Evaluation of the effectiveness of photodynamic therapy in the complex treatment of patients with homogenous leukoplakia depending on the method of using the photosensitizer

Abstract

The aim of the study is to evaluate the effectiveness of complex treatment of patients with homogenous leukoplakia of the oral mucosa based on a comparison of two different methods of photodynamic therapy (PDT).
Materials and methods.
The study involved 60 patients with homogenous leukoplakia of the oral mucosa, including 36 men and 24 women, aged 38 to 70 years. Depending on the treatment method, the patients were divided into two groups (I and II). Group I consisted of 30 patients with homogenous leukoplakia of the oral mucosa, who received PDT with the application of a photosensitizer gel to the lesion in combination with subsequent local drug treatment. Group II consisted of 30 patients with homogenous leukoplakia of the oral mucosa, who were treated with PDT with the introduction of a photosensitizer gel under the lesion element in combination with local drug treatment. All patients were monitored for oral microbiota by microbiological examination before and after treatment. During PDT, a 0.5% Photoditazine gel penetrator based on chlorine E6 was used as a photosensitizer. The source of the laser radiation was the Latus-T device with a wavelength of 662 nm. The power of the laser radiation varied up to 1 watt.
Results.
According to microbiological studies, representatives of opportunistic pathogenic microorganisms of the oral cavity were detected in the majority of patients with homogenous leukoplakia before treatment in an amount not exceeding normal values, in various combinations: Streptococcus viridans, Neisseria spp., Staphylococcus spp., Enterobacteriaceae spp., Lactobacillus spp. Increased growth of Streptococcus viridans was observed in 13% of cases, Candida albicans in 15%. A combination of increased growth of Streptococcus viridans and Candida albicans was observed in 10% of patients. After a course of PDT and completion of a course of local drug treatment in group I, 20% of patients showed complete disappearance of leukoplakia. In 60% of cases, a decrease in lesions was observed. In 20%, the foci remained unchanged. The appearance of new lesions was not observed. In the composition of the oral microbiota in group I patients, an increased growth of Streptococcus viridans was observed in 7% of cases. In Group II, after PDT and a course of local drug treatment, 63% of patients showed complete absence of lesions. 37% of patients had a decrease in lesion size. There were no patients in whom the lesion did not change. According to microbiological research data, there was no increased growth of opportunistic microorganisms. However, 33% of the patients lacked lactobacilli.
Conclusion.
The method of PDT in the complex treatment of patients with homogenous leukoplakia of the oral mucosa is effective, affordable and can be used in a wide outpatient dental practice.