that use LED making LLLT an inaccurate term when LED is used. LED is limited in treatment, while Laser-based devices have the most flexibility in treatment capabilities as they can treat both superficial and deep tissue conditions.
We use a Summus Class IV laser with 4 wavelengths in the visible red and near-infrared range.
The (650nm) wavelength is highly absorbed by melanin and other superficial receptors. These can enhance wound healing and may also stimulate trigger points and acupuncture points.
Wavelengths at 810nm are at the peak of absorption for the cytochrome-c-oxidase enzyme. This is the rate-limiting step in the conversion of O2 to adenosine triphosphate (ATP) within the electron transport cycle. These wavelengths will accelerate the production of ATP within the mitochondria.
The 915nm wavelength targets hemoglobin. Recent studies have indicated that this wavelength creates as much as a 30-50% increase in molecular oxygen (O2) release to the tissue over the 980nm wavelengths.
Wavelengths at 980nm have moderate increased absorption by water. The higher-powered lasers can create some thermal gradients and increase circulation in treated areas.
The Horizon laser from Summus Medical Laser delivers therapeutic wavelengths of 650, 810, 915, and 980nm. The red 650nm wavelength is absorbed in the superficial tissues. The infrared wavelengths of 810, 915, and 980nm penetrate deeper into the body. When the power is turned up, brighter laser light is emitted, and a therapeutic dosage can be delivered deeper into the body.
Effects of Photobiomodulation
- Enhanced Tissue Healing: Laser treatments enhance blood circulation and lymphatic drainage; release oxygen and nutrients from the bloodstream into the tissues and improve cellular metabolic activity to produce more cellular energy. With more energy available, damaged cells can repair and regenerate more quickly, and with better quality.
- Accelerated Tissue Repair and Cell Growth: Photons of laser light penetrate deeply into tissue and accelerate cellular reproduction and growth. The laser light increases the energy available to the cell so that the cell can take on nutrients faster and get rid of waste products. As a result, the cells of tendons, ligaments, bones, nerves, and muscles are repaired faster.
- Faster Wound Healing: Laser therapy stimulates fibroblast development (fibroblasts are the building blocks of collagen, which is predominant in wound healing) in damaged tissue. Collagen is the essential protein required to replace old tissue or to repair tissue injuries. As a result, laser therapy is effective on open wounds, scars, and burns.
- Reduced Fibrous Scar Tissue Formation: Laser therapy reduces the formation of scar tissue following tissue damage from cuts, scratches, burns, or surgery by inducing production of more normal type-1 collagen. Scar tissue is the primary source of chronic pain. Laser treatments should be given as soon as possible after any acute injury to promote type-1 collagen production and parallel alignment of the collagen fibers.
- Modulating Inflammation: Laser treatments modulate inflammation by causing vasodilation and activating the lymphatic drainage system. As a result, there is a reduction in swelling caused by bruising or inflammation. Try not to say that laser treatments are “anti-inflammatory”, as they do not suppress inflammation as non-steroidal anti-inflammatory drugs (NSAIDs) do. Rather, Class IV laser therapy treatments help the body progress through the stages of inflammation more efficiently.
- Analgesia: Laser therapy can reduce the firing of the C-pain fibers that transmit signals of ‘pain’ from the cells to the brain. Increased blood circulation flushes away tissue irritants called ‘kinins’. Pain-modulating chemicals such as endorphins and enkephalins are released from the brain and adrenal gland. Increased cell membrane permeability encourages normal concentrations of ions across the cell membrane, and the resting potential of pain fibers is returned to -70 millivolts.
- Improved Vascular Activity: Laser therapy will significantly increase the formation of new capillaries in damaged tissue that speeds up the healing process, closes wounds quickly, and reduces scar tissue. Additional benefits include acceleration of angiogenesis, which causes temporary vasodilatation, and an increase in the diameter of blood vessels. More blood flow equals faster healing and less pain.
- Improved Nerve Function: Slow recovery of nerve functions in damaged tissue can result in numbness and impaired limbs. Laser therapy will speed up the process of nerve cell reconnection and increase the amplitude of action potentials to optimize muscle action.
