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The use of light-activated therapies in medical treatment has grown in popularity for decades.
Today, a specific light-based therapy known as photodisinfection therapy offers new hope for patients with advancing gum disease (periodontitis).
This specialized dental photodynamic therapy can kill inflammatory bacteria that harms gums without contributing to antibiotic resistance.
So, what is photodisinfection, how does it work, and what can you expect?
What is photodisinfection?
Photodisinfection is an antimicrobial photodynamic therapy that uses a specialized laser with a photosensitizing solution to kill bacteria without the risk of antimicrobial resistance.
It is a non-antibiotic antimicrobial photodisinfection that boasts impressive results for infection control and other antibacterial uses.
In dental practice, photodisinfection is a powerful treatment for periodontal disease to selectively eliminate bacteria in the biofilm on teeth under the gumline. This technology is used along with periodontal debridement (scaling and root planing, or SRP).
Periowave™, by Ondine Biomedical, Inc. (a Canadian company based in Vancouver), is the photodisinfection technology used for periodontal treatment. It is approved by the FDA and Health Canada.
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How does photodisinfection work?
During photodisinfection therapy, a dentist or periodontist first inject methylene blue dye into a gum pocket (no anesthesia required).
The blue dye binds to the cell walls of the bacteria within the pocket, but it attaches more quickly to Gram-negative than Gram-positive bacteria. Gram-negative bacteria are most often associated with disease and inflammation.
Then, a nonthermal diode laser is used to start a chain of events that destroys bacteria based on the way the dye has attached to the cell wall. In general, it kills most Gram-negative bacteria without wiping all the Gram-positive bacteria (which are often beneficial strains necessary for a healthy oral microbiome).
Used alongside traditional periodontal treatment, photodisinfection dramatically improves gum disease symptoms like deep gum pockets, bleeding gums, and inflammation.
Unlike antibiotic therapy, this broad spectrum photodisinfection technology does not lead to antibiotic resistance, even with repeated applications.
Who can benefit from photodisinfection treatment?
Photodisinfection benefits patients with chronic periodontitis and peri implantitis (in which the gum tissue around a dental implant becomes inflamed).
How Photodisinfection Treats Gum Disease
Patients with gum disease who are treated with photodisinfection along with traditional scaling and root planing experience a dramatic decrease in gum pocket size, bleeding, and inflammation.
Advancing gum disease can result in gum recession and bone loss, neither of which are easily (or at all) reversible.
Typically, patients with gum disease are treated with quarterly scaling and root planing. For stubborn infections, systemic antibiotics may be used. This doesn’t happen often, though, because of the risk of the epidemic of antibiotic resistance.
If these are not successful, invasive oral surgery may be required to manage the pain and symptoms of advanced gum disease.
However, photodisinfection may help to improve results in severe periodontitis cases when used with SRP.
This seems to occur, in part, because it more selectively kills pathogenic bacteria than other management techniques, such as antibacterial mouthwash or toothpaste. This allows for a thriving oral microbiome that is not robbed of its ability to fight infection in the mouth.
Plus, because photodisinfection will not create resistant bacteria (like antibiotic therapy does), it won’t compound other health concerns that can cause inflammation or chronic autoimmune reactions.
One study found that multiple photodisinfection treatments led to a decrease in C-reactive protein (CRP) levels, which are a marker for not only gum disease, but heart disease as well.
Read clinical trials that examine how photodisinfection treats gum disease:
- Antimicrobial photodynamic therapy for the treatment of periodontitis and peri-implantitis: An American Academy of Periodontology best evidence review
- Photodynamic Disinfection in the Treatment of Chronic Adult Periodontitis: A Multicenter Clinical Trial
- Adjunctive effect of photodynamic therapy to scaling and root planing in the treatment of chronic periodontitis
- Treatment of periodontal disease by photodisinfection compared to scaling and root planing
- Comparison between scaling-root-planing (SRP) and SRP/photodynamic therapy: six-month study
Photodisinfection Therapy: What to Expect
The procedure of photodisinfection therapy for periodontitis, step-by-step:
- First, a scaling and root planing will be performed to clear your teeth of plaque and endotoxins below your gumline. Local anesthetic is used during SRP.
- If your gums are bleeding excessively, you may be asked to return in 2 weeks for the photodisinfection procedure. Otherwise, your periodontist can begin immediately after your SRP.
- Your periodontist will very gently inject the blue dye into each gum pocket (the space where your tooth connects to the gumline) one-by-one.
- Your gum pockets will then be exposed to the non-heat laser for one minute. This time is essential to the process.
- For particularly infected areas, your periodontist may repeat treatment before ending the procedure.
