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• W3087522360 abstract "Photobiomodulation, Photomedicine, and Laser SurgeryVol. 38, No. 9 Guest EditorialFree AccessBiophotonics in Health Care and Its Relevance in Fighting the Coronavirus DiseaseAldo Brugnera Junior, Fatima Zanin, Samir Nammour, and Sonia GroismanAldo Brugnera JuniorAddress correspondence to: Aldo Brugnera Junior, DDS, MS, PhD, IFSC–University of São Paulo-USP, Rua Groenlândia 183-Jardim América, CEP-01434-000-São Paulo-SP, Brazil E-mail Address: [email protected]Education College of the European Master in Oral Laser Applications (EMDOLA), University of Liege, Liege, Belgium.IFSC-University of São Paulo, São Paulo, Brazil.Search for more papers by this author, Fatima ZaninCollaborative Professor of the Collective Health Specialization, Faculty of Dentistry, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, Brazil.Search for more papers by this author, Samir NammourDepartment of Dental Sciences, Faculty of Medicine, University of Liege, Liege, Belgium.Search for more papers by this author, and Sonia GroismanDepartment of Community Dentistry, School of Dentistry, Federal University of Rio de Janeiro-UFRJ, Rio de Janeiro, Brazil.Oral Health Work Group from World Federation of Public Health Associations, Tonny Volpi Award-Global Child Dental Fund-Harvard University in Preventive Research in Public Health, Boston, Massachusetts, USA.Search for more papers by this authorPublished Online:16 Sep 2020https://doi.org/10.1089/photob.2020.4883AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The development of techniques using light related to living matter is called biophotonics, which can be considered a relatively new science, which integrates elements of physics, chemistry, and biology and provides health care with new therapeutical resources. It resulted from the development of quantum physics by the end of the 20th century technological revolution. In 2015, Brugnera Junior and Bagnato1 wrote an editorial for Photobiomodulation, Photomedicine and Laser Surgery (PPMLS) highlighting that the control of microorganisms was one of the most researched areas of pharmacology, since a significant part of modern civilization was destroyed by an uncontrolled attack of microorganisms and new threats are constantly emerging. The number of pathogens resistant to chemical agents increases the death rate after infections that were easily treated in the past, because despite technology, they seem to become stronger, and pharmaceutical resources may be reaching their limit. Some kinds of pneumonia in hospitals do not respond to traditional antibiotics, and biophotonics could make a difference in situations in which microbiological control is necessary.1Coronavirus disease 19 (COVID-19) presents symptoms similar to SARS-CoV-1 (Severe Acute Respiratory Syndrome Coronavirus). Both could be described as a piece of genetic material (RNA) wrapped in a coat of proteins that has spikes helping the virus enter into human cells, hijack them, and create copies of itself and eventually kill the host. However, the virus is inert outside the cells, and at that stage could be disinfected with pharmaceutical drugs and photodynamic therapy (PDT).2 The most usual symptoms are fever, dry cough, difficulty breathing, loss of taste, and dryness of buccal cavity.COVID-19 is even more serious since it can evolve from respiratory insufficiency due to pulmonary lesion to death. A study by Xu et al.3 indicated that the receptor for COVID-19 is the same as for SARS-CoV-1: the angiotensin-converting enzyme (ACE2). This converting enzyme has a key role at the cell entry door, enabling the virus its first adhesion/attachment line, then grow and infect the human body.In a recently published study by the International Journal of Oral Science, Xu et al.4 reported that a high expression of ACE2 was identified in lung samples, with the same standard deviation of the mean on the dorsum of the tongue and in oral and gingival tissues, evidencing that the buccal cavity is a high-risk route for the entry, multiplication, and pathogenicity of the infection by the COVID-19. The study also showed that the virus scatters throughout the human body reaching other areas such as lungs, liver, intestine, cardiovascular, and urinary systems, including the prostate. ACE2-positive cells were present in high concentrations in buccal and epithelial cells, consistently detected in whole saliva at an early stage and in saliva collected from the salivary gland ducts at a later stage.4How Is Biophotonics Inserted