Effect of Immediate Photobiomodulation on Pain and Inflammation After Oral Biopsy: A Randomized Clinical Study

Effect of Immediate Photobiomodulation on Pain and Inflammation After Oral Biopsy: A Randomized Clinical Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Immediate Photobiomodulation on Pain and Inflammation After Oral Biopsy: A Randomized Clinical Study Yolanda Collado Murcia, Francisco Parra Perez, Pia López-Jornet This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8051000/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Feb, 2026 Read the published version in Clinical Oral Investigations → Version 1 posted 11 You are reading this latest preprint version Abstract Objective To evaluate if photobiomodulation (PBM) reduces pain and inflammation in patients subjected to a soft tissue oral biopsy, compared to a sham treatment. Materials and method A prospective and randomized clinical study was performed. The oral mucosa biopsy was performed in a standardized manner. The group assignment was performed with a simple randomization. The participants were distributed into two groups: active PBM (n = 31) and simulated/sham PBM (n = 31). A single intraoral PBM session took place (0.5 W) immediately after the biopsy. Results No significant differences were observed between the groups with respect to pain or inflammation reduction during the 7 days of follow-up. Both variables decreased over time in both groups, without a group or time-group interaction effect (p = 0.279 and p = 0.220, respectively). Conclusions A single PBM session after the soft tissue oral biopsy did not show advantages as compared to the sham treatment in the reduction of pain or inflammation after 7 days. Additional studies are recommended to more precisely define the role of PBM in this specific indication. oral biopsy pain photobiomodulation swelling Figures Figure 1 Figure 2 Figure 3 1. INTRODUCTION Biopsies are the gold standard procedures for the diagnosis of many oral lesions. These are minor surgical interventions in which a tissue fragment is removed to examine it histologically in order to obtain a complete diagnosis along with a clinical diagnosis ( 1 ). For this, different instruments must be used, and there are different classifications according to the technique, extent, and amount of tissue removed. A biopsy in the oral cavity can provoke undesirable secondary effects such as pain and inflammation ( 2 ), aside from producing different levels of stress and uncomfortableness in the patient ( 3 , 4 ). This anxiety towards oral and dental procedures can delay or hinder diagnosis ( 5 , 6 ). In addition, high levels of anxiety towards dental treatments have been related to increases in the feelings of pain of the patient and delays in recovery ( 7 ). To reduce these levels of stress, diverse techniques are being used, with non-pharmacological ones increasing in popularity ( 8 ). The use of laser-based systems are being implemented after oral interventions, as photobiomodulation (PBM) produces beneficial effects in the management of inflammation and pain, and therefore, the comfort of patients and their level of anxiety ( 9 ). PBM is associated with an increase in vascular microirrigation ( 10 ) with an increase in vascularization observed in the surgical area along with the presence of newly-formed blood vessels and a high proliferation of cells ( 11 , 12 ). This therapy is being used as a coadjuvant after extractions of third molars ( 13 , 14 ), for the prevention of oral mucositis in cancer patients along with other treatments for the management of pain ( 15 , 16 ), as well as patients with burning mouth syndrome ( 17 ), or to improve trismus in patients with temporomandibular joint disorders ( 18 ). However, no studies have applied PBM after oral biopsies in soft tissue. The aim of the present study was to assess if photobiomodulation reduces postoperative pain and inflammation of patients subjected to an oral biopsy in soft tissue, as compared with a simulated treatment. 2. MATERIALS AND METHODS A prospective, randomized, exploratory clinical study was conducted. The study took place at the University Dental Clinic of the Department of Oral Medicine, Morales Meseguer Hosptial (Murcia, Spain), between January, 2023, and June, 2025. The protocol was adapted to the ethical principles of the Declaration of Helsinki . The project was approved by the Bioethics Committee of the University of Murcia (ID: 2934/2020). All the participants signed an informed consent after their inclusion. Participants Inclusion criteria Patients older than 18 years of age, who required a biopsy in soft tissue in the oral cavity according to a diagnostic or therapeutic indication, who provided their written informed consent, after receiving all the information about the procedure. Exclusion criteria Patients not apt for minor surgery according to the ASA classification; Presence of decompensated systemic diseases; pregnancy; or severe mental disorders that would prevent cooperation or follow-up. A prospective, randomized, exploratory and partially double-blinded clinical study was performed. Both the patient and evaluator were unaware of the type of treatment assigned (active or simulated PBM). The operator, due to technical reasons, knew about the assignment, but did not participate neither in the collection or analysis of the data. The randomization of the assignment was performed with the OxMaR program (Oxford Minimization and Randomization) ( 19 ). The sample size was determined according to the availability of the cases during the study period and was considered adequate for an exploratory analysis. The following data were recorded: age, sex, habits, location of the biopsy, type of scalpel, oral hygiene, duration of the surgery (min), and initial MDAS and OHIP-14Sp scores. All the participants were subjected to a conventional soft-tissue biopsy under local anesthesia( Fig. 1 ). Immediately after, the laser procedure was applied according to the group assignment (Fig. 2 ) : Test group (active PBM): a single intraoral laser session with an EPIC X Biolase diode laser (BIOLASE, Inc., USA), 0.5 W, 15 J/cm², for 10–30 s (adapted to the size of the wound) at a distance of approximately 1 mm using a sterile