Contraindications & Side Effects
There are no known side effects or contraindications for photodisinfection therapy. It is safe for pregnant or lactating mothers.
Other Health Benefits of Photodisinfection
Similar variations of photodisinfection therapy, like nasal photodisinfection, are used for:
- Infection control, especially after nasal surgery
- Chronic rhinosinusitis (sinus infection)
- Ventilator tube disinfection
- Burn/wound healing
- HIV transmission from mother to child
- Andersen, R. C., & Loebel, N. G. (2017). Photodynamic Disinfection in the Treatment of Chronic Adult Periodontitis: A Multicenter Clinical Trial. J Dent Health Oral Disord Ther, 8(4), 00289. Ful text: https://www.researchgate.net/profile/Roger_Andersen3/publication/323877536_Photodynamic_Disinfection_in_the_Treatment_of_Chronic_Adult_Periodontitis_A_Multicenter_Clinical_Trial/links/5b524e310f7e9b240ff274d6/Photodynamic-Disinfection-in-the-Treatment-of-Chronic-Adult-Periodontitis-A-Multicenter-Clinical-Trial.pdf
- Meller, D. M., Loebel, N. G., & Wilson, P. M. Photodisinfection Therapy: Essential Technology for Infection Control. Full text: https://infectioncontrol.tips/wp/wp-content/uploads/2020/01/Photodisinfection-Therapy-Essential-Technology-for-Infection-Control.pdf
- Campanile, V. S. M., Giannopoulou, C., Campanile, G., Cancela, J. A., & Mombelli, A. (2015). Single or repeated antimicrobial photodynamic therapy as adjunct to ultrasonic debridement in residual periodontal pockets: clinical, microbiological, and local biological effects. Lasers in medical science, 30(1), 27-34. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289155/
- Chambrone, L., Wang, H. L., & Romanos, G. E. (2018). Antimicrobial photodynamic therapy for the treatment of periodontitis and peri‐implantitis: An American Academy of Periodontology best evidence review. Journal of periodontology, 89(7), 783-803. Abstract: https://pubmed.ncbi.nlm.nih.gov/30133749/
- Ge, L., Shu, R., Li, Y., Li, C., Luo, L., Song, Z., … & Liu, D. (2011). Adjunctive effect of photodynamic therapy to scaling and root planing in the treatment of chronic periodontitis. Photomedicine and laser surgery, 29(1), 33-37. Abstract: https://pubmed.ncbi.nlm.nih.gov/21166588/
- Andersen, R., Loebel, N., Hammond, D., & Wilson, M. (2007). Treatment of periodontal disease by photodisinfection compared to scaling and root planing. Journal of Clinical Dentistry, 18(2), 34. Abstract: https://pubmed.ncbi.nlm.nih.gov/17508621/
- Berakdar, M., Callaway, A., Eddin, M. F., Roß, A., & Willershausen, B. (2012). Comparison between scaling-root-planing (SRP) and SRP/photodynamic therapy: six-month study. Head & face medicine, 8(1), 1-6. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353176/
- Banaszek, D., Inglis, T., Ailon, T., Charest-Morin, R., Dea, N., Fisher, C. G., … & Street, J. (2019). 283. The efficacy and cost-effectiveness of photodynamic therapy in prevention of surgical site infection. The Spine Journal, 19(9), S138. Abstract: https://www.sciencedirect.com/science/article/abs/pii/S1529943019304851
- Biel, M. A., Sievert, C., Usacheva, M., Teichert, M., & Balcom, J. (2011, September). Antimicrobial photodynamic therapy treatment of chronic recurrent sinusitis biofilms. In International forum of allergy & rhinology (Vol. 1, No. 5, pp. 329-334). Hoboken: Wiley Subscription Services, Inc., A Wiley Company. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270367/
- Biel, M. A., Sievert, C., Usacheva, M., Teichert, M., Wedell, E., Loebel, N., … & Zimmermann, R. (2011). Reduction of endotracheal tube biofilms using antimicrobial photodynamic therapy. Lasers in surgery and medicine, 43(7), 586-590. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188855/
- Pourhajibagher, M., Partoazar, A., Alaeddini, M., Etemad-Moghadam, S., & Bahador, A. (2020). Photodisinfection effects of silver sulfadiazine nanoliposomes doped-curcumin on Acinetobacter baumannii: a mouse model. Nanomedicine, 15(05), 437-452. Abstract: https://pubmed.ncbi.nlm.nih.gov/32028870/
- B. Bhagwandin, N. Loebel, S. Baskaran, R. Andersen. (2011). Use of antimicrobial photodynamic therapy for prevention of HIV transmission from mother to child: A novel approach. Lasers in Surgery and Medicine. Abstract: http://www.abstract-archive.org/Abstract/Share/7964