in the Oral Context of Patients' Health?As the virus adheres to oral mucosa epithelial cells, prevention should focus on stimulating the patient to keep a balanced oral cavity, without any biofilm, a balanced buffer capacity, and good salivary flow secretion,5 creating natural difficulties for the virus adhesion to its specific receptor ACE2. However, if buccal health is compromised, the virus will find fertile ground for adhesion, entry, and dissemination. Some countries report the affected age groups of their populations are younger than in China and Europe, which may be related to the precocious use of drugs that decrease salivary secretion. Anxiolytics and medications for weight loss decrease salivary secretion, but are nevertheless very popular with the young population. Elderly people and radio- and chemotherapy patients suffer from a decrease of salivary flow, which might increase the accumulation of bacteria on the tongue tissue, especially in the fissure and microvilli areas, thus decreasing defensive immunoglobulins against bacteria and virus.5According to the current concepts of integrated oral and general health, the buccal cavity becomes an important line of defense and prevention against COVID-19. In addition to all medical protocols regarding the control of COVID-19, basic individual oral hygiene care, such as brushing the tongue efficiently, treating gingival tissue diseases, caries, and dental erosion, are of major importance to improve oral heath, thus helping the general health.In this item biophotonics presented the third generation of Er:YAG laser equipment to be used in odontology. Besides being able to work with reduced water spray decreasing contamination of the environment through the aerosol produced during preparation of carious lesions, it has got new parameter options with low density energy that allows remineralization of dental erosions and hypoplasic surfaces simultaneously removing bacterial content and microorganisms, in a noninvasive approach, preserving and strengthening healthy dentine.6Er:YAG laser helps create a less contaminated clinical environment as it significantly decreases the buccal aerosol, preventing the high rotation water aerosol from contaminating both the health professional during procedure and the environment and equipment. Studies show that surgeon dentists are among those most contaminated while working, since they remain very close to the buccal cavity for a long time. To improve the professional and patient's protection, new prevention, hygiene, and treatment practices are necessary.It is important to know that not only the tongue and gingival tissues present specific receptors for COVID-19 but also the saliva presents fluids, immunoglobulins, cytokines, and chemokines that allow detection of the virus in its status.3 To modify the contamination cycle of COVID-19, the authors of this editorial recommend that basic control measures of buccal health be associated with complementary techniques presented by biophotonics, such as PDT, a noninvasive technique of photosensitization lethal to bacteria, fungi, and virus and that may be used on mucosa or lesions infected by microorganisms. It is based on the use of laser light at appropriate wavelength to activate a photosensitive dye that when applied on sites affected by microorganisms, they absorb laser light and trigger an interaction that induces a series of reactions with the molecular oxygen present, and can generate cytotoxic species that cause the death of these microorganisms and bacteria without affecting the healthy tissue. Thus, the simultaneous presence of light, photosensitizer, and oxygen is fundamental for the PDT action.6Unfortunately, there is no reliable treatment or vaccine for SARS/COVID-19 right now. The use of photobiomodulation (PBM) laser as new option ILIB (intravascular laser irradiation of blood) on the tongue with appropriate parameters decreases the presence of receptors ACE2, preventing the initial adhesion of the COVID-19 to its route of penetration into the human cell. Nevertheless, due to the understanding of the need of oxygen and faster rehabilitation of damaged tissue, antiviral effects and finally reduction or control of the cytokine storm by reducing inflammatory agents. ILIB could be used as a preventive and adjuvant therapy or even alternative therapy in all these mechanisms without side effects or drug interactions.2 It is which consists of a continuous and direct therapeutic red laser application on the region of the radial artery to fight free oxygen radicals