tip. The parameters were selected according to the recommendations described by Cronshaw et al ( 20 ) for biostimulation and management of pain/inflammation. Control group (simulated PBM): identical procedure without an effective emission (sham). After the intervention, both groups received standard postoperative instructions: no rinsing the mouth or spitting on the same day, avoid smoking, maintain careful oral hygiene, and follow a soft food diet. Procedure Visit 1 (Day 0 – Biopsy) The biopsy was performed, the baseline data were collected, and the assigned intervention was applied (active or simulated PBM). The patient was given a notebook to record pain and inflammation every day, through a visual analog scale (VAS) , during the following 7 days, with uniform instructions. Visit 2 (Day 7) The sutures were removed, the VAS scales were collected, and the MDAS (dental anxiety) and OHIP-14Sp (quality of life) questionnaires were repeated. The possible local complications were recorded (dehiscence, hematoma, bleeding, or infection). Variables and assessments Main variables : Postoperative pain and inflammation, assessed with a VAS scale (0–10), where 0 indicates absence and 10 maximum intensity. The pain and inflammation were recorded with a self-administered scale (VAS), reducing the risk of bias by the evaluator. Complementary evaluations : Modified Dental Anxiety Scale (MDAS) : 5-item instrument, each scored from 1 to 5 (total range 5–25). The MDAS was applied at the start and end of the follow-up. Classification: 5–9: low or normal anxiety 10–12: moderate anxiety 13–14: high anxiety ≥ 15: possible dental phobia OHIP-14Sp questionnaire (Oral Health Impact Profile, abbreviated version) : instrument validated in Spanish by Montero et al ( 21 ), composed of 14 items distributed in seven dimensions. Each item is scored from 1 (never) to 5 (very often), with range of 14–70 points. The higher scores indicated a greater negative impact on oral health in quality of life. This questionnaire was applied at the start and after seven days. Postoperative complications were recorded (dehiscence, hematoma, bleeding, and infection). Statistical analysis The SPSS software (version 29.0) was used. Given the intermediate size of the sample (n = 62), a normality study of the variables was necessary (Kolmogorov-Smirnov test), which rejected the hypothesis that the variables are normal, and therefore the objectives were addressed using a non-parametric approach. The aim of the inferential analysis was to determine the existence or not of significant differences between the control and test groups. For pain and inflammation, the Brunner-Langer model was estimated with the intra-subject factor being time (T1 to T7) of measurement, and the inter-subject factor being the patient group, in order to study the effect of these factors on non-normal variables. In the case of a binary outcome, a binary logistic regression with OR (odds ratio) estimations was used. To assess the homogeneity of the groups with respect to the pre-surgery variables, the Chi 2 and Mann-Whitney tests were used. The level of significance used in the analyses was 5% (α = 0.05). 3. RESULTS Descriptive analysis The sample was composed of 62 individuals who were subjected to a soft tissue biopsy in the oral cavity. Of these, 45.2% were men and 54.8% women. The mean age of the participants was 55.7 years old, with a standard deviation of 17.4 years and a range from 18 to 84 years old. About a fourth of the participants consumed alcohol and a third smoked (Table 1 ). In addition, 79% of the sample showed bad mouth hygiene. With respect to anxiety, in the pre-surgery assessment, 86% had mild-none anxiety, 11% moderate, 2% high, and 2% severe. As for quality of life, a mean of 4.3 was observed in the OHIP-14Sp scale, with a standard deviation of 11.7 units. Also, 64.5% of the lesions analyzed were potentially malignant oral lesions, 19.4% of the biopsies performed were done so to complete the Sjögren syndrome or amyloidosis diagnosis, and the remaining 16.1% were catalogued as other tumorous lesions in the oral cavity. Table 1 Description of the most relevant data from the study. Group p Control/SHAM (n = 31) Test (n = 31) Sex 0.444 Male 12 (38.7%) 16 (51.6%) Female 19 (61.3%) 15 (48.4%) Age (years) 55.8 55.5 0.961 Duration of surgery (minutes) 10.5 12.6 0.017 Biopsy location 0.330 Gum 17 (54.8%) 12 (38.7%) Tongue 4 (12.9%) 5 (16.1%) Lower lip 8 (25.8%) 7 (22.6%) Palatal 1 (3.2%) 1 (3.2%) Buccal mucosa 1 (3.2%) 6 (19.4%) OHIP-14Sp TOTAL (Day 0) 4.5 4.1 0.163 MDAS TOTAL (Day 0) 2.4 4.2 0.793 Suture 0.444 Yes 16 (51.6%) 12 (38.7%) No 15(48.4%) 19 (61.3%) Type of scalpel 0.730 Cold scalpel 27 (89.1%) 25 (80.6%) Punch 4 (12.9%) 6 (19.4%) Hygiene 1 Good hygiene 7 (22.6%) 6 (19.4%) Poor hygiene 24 (77.4%) 25 (80.6%) Pain and inflammation analysis The pain significantly decreased over time (p < 0.001) and equally in both groups (p = 0.279). There was no significant evidence in that the mean level of pain was different between both groups (p = 0.993). In the sham group, significant differences were found between day 3 and day 1, and in the test group between many of the days (Tables 2 and 3 ). Table 2 Changes in pain in the sham group. Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 2 1 Day 3 0.033* 0.167 Day 4 0.067 0.276 1 Day 5 0.119 0.244 1 1 Day 6 0.208 0.316 1 1 1 Day 7 0.303 0.373 1 1 1 1 *p<0.05; **p<0.01; ***p<0.001 Table 3 Changes in pain in the test group. Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 2 0.827 Day 3 0.062 0.077 Day 4 0.021 0.013* 0.516 Day 5 0.033* 0.033* 0.727 1 Day 6 0.022* 0.021* 0.407 1 1 Day 7 0.106 0.006** 0.236 0.931 0.863 1 *p<0.05; **p<0.01; ***p<0.001 Inflammation significantly decreased over time (p < 0.001) and similarly in both groups (p = 0.220). There was no significance evidence that the mean level of inflammation was different in both groups (p = 0.995). At the start, both groups had similar levels of inflammation, but in the test group it decreased slower. In the sham group, no significant differences were observed between the different days. In the test group, significant differences were observed between day 1 and days 4-7 and between day 2 and days 3-7. (table 4and5) Table 4 Changes in inflammation in the sham group. Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 2 1 Day 3 0.148 0.089 Day 4 0.068 0.104 1 Day 5 0.149 0.192 1 1 Day 6 0.131 0.143 1 1 1 Day 7 0.187 0.227 1 1 1 1 *p<0.05; **p<0.01; ***p<0.001 Tabla 5. Changes in inflammation in the test group. Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 2 1 Day 3 0.086 0.047* Day 4 0.012* 0.013* 1 Day 5 0.011* 0.009** 0.294 0.610 Day 6 0.032* 0.038* 0.475 1 1 Day 7 0.009** 0.008** 0.091 0.169 0.307 0.309 *p<0.05; **p<0.01; ***p<0.001 Analysis of pain and inflammation according to hygiene. Both pain and inflammation significantly decreased over time (p = 0.009) (p = 0.006) and in a similar manner, independently of hygiene (p = 0.287) (p = 0.615). There was no significant evidence that the mean level of pain (p = 0.926) nor inflammation (0.247) was different according to hygiene. Analysis of pain and inflammation according to location and type of scalpel used. In the sham group, most had lesions in the gums and lips, while in the test group, there was a greater distribution between both locations. Pain significantly decreased over time (p < 0.001) and similarly, independently of the location of the lesion (p = 0.144). There was no significant evidence that the mean level of pain was different according to location (p = 0.389). In addition, inflammation significantly decreased over time (p < 0.001) and with a marginal significance, in a different manner according to the location of the lesion (p = 0.061). Certain locations, such as the lips and tongue, showed a significant initial inflammation, as observed in Fig. 3 . The results suggest a different level of inflammation according to location (p = 0.061), although independent from the assessment day. On the other hand, there was no significant evidence that the mean level of pain was different according to the scalpel used (p = 0.793) or the level of inflammation (p = 0.787). Analysis of pain and inflammation according to anxiety and quality of life. There was no significant evidence that the mean level of pain was different according to anxiety (p = 0.05), nor daily differences in the decrease in pain due to anxiety (p = 0.477). As for quality of life, pain significantly decreased over time (p = 0.002) and in a different manner according to the OHIP-14sp score (p = 0.024). The patients with a better quality of life (score = 0) experienced pain reduction with a stronger slope. There was no significant evidence that the level of mean inflammation was different according to anxiety (p = 0.384). And neither were daily differences in the decrease in inflammation due to anxiety (p = 0.711). The patients with an initially better quality of life experienced a marked reduction in the degree of inflammation, just as it was observed with pain (p = 0.016).( table 6y7) Table 6 MDAS scale, day 0 (T1: basal), day 7 (T2: post-treatment) and difference between them and OHIP14-Sp scale, day 0 (T1: basal), day 7 (T2: post-treatment) and differences between them. GROUP TOTAL Control/SHAM Test p-value MDAS BASAL (T1) Total 62(100%) 31 (100%) 31 (100%) 0.477 Mild-none (0–8) 53(85.6%) 29 (93.5%) 24(77.4%) Moderate ( 9 – 12 ) 7 (11.3%) 2(6.5%) 5 (16.1%) High ( 13 – 14 ) 1(1.6%) 0 (0.0%) 1 (2.3%) Severe (> 15) 1 (1.6%) 0 (0.0%) 1 (3.2%) MDAS POST (T2) Total 62 (100%) 31(100%) 31 (100%) Mild-none (0–8) 58 (93.5%) 30 (96.8%) 28 (90.3%) Moderate ( 9 – 12 ) 4 (6.5%) 1 (3.2%) 3 (9.7%) OHIP14-SP (T1) N 62 31 31 0.164 Mean 4.3 4.5 4.1 Standard deviation 11.7 13.5 9.9 OHIP14-SP (T2) N 62 31 31 Mean 6.1 7.4 4.8 Standard deviation 12.0 13.8 9.8 Analysis of the postoperative complications The same rate of appearance of complications was observed in both groups: 22.6%. Likewise, the duration of the surgery, hygiene, and the type of scalpel used were not associated with the risk of having complications. An association with a marginal significance was found between the variable location and the probability of having some complication; when the location of the biopsy was on the lips, it was multiplied by 4 with respect to the reference (gums). The likelihood of having complications when the location was the gums was 13.8%, while when the location was the lips, it was 40%. Table 7 Most frequent complications by lesion location: results of the simple logistic regression model: odds ratio (OR) and 95% confidence interval. OR 95% CI p-value LOCATION Gum 1 Tongue 3.12 0.51–18.36 0.200 Lower lip 4.17 0.97–19.80 0.058 Buccal mucosa 1.04 0.05–8.86 0.973 *p<0.05; **p<0.01; ***p<0.001 4. DISCUSSION The results from the present study indicate that a single session of photobiomodulation (PBM) applied immediately after the oral biopsy did not significantly reduce pain nor inflammation during the seven days after the procedure. This finding suggests that although PBM has a biostimulant potential, as shown in other contexts (mucositis, wisdom tooth extraction), its isolated and immediate application may be insufficient for inducing a sustained biological effect. The progressive decrease in pain and inflammation observed in both groups is in agreement with natural healing processes, which tends to be fast and without relevant complications. In the study by Emperumal et al ( 22 ) the authors indicated that the procedure was well tolerated and created minimum levels of anxiety or fear. In addition, the postoperative pain after an oral biopsy was generally low, with a tendency to disappear after the first week ( 23 ). The findings coincide with the recent literature, which showed that an oral biopsy is a safe and low impact procedure with a fast recovery. Lajolo et al. ( 24 ) observed that only 27–30% of the patients had relevant pain or discomfort (NRS ≥ 4; OHIP-14Sp ≥ 20) 6 hours after the procedure, which was significantly reduced after 7 days. These authors found a correlation between a worse quality of life and a higher degree of pain perceived, but without an influence from the type of technique or the sample size. Cohen et al. ( 25 ), in a retrospective study with 695 patients, reported an incidence of chronic pain after the biopsy of only 0.57%, with all the cases being mild and self-limiting. The oral biopsies produce a mild tissue trauma, and they are rarely associated with nerve complications. For