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Key messages
We are uncertain whether adding antimicrobial photodynamic therapy (aPDT) to standard treatment has significant benefits for adults with gum disease compared with usual treatment alone.
What is gum disease around natural teeth and around dental implants?
Symptoms of periodontal disease include bleeding gums, swollen gums, and bad breath. The infection can damage the soft tissues around the teeth, and in some cases, people can lose their teeth. Many people with dental implants (a false tooth fixed into the gum) will experience this type of disease around the implant.
How is gum disease treated?
In addition to the advice to brush twice a day and floss regularly, people with gum disease may need treatment from their dentist. Standard periodontal treatment involves scraping bacteria from infected areas of the mouth using manual or powered instruments. People may also need to take antibiotics, but due to the increasing resistance of bacteria to antibiotics, alternative additional treatments may be helpful.
Antimicrobial photodynamic therapy (aPDT) combines a light-absorbing dye (applied to affected areas of the mouth after bacteria have been killed) and a light source (usually a low-energy diode laser device).
What did we want to discover?
We wanted to find out whether adding active phototherapy to standard treatment was more effective than standard treatment alone in people with gum disease. We were interested in the long-term effects of using additional active phototherapy, so we looked at the results six months after treatment. We looked at the difference in pocket depth (gaps around the teeth caused by gum disease), bleeding (after gentle probing of the affected areas), attachment of the tooth to the bone, the amount of gum that had pulled away from the tooth (gum recession), and the number of pockets that had closed after treatment. We also wanted to find out if there were any harmful effects associated with using active phototherapy.
What have we done?
We searched for studies involving adults with gum disease or disease around dental implants. We included studies comparing PDT given after standard treatment versus standard treatment alone. We compared and summarised the results according to whether the treatment was given to people who had never been treated for gum disease (active treatment) or to people receiving long-term care (supportive treatment). We rated our confidence in the evidence based on factors such as study methods and size.
What did we find?
We included 50 studies involving 1407 adults. In most studies, PDT was done in one session. In 11 studies, people had multiple sessions of PDT (two, three or four sessions). Most studies involved non-smokers. None of the people in the studies had taken antibiotics in the six months before they entered the study. One very small study involved people who had swelling around dental implants. All other studies involved people with gum disease around natural teeth.
What were the main results?
In active treatment of gum disease, we are uncertain whether additional aPDT provides significant benefits after six months compared with standard treatment. This includes change in pocket depth, bleeding, tooth attachment to bone, and gum recession.
We are also very uncertain about the results of the same measures at six months during the supportive phase of gum disease treatment.
In one study, a participant developed an abscess (swelling of a tooth), but it is not known whether this was related to active phototherapy therapy. Other studies found no harmful effects related to active phototherapy therapy. No study provided information on the number of pockets that had closed six months after treatment.
What are the limits of the evidence?
We are not sure about the results of these studies because they may not have been well done and may have included very small numbers of people. We also found differences in the results of many of the studies and could not explain what caused these variations.
How up-to-date is this evidence?
This evidence is current as of February 14, 2024.