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Background and Objective: Intraoral photobiomodulation therapy (PBMT) is effective at preventing oral mucositis (OM). Extraoral PBMT is a novel approach with distinct advantages over intraoral PBMT, but no evidence-based treatment protocol has been proposed. The goal of this contribution was to develop a practical and effective treatment protocol for extraoral PBMT to prevent OM.
Methods: Extraoral PBMT was modeled using Monte Carlo simulations with parameters established in intraoral PBMT: 50 mW/cm2 (1 minute treatment time), at either 660 nm, used in superficial PBMT, or 850 nm, used in deeper PBMT. The effective therapeutic dose of ~ 2.0 J/cm2 was assumed to be identical for intraoral and extraoral PBMT. The results prompted a review of the literature regarding PBMT parameters for deep tissue treatment, as well as the mechanism of PBMT.
Summary: Per our Monte Carlo simulations, the treatment parameters established for intraoral PBMT are not appropriate for extraoral delivery. Visible light (660 nm) showed poor penetration, producing an insufficient dose at the oral mucosa. The infrared light (850 nm) penetrated deeper. However, at 50 mW/cm2 and 1 minute treatment time, the dose was still less than targeted 2 J/cm2. Therefore, based on the optical properties of tissues, anatomy of the target population, and established protocols for deeper PBMT, we propose a wavelength of 850 nm, at 399 mW/cm2, and exposure time of 1-11 minutes, depending on the treatment site, to achieve the therapeutic dose of ~2 J/cm2 at the depth of the oral mucosa for preventing OM using extraoral PBMT.
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