this, the potential impact of immediate PBM is difficult to observe in procedures with scarce pain and fast recovery. On the other hand, studies on PBM in more invasive procedures have shown favorable results. In wisdom tooth extractions, oral mucositis induced by chemotherapy, or periodontal surgery, multi-session protocols with wavelengths between 660 and 980 nm, significant reductions in pain and edema have been observed ( 26 , 27 ). These differences could be attributed to the greater surgical trauma of these procedures, together with the repeated use of the laser. Until today, no consolidated studies on PBM applied to conventional oral biopsies have been found. The only previous study that is partially comparable is the one by Palaia et al. ( 2 ), in which the biopsy was performed with a surgical laser, a technique that produces a tissue response that is different due to its photothermal and hemostatic effect. As a result, the direct comparison is limited. Our results, along with those by Emperumal ( 22 ) and Lajolo ( 24 ), contribute to the definition of the real clinical profile of the conventional biopsy with a cold scalpel: a well-tolerated procedure with minimum inflammation and self-limiting pain. The use of the cold scalpel in our study ensures comprehensive histological margins and a predictable inflammatory response. On the other hand, Lazzarotto et al. ( 28 ), in a review of 1089 biopsies, showed that the size of the fragment –rather than the cutting technique- was the main determining factor of a concluding diagnosis. In their series, samples ≥ 10 mm doubled the probability of obtaining a definite diagnosis. This finding reinforces the importance of prioritizing the representativeness of the tissue as opposed to considerations of postoperative comfort. The assessment through the MDAS and OHIP-14Sp scales did not show significant correlations between pre-surgery anxiety, quality of life, and postoperative symptoms. This finding coincides with that described by Emperumal et al. ( 22 ) who found mean anxiety/fear scores of 1/10 a week after the procedure, indicating that the emotional memory of the biopsy is mild and transitory. Although in more extensive surgeries pre-surgery anxiety can amplify the perception of pain, in minor procedures such as an oral biopsy, the psychological impact seems to be marginal. From the clinical perspective, the results support the safety of immediate PBM after an oral biopsy, although without demonstrating significant analgesic or anti-inflammatory benefits. The technique is presented as an innocuous alternative that is potentially useful for improving the subjective perception of comfort, especially in patients who are anxious or with a history of exaggerated pain during dental procedures. However, its systematic application does not seem to be justified based on current evidence. Limitations and future perspectives Until now, no clinical studies have been published that analyzed photobiomodulation applied immediately after a conventional oral biopsy. For this, the results must be interpreted with caution and within the framework of a preliminary exploratory study. The number of cases included responds to the pilot design and does not allow for drawing firm conclusions, although it provides useful information for estimating variability and guiding future assays. The application of a single PBM session limits the assessment of possible cumulative effects described in multi-session protocols. On the other hand, the main variables were obtained through self-informed scales, with the subjectivity they imply. In spite of this, the randomization and standardization of the surgical techniques reinforce the internal validity of the study and justify the performance of multi-center studies with a larger sample size and prolonged follow-up. Conclusion As a whole, the results from this study confirm that oral biopsies are safe procedures, with a fast recovery and low level of postoperative pain. The immediate application of PBM did not significantly reduce pain or inflammation, but it was well-tolerated and without adverse effects. These findings provide exploratory evidence on a little-studied field and justify the performance of randomized clinical trials with a larger sample size and repeated protocols that allow for the more precise definition of the real role of photobiomodulation as a coadjuvant in an oral biopsy. Declarations Funding Declaration None. Data Availability Declaration The data presented in this study are available on request from the corresponding author. Author Contributions: Conceptualization: Y.C.M., F.P.P., and P.L.-J.; Methodology: P.L.-J., F.P.P.; Software: Y.C.M., F.P.P.; Validation: Y.C.M., F.P.P., and P.L.-J.; Formal Analysis: Y.C.M.; Investigation: Y.C.M.; Resources: Y.C.M., F.P.P., and P.L.-J.; Data Curation: Y.C.M., F.P.P.; Writing – Original Draft Preparation: Y.C.M.; Writing – Review & Editing: Y.C.M.; Supervision: F.P.P., P.L.-J.; Project Administration: P.L.-J. All authors have read and approved the final version of the manuscript. Competing Interests T he authors declare no competing interests as defined by Springer or other interests that might be perceived to influence the results and/or discussion reported in this paper. Ethics Declaration This study was approved by the Research Ethics Committee of the Faculty of Dentistry, University of Murcia, Spain (ID: 2934/2020), and conducted in accordance with the Declaration of Helsinki (2002 version) and institutional ethical guidelines. 