- Immune System Regulation: Laser therapy can both increase the local immune system response as well as have a positive effect on the whole-body immune response. Increased circulation and enhanced cellular energy production will enhance the activity of immune system cells, helping to reduce and fight infection.
- Trigger Points and Acupressure Points: Laser therapy reduces muscle trigger points and stimulates acupuncture points on a non-invasive basis providing musculoskeletal pain relief. Apply the laser treatment before soft tissue manipulation techniques in order to initiate trigger point resolution and increase the effectiveness of your soft tissue work.
During laser therapy, infrared laser light interacts with tissues at the cellular level increasing metabolic activity within the cell. It improves the transport of nutrients across the cell membrane and the increased production of cellular energy (ATP) is stimulated. The cascade of beneficial effects that follows includes increased cellular function and tissue repair.
Healing begins at the cellular level. Cellular chromophores within the bloodstream and the mitochondria absorb laser photons and the light energy is converted to chemical energy. Specifically, it is water (peak at 970-980nm), hemoglobin (peak at 904-905nm), and cytochrome- c-oxidase (peak at 790-830nm) that are being targeted. This causes an improved efficiency of the respiratory chain leading to an increase synthesis of ATP.
In addition, reactive oxygen species such as nitric oxide (NO) and super-oxide dismutase (SOD) are produced. A cascade of secondary effects can then take place including DNA and RNA synthesis; activation of fibroblasts, macrophages, and lymphocytes; growth factor release; neurotransmitter release; vasodilation; collagen synthesis; improvement of cell membrane permeability and function of the Na+/ K+ pump. Increased metabolic activity will increase oxygen and nutrient availability which leads to enhanced protein and enzyme production. These factors will moderate the inflammatory response, provide analgesia and accelerate/stimulate cell reproduction and growth which leads to faster repair of damaged tissues.
Laser therapy moderates inflammation by the following actions: there is production of nitric oxide (NO) along with other mediators which stimulate vasodilation. This facilitates removal of cellular debris along with activation of the lymphatic drainage channels. But more importantly, it reduces ischemia and all the negative events associated with a negative oxygen balance in tissue. Angiogenesis is stimulated as well which increases oxygen and nutrient transport to improve tissue repair and therefore reduce inflammation.
During each painless treatment, laser energy increases circulation, drawing water, oxygen, and nutrients to the damaged area. This creates an optimal healing environment that reduces inflammation, swelling, muscle spasms, stiffness, and pain. As the injured area returns to normal, function is restored and pain is relieved.
Laser therapy can reduce healing times by 30%- 50%. It is not just faster healing; it’s better healing!
Laser therapy is frequently described as being “anti-inflammatory” which is not the best term. Non-steroidal anti-inflammatory drugs (NSAIDs) suppress inflammation by blocking certain pro-inflammatory chemicals, and can certainly be called ‘anti-inflammatory’. However, laser therapy helps the body progress through the stages of inflammation more efficiently, shortening the duration of the inflammatory episode, and enhancing tissue healing.
Our goal is not just to make the patient comfortable. We want to restore range of motion, improve muscle strength and function and get them back to normal activity. At the cellular level we are healing tissues, in some cases as good as they were before injury. The tissues will be stronger, more flexible, and longer lasting as a result of the laser treatments.
The most obvious and beneficial conclusion we have been able to extract from in vivo studies is that our immune system can handle an extraordinary range of pathologies. The time scale and degree to which our cells can react to and combat ‘foreign invaders’ is the subject of much study. Therapeutic lasers do stimulate the immune system, and restoration of healthy function continues well after the initial application. The amount of healing accomplished during the few minutes of laser treatment is minuscule compared to what it takes to relieve the body of disease or infection. This leads to one very important piece of information: the body does most of the work itself and so the target for an effective laser treatment is not the pathology itself, but rather to stimulate the appropriate cell compartments that lead to the body’s natural repair mechanisms. Basically, we want to stimulate the cell’s metabolism, that is, its ability to use oxygen and nutrients to create energy.