IJCRR - 4(1), January, 2012
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PHOTODYNAMIC THERAPY - A NOVEL APPROACH IN POCKET STERILIZATION
Author: Jannani Muthu, Jaideep Mahendra
Abstract:Anti microbial photodynamic therapy is one of the most upcoming treatment approaches in field on dentistry. Applications of PDT in dentistry are growing rapidly: the treatment of oral cancer, bacterial and fungal infection therapies, and the photodynamic diagnosis (PDD) of the malignant transformation of oral lesions. Periodontitis as known is polymicrobial disease and this novel therapeutic approach sounds promising in eliminating the microorganisms when usedin adjunct to conventional debridement methods. This technique involves application of a photosensitizer and activating it with a light source of specific wavelength. This system in presence of oxygen creates reactive oxygen species that exerts the classic photodynamic reaction. The advantage of this new approach includes rapid bacterial elimination, minimal chance of resistance development and safety of adjacent host tissue and normal microflora. This review discusses about the general principles, mechanism of photodynamic therapy with additional highlights on its application in periodontal diseases.
Keywords: Antimicrobial photodynamic therapy, periodontitis, photosensitizers, lasers.
There have been many changes and developments in dentistry over the past decade than in the previous hundred years combined, and the pace is accelerating! Oral cavity is an abode of variety of microorganisms and periodontitis is an infectious disease caused by number of these organisms. Current treatment techniques involve either periodic mechanical disruption of oral microbial biofilms or maintaining therapeutic concentrations of antimicrobials in the oral cavity, both of which are fraught with limitations. The development of alternative antibacterial therapeutic strategies therefore becomes important in the evolution of methods to control microbial growth in the oral cavity. Numerous adjunct conventional antimicrobial therapies have been attempted. One disadvantage of these therapies is development of resistant strains. So alternate antimicrobial treatment modalities have been researched and one such promising alternative is antimicrobial photodynamic therapy1 . The history dates back over 3000 years when Indians used psoralens in the treatment of vitiligo and the Egyptians employed it in the treatment of leucoderma.
Later It was rediscovered by Western civilization at the beginning of the twentieth century. In 1834, Kalbrunner isolated the chemical bergapten from bergamot oil but did not use it in any therapeutic application2 . In 1900 Prime, a French neurologist, used eosin orally in the treatment of epilepsy. He discovered that this induced dermatitis in sun-exposed areas of skin. This discovery then led to the first medical application of an interaction between a fluorescent compound and light3 . It was further developed by the Danish physician, Niels Finsen, who at the turn of the last century described the successful treatment of smallpox using red light. He then went on to use ultraviolet light to treat cutaneous tuberculosis and developed the use of carbon arc phototherapy in the treatment of this condition for which he was awarded a Nobel Prize in 19033 . History of photodynamic therapy began when Von Tappeiner,who along with dermatologist Jesionek, used a combination of topical eosin and white light to treat skin tumors. They demonstrated the requirement of oxygen in photosensitization reactions and in 1907 they introduced the term "photodynamic action" to describe this phenomenon. The German physician Friedrich Meyer–Betz performed the first study with what was first called photoradiation therapy (PRT) with porphyrins in humans in 1913. Meyer. In 1989, First Paper on photodynamic therapy was presented at the Congress on photodynamic therapy of Tumours4 . This review elucidates the evolution and the current position of photodynamic therapy, its applications in dentistry, especially in periodontal treatments and its likely impact in future.
COMPONENTS OF PHOTODYNAMIC THERAPY
Photodynamic reaction is a physicochemical reaction that basically involves 2 components: Photo sensitizer and the activating light source.
These are natural or synthetic photoactive compounds that have photosensitizing potential. They function by trapping the light in the form of photons and transferring the energy to other molecules resulting in the liberation of short-lived energetic species that interact with biological systems and produce tissue damage32 . Ideal properties of photosensitizers – this includes photo-physical, chemical, and biological characteristics5 .
> An ideal photosensitizer must be biologically stable.
> Photochemically efficient.
> Selectively retained in the target tissue.
> Low toxicity and fast elimination from the skin and epithelium.
> Absorption peaks in the low-loss transmission window of biological tissues.
> High quantum yield of singlet oxygen production in vivo.
> Cost-effectiveness and commercial availability
> High solubility in water, injection solutions, and blood substitutes. > Storage and application light stability.
Generations – Three generations of photosensitizers have evolved over period of time. I generation includes Hematoporphyrins and pthalocyanines, II generation photosensitizers are mesotetra(hydroxyphenyl)porphyrins marketed as foscan, 5-aminolevulinic acid , tin ethyl etiopurpurin, benzoporphyrin derivative monoacid ring (verteporfin, visudyne) and phenothiazine dyes5,6,7
Phenothiazine dyes includes toluidine blue and methylene blue. These are the recent major photosensitizers used in dental field. Both have similar chemical and physiochemical characteristics. (I).Toluidine blue – It?s a blue-violet solution. It stains granules within mast cells, proteoglycans and glycosaminoglycans. Used to detect mucosal tumors or atypical epithelia.
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