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Cite Share Download PDF Status: Published Journal Publication published 24 Feb, 2026 Read the published version in Clinical Oral Investigations → Version 1 posted Editorial decision: Revision requested 22 Dec, 2025 Reviews received at journal 22 Dec, 2025 Reviews received at journal 03 Dec, 2025 Reviews received at journal 19 Nov, 2025 Reviewers agreed at journal 15 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviewers invited by journal 13 Nov, 2025 Editor assigned by journal 11 Nov, 2025 Submission checks completed at journal 11 Nov, 2025 First submitted to journal 06 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Murcia","correspondingAuthor":false,"prefix":"","firstName":"Francisco","middleName":"Parra","lastName":"Perez","suffix":""},{"id":549323785,"identity":"3d8b313a-1565-4eeb-a0e8-03688b81f732","order_by":2,"name":"Pia López-Jornet","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAqklEQVRIiWNgGAWjYHCCBDDJT7IWCckGUq2SMDhArFLd9gMPH1fusKkzvpGdwPDhDxFazM4kJBuePZMmYXYjdwPjzDZitBxISJNsbDsM1sLM20CMlvMPQFr+SxjPAGr5Q5TDboBtOSBhIAHUwsBGlJYHyYaNbcmSM8683XCwlyi/nM9JfNjYZsfP35678cEPYhzGwMCTAGceIEoDAwM7sQpHwSgYBaNgxAIA33U6M8nJBm4AAAAASUVORK5CYII=","orcid":"","institution":"University of Murcia","correspondingAuthor":true,"prefix":"","firstName":"Pia","middleName":"","lastName":"López-Jornet","suffix":""}],"badges":[],"createdAt":"2025-11-06 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10:30:18","extension":"xml","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":114979,"visible":true,"origin":"","legend":"","description":"","filename":"030af5db9df34c3db17fb37e57670bed1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8051000/v1/9026f4450c2dd2c610713075.xml"},{"id":96617739,"identity":"7d1879ab-f580-4c50-be3c-0133e1a1bb33","added_by":"auto","created_at":"2025-11-24 10:30:18","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":126029,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8051000/v1/9af9b132d18fdd6a3991ba1f.html"},{"id":96708714,"identity":"af13b911-3f68-4ee7-b8a8-8437f37638ed","added_by":"auto","created_at":"2025-11-25 10:05:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":2186699,"visible":true,"origin":"","legend":"\u003cp\u003eMinor salivary gland biopsy in the lip for diagnosis of Sjögren's Syndrome with PBM session (test group )\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8051000/v1/83d021a1b719a75daf299aeb.png"},{"id":96617729,"identity":"55fe748f-cce8-467d-8bba-bb80f5203e59","added_by":"auto","created_at":"2025-11-24 10:30:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":348580,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of the study\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8051000/v1/2776d54125e2fc97d9b4854b.png"},{"id":96708973,"identity":"c884bba7-26db-4912-a8a2-bc7ba6dfb2e8","added_by":"auto","created_at":"2025-11-25 10:06:46","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":145437,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in pain (left) and inflammation (right) according to the location of the lesion.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8051000/v1/6d9843261c087c6f4af68e43.png"},{"id":103766043,"identity":"bcf2847a-547e-4426-98d0-0fbf1f3b6527","added_by":"auto","created_at":"2026-03-02 16:11:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":7059589,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8051000/v1/47f83df2-ac18-4b05-88ff-60daab5fe342.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffect of Immediate Photobiomodulation on Pain and Inflammation After Oral Biopsy: A Randomized Clinical Study\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eBiopsies are the gold standard procedures for the diagnosis of many oral lesions. These are minor surgical interventions in which a tissue fragment is removed to examine it histologically in order to obtain a complete diagnosis along with a clinical diagnosis (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). For this, different instruments must be used, and there are different classifications according to the technique, extent, and amount of tissue removed. A biopsy in the oral cavity can provoke undesirable secondary effects such as pain and inflammation (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), aside from producing different levels of stress and uncomfortableness in the patient (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This anxiety towards oral and dental procedures can delay or hinder diagnosis (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In addition, high levels of anxiety towards dental treatments have been related to increases in the feelings of pain of the patient and delays in recovery (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). To reduce these levels of stress, diverse techniques are being used, with non-pharmacological ones increasing in popularity (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The use of laser-based systems are being implemented after oral interventions, as photobiomodulation (PBM) produces beneficial effects in the management of inflammation and pain, and therefore, the comfort of patients and their level of anxiety (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). PBM is associated with an increase in vascular microirrigation (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) with an increase in vascularization observed in the surgical area along with the presence of newly-formed blood vessels and a high proliferation of cells (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This therapy is being used as a coadjuvant after extractions of third molars (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), for the prevention of oral mucositis in cancer patients along with other treatments for the management of pain (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), as well as patients with burning mouth syndrome (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), or to improve trismus in patients with temporomandibular joint disorders (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, no studies have applied PBM after oral biopsies in soft tissue. The aim of the present study was to assess if photobiomodulation reduces postoperative pain and inflammation of patients subjected to an oral biopsy in soft tissue, as compared with a simulated treatment.\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cp\u003eA prospective, randomized, exploratory clinical study was conducted. The study took place at the University Dental Clinic of the Department of Oral Medicine, Morales Meseguer Hosptial (Murcia, Spain), between January, 2023, and June, 2025.\u003c/p\u003e\u003cp\u003eThe protocol was adapted to the ethical principles of the \u003cb\u003eDeclaration of Helsinki\u003c/b\u003e. The project was approved by the \u003cb\u003eBioethics Committee of the University of Murcia\u003c/b\u003e (ID: 2934/2020). All the participants signed an informed consent after their inclusion.