Understanding the essentials of photodynamic therapy for dental practitioners: Shining a spotlight

Abstract

Background: Oral disorders, including tooth decay, periodontal disease, and endodontic infections, are prevalent worldwide. The escalating issue of antibiotic resistance exacerbates the need for alternative treatment modalities. Aim: This review aims to provide a comprehensive overview of advancements in photodynamic therapy (PDT) for dental applications, highlighting its potential as a non-invasive local and adjuvant therapy for various oral infectious disorders. PDT, which originated in the early 20th century, involves three primary components: A photosensitizer (PS), light, and oxygen. The PS selectively targets unwanted eukaryotic cells, such as tumors in the oral cavity, or pathogenic microorganisms, while sparing healthy cells. The efficacy of PDT is significantly influenced by the type of PS utilized. Method: An electronic search was conducted using the PubMed database focusing on peer-reviewed articles up to November 2023 using the keywords “photodynamic therapy,” “photochemotherapy,” “antimicrobial photodynamic therapy,” “antimicrobial photodynamic therapy oral,” resulting in 2341, 1034, 389, 221, and 96 items, respectively. After appropriate review, relevant data from other electronic sources are also included for additional information. Results: Historical and recent studies have demonstrated the effectiveness of porphyrin PSs and temoporfin in treating premalignant and malignant intraoral lesions, particularly as palliative treatments when conventional therapies have failed. In addition, phenothiazinium PSs, such as methylene blue and toluidine blue, have shown substantial antimicrobial activity against bacteria, viruses, and fungi. PDT has been applied successfully to treat specific oral conditions, including caries, endodontic and mucosal infections, periodontal disorders, and periimplantitis. Notably, its antibacterial properties suggest that PDT could reduce the dependency on systemic antibiotics. Conclusion: PDT emerges as a promising alternative to conventional treatments for oral infections, offering a potential solution to the global challenge of antibiotic resistance. Continued research and development are essential to enhance the effectiveness and broaden the application of PDT in dental care.