responsible for the precocious aging of cells and tissues. It can also be applied close to the sublingual artery, decreasing organic inflammation, interfering in the close relationship between genet susceptibility and inflammatory cytokines by changing the interleukin cells.1 PBM has an important action on tissues due to its anti-inflammatory and analgesic effects and is used in the treatment of several pathologies. To fight the coronavirus, the best use of PBM is a combination of pharmaceutical methods and PBM to remove the virus, oxygenate tissues, and reduce or inhibit the cytokine storm caused by severe inflammation. Biophotonics is an efficient tool against COVID-19 as it requires a multi-disciplinary approach. Above all, the virus route toward the buccal cavity has to be blocked. In this kind of contamination, it is very relevant to change the contamination cycle to healthy cycle.Biophotonics present to us the use of UV-C ultraviolet C light reaches its highest germicide action in the 264 nm wavelength. Currently UV-C equipment is used all over the world in different ways, including water, air, and surface disinfection and elimination of microorganisms.Regarding the present pandemic, we think that UV-C radiation should be an ally in working.A recent study published by Ewemeka et al.7 evidences in an unquestionable way the importance of light to fight bacteria and viruses. It also shows that violet/blue (400–470 nm) is an antimicrobial light against numerous bacteria. Further evidence shows that the blue light inactivates several viruses, including the common cold coronavirus. It was observed in experiments with animals that red and infrared light at close range reduces respiratory disorders similar to those associated with infections caused by the new coronavirus. Further, using red light in patients eased chronic obstructive pulmonary disease and asthmatic bronchitis. The authors7 concluded that these results call for urgent efforts to further investigate the clinical value of light, before yet another pandemic hits the world.Biophotonics has been unveiling new scientific possibilities and those who research the benefits of light have to come forward and stimulate new therapies related to the prevention, diagnosis, and treatment of COVID-19. This pandemic presents challenges for oral medicine and is also an opportunity to highlight the importance of treating the patient in an integrated way, having dentists, doctors, and scientists join forces to reach the best outcome for the patient.AcknowledgmentsThe authors thank Prof Chukuka S. Ewemeka for encouraging them to study laser therapy and creating the opportunity to deliver our courses in the United States and worldwide. We also thank Prof. Vanderlei Salvador Bagnato, IFSC-USP, for his support to write this Editorial. We are grateful for the opportunity to be a researcher at IFSC-USP, one of the most important research centers in Brazil.References1. Brugnera Junior A, Bagnato VS. Biophotonics and the lifesciences. Photomed Laser Surg 2015;33:531–532. Link, Google Scholar2. Fekrazad R. Photobiomodulation and antiviral photodynamic therapy as a possible novel approach in COVID-19 management. Photobiomodul Photomed Laser Surg 2020;38:255–257. Link, Google Scholar3. Xu H, Zhong L, Deng J, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 2020;12:8. Crossref, Medline, Google Scholar4. Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci 2020;63:457–460. Crossref, Medline, Google Scholar5. Maltz M, Tenuta LMA, Groisman S, Cury JA. Cariology: Basic Concepts, Diagnostic and Non Restaurative Treatment, 1st ed. São Paulo, Brazil: Brazilian Association of Teaching Dentistry; Editora Artes Médicas, Volume 1, 2016; pp. 144–148. Google Scholar6. Brugnera Junior A, Namour S. Laser in Dentistry, Current Clinical Applications. Irvine, CA: Universal Published, Inc., 2018, pp. 1–547. Google Scholar7. Enwemeka CS,Bumaha V, Masson-Meyersc DS. Light as a potential treatment for pandemic coronavirus infections: A perspective. J Photochem Photobiol B Biol 2020;207:1–6. Crossref, Google ScholarFiguresReferencesRelatedDetails Volume 38Issue 9Sep 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Aldo Brugnera Junior, Fatima Zanin, Samir Nammour, and Sonia Groisman.Biophotonics in Health Care and Its Relevance in Fighting the Coronavirus Disease.Photobiomodulation, Photomedicine, and Laser Surgery.Sep 2020.521-523.http://doi.org/10.1089/photob.2020.4883Published in Volume: 38 Issue 9: September 16, 2020PDF download" @default.
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