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003cp\u003ePatients older than 18 years of age, who required a biopsy in soft tissue in the oral cavity according to a diagnostic or therapeutic indication, who provided their written informed consent, after receiving all the information about the procedure.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003cp\u003ePatients not apt for minor surgery according to the \u003cb\u003eASA\u003c/b\u003e classification; Presence of decompensated systemic diseases; pregnancy; or severe mental disorders that would prevent cooperation or follow-up.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eA prospective, randomized, exploratory and partially double-blinded clinical study was performed. Both the patient and evaluator were unaware of the type of treatment assigned (active or simulated PBM). The operator, due to technical reasons, knew about the assignment, but did not participate neither in the collection or analysis of the data. The randomization of the assignment was performed with the OxMaR program (Oxford Minimization and Randomization) (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The sample size was determined according to the availability of the cases during the study period and was considered adequate for an exploratory analysis. The following data were recorded: age, sex, habits, location of the biopsy, type of scalpel, oral hygiene, duration of the surgery (min), and initial MDAS and OHIP-14Sp scores. All the participants were subjected to a conventional soft-tissue biopsy under local anesthesia( Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Immediately after, the laser procedure was applied according to the group assignment (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) :\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eTest group (active PBM): a single intraoral laser session with an EPIC X Biolase diode laser (BIOLASE, Inc., USA), 0.5 W, 15 J/cm\u0026sup2;, for 10\u0026ndash;30 s (adapted to the size of the wound) at a distance of approximately 1 mm using a sterile tip. The parameters were selected according to the recommendations described by Cronshaw et al (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) for biostimulation and management of pain/inflammation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eControl group (simulated PBM): identical procedure without an effective emission (sham).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e After the intervention, both groups received standard postoperative instructions: no rinsing the mouth or spitting on the same day, avoid smoking, maintain careful oral hygiene, and follow a soft food diet.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedure\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eVisit 1 (Day 0 \u0026ndash; Biopsy)\u003c/strong\u003e\u003cp\u003eThe biopsy was performed, the baseline data were collected, and the assigned intervention was applied (active or simulated PBM). The patient was given a notebook to record pain and inflammation every day, through a \u003cb\u003evisual analog scale (VAS)\u003c/b\u003e, during the following 7 days, with uniform instructions.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eVisit 2 (Day 7)\u003c/strong\u003e\u003cp\u003eThe sutures were removed, the VAS scales were collected, and the \u003cb\u003eMDAS\u003c/b\u003e (dental anxiety) and \u003cb\u003eOHIP-14Sp\u003c/b\u003e (quality of life) questionnaires were repeated. The possible local complications were recorded (dehiscence, hematoma, bleeding, or infection).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eVariables and assessments\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eMain variables\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePostoperative pain and inflammation, assessed with a VAS scale (0\u0026ndash;10), where 0 indicates absence and 10 maximum intensity. The pain and inflammation were recorded with a self-administered scale (VAS), reducing the risk of bias by the evaluator.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eComplementary evaluations\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eModified Dental Anxiety Scale (MDAS)\u003c/b\u003e: 5-item instrument, each scored from 1 to 5 (total range 5\u0026ndash;25). The MDAS was applied at the start and end of the follow-up. Classification:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e5\u0026ndash;9: low or normal anxiety\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e10\u0026ndash;12: moderate anxiety\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e13\u0026ndash;14: high anxiety\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ge;\u0026thinsp;15: possible dental phobia\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eOHIP-14Sp questionnaire (Oral Health Impact Profile, abbreviated version)\u003c/b\u003e: instrument validated in Spanish by \u003cb\u003eMontero et al\u003c/b\u003e (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), composed of 14 items distributed in seven dimensions. Each item is scored from 1 (never) to 5 (very often), with range of 14\u0026ndash;70 points. The higher scores indicated a greater negative impact on oral health in quality of life. This questionnaire was applied at the start and after seven days.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePostoperative complications were recorded (dehiscence, hematoma, bleeding, and infection).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe SPSS software (version 29.0) was used. Given the intermediate size of the sample (n\u0026thinsp;=\u0026thinsp;62), a normality study of the variables was necessary (Kolmogorov-Smirnov test), which rejected the hypothesis that the variables are normal, and therefore the objectives were addressed using a non-parametric approach. The aim of the inferential analysis was to determine the existence or not of significant differences between the control and test groups. For pain and inflammation, the Brunner-Langer model was estimated with the intra-subject factor being time (T1 to T7) of measurement, and the inter-subject factor being the patient group, in order to study the effect of these factors on non-normal variables. In the case of a binary outcome, a binary logistic regression with OR (odds ratio) estimations was used. To assess the homogeneity of the groups with respect to the pre-surgery variables, the Chi\u003csup\u003e2\u003c/sup\u003e and Mann-Whitney tests were used. The level of significance used in the analyses was 5% (α\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003e\u003cb\u003eDescriptive analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample was composed of 62 individuals who were subjected to a soft tissue biopsy in the oral cavity. Of these, 45.2% were men and 54.8% women. The mean age of the participants was 55.7 years old, with a standard deviation of 17.4 years and a range from 18 to 84 years old. About a fourth of the participants consumed alcohol and a third smoked (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In addition, 79% of the sample showed bad mouth hygiene. With respect to anxiety, in the pre-surgery assessment, 86% had mild-none anxiety, 11% moderate, 2% high, and 2% severe. As for quality of life, a mean of 4.3 was observed in the OHIP-14Sp scale, with a standard deviation of 11.7 units. Also, 64.5% of the lesions analyzed were potentially malignant oral lesions, 19.4% of the biopsies performed were done so to complete the Sj\u0026ouml;gren syndrome or amyloidosis diagnosis, and the remaining 16.1% were catalogued as other tumorous lesions in the oral cavity.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescription of the most relevant data from the study.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eControl/SHAM\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;31)\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eTest\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;31)\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e12 (38.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (51.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e19 (61.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15 (48.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e55.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e55.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.961\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of surgery (minutes)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBiopsy location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.330\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e17 (54.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (38.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTongue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e4 (12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLower lip\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e8 (25.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (22.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePalatal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBuccal mucosa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e1 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOHIP-14Sp TOTAL (Day 0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.163\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMDAS TOTAL (Day 0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.793\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e16 (51.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (38.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e15(48.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (61.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType of scalpel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.730\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCold scalpel\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e27 (89.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (80.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePunch\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e4 (12.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHygiene\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood hygiene\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e7 (22.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (19.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor hygiene\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e24 (77.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (80.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePain and inflammation analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe pain significantly decreased over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and equally in both groups (p\u0026thinsp;=\u0026thinsp;0.279). There was no significant evidence in that the mean level of pain was different between both groups (p\u0026thinsp;=\u0026thinsp;0.993). In the sham group, significant differences were found between day 3 and day 1, and in the test group between many of the days (Tables\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in pain in the sham group.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDay 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDay 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDay 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDay 4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDay 5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDay 6\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.033*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.067\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.316\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.373\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003e*p\u0026lt;0.05; **p\u0026lt;0.01; ***p\u0026lt;0.001\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in pain in the test group.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDay 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDay 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDay 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDay 4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDay 5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDay 6\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.827\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.013*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.516\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.033*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.033*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.727\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.022*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.021*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.407\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.006**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.931\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003e*p\u0026lt;0.05; **p\u0026lt;0.01; ***p\u0026lt;0.001\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInflammation significantly decreased over time (p \u0026lt; 0.001) and similarly in both groups (p = 0.220). There was no significance evidence that the mean level of inflammation was different in both groups (p = 0.995). At the start, both groups had similar levels of inflammation, but in the test group \u003ca id=\"_anchor_1\" href=\"#_msocom_1\" language=\"JavaScript\" name=\"_msoanchor_1\"\u003e\u003c/a\u003eit decreased slower. In the sham group, no significant differences were observed between the different days. In the test group, significant differences were observed between day 1 and days 4-7 and between day 2 and days 3-7. (table 4and5)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in inflammation in the sham group.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDay 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDay 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDay 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDay 4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDay 5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDay 6\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.192\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.131\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.187\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003e*p\u0026lt;0.05; **p\u0026lt;0.01; ***p\u0026lt;0.001\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTabla 5. Changes in inflammation in the test group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDay 1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDay 2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDay 3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDay 4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDay 5\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDay 6\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 2\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 3\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.047*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.012*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.013*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 5\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.011*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.009**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.610\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.032*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.038*\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.475\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDay 7\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e0.009**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.008**\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.307\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.309\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003e*p\u0026lt;0.05; **p\u0026lt;0.01; ***p\u0026lt;0.001\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAnalysis of pain and inflammation according to hygiene.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eBoth pain and inflammation significantly decreased over time (p\u0026thinsp;=\u0026thinsp;0.009) (p\u0026thinsp;=\u0026thinsp;0.006) and in a similar manner, independently of hygiene (p\u0026thinsp;=\u0026thinsp;0.287) (p\u0026thinsp;=\u0026thinsp;0.615). There was no significant evidence that the mean level of pain (p\u0026thinsp;=\u0026thinsp;0.926) nor inflammation (0.247) was different according to hygiene.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAnalysis of pain and inflammation according to location and type of scalpel used.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eIn the sham group, most had lesions in the gums and lips, while in the test group, there was a greater distribution between both locations. Pain significantly decreased over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and similarly, independently of the location of the lesion (p\u0026thinsp;=\u0026thinsp;0.144). There was no significant evidence that the mean level of pain was different according to location (p\u0026thinsp;=\u0026thinsp;0.389). In addition, inflammation significantly decreased over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and with a marginal significance, in a different manner according to the location of the lesion (p\u0026thinsp;=\u0026thinsp;0.061). Certain locations, such as the lips and tongue, showed a significant initial inflammation, as observed in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The results suggest a different level of inflammation according to location (p\u0026thinsp;=\u0026thinsp;0.061), although independent from the assessment day.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOn the other hand, there was no significant evidence that the mean level of pain was different according to the scalpel used (p\u0026thinsp;=\u0026thinsp;0.793) or the level of inflammation (p\u0026thinsp;=\u0026thinsp;0.787).\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAnalysis of pain and inflammation according to anxiety and quality of life.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eThere was no significant evidence that the mean level of pain was different according to anxiety (p\u0026thinsp;=\u0026thinsp;0.05), nor daily differences in the decrease in pain due to anxiety (p\u0026thinsp;=\u0026thinsp;0.477). As for quality of life, pain significantly decreased over time (p\u0026thinsp;=\u0026thinsp;0.002) and in a different manner according to the OHIP-14sp score (p\u0026thinsp;=\u0026thinsp;0.024). The patients with a better quality of life (score\u0026thinsp;=\u0026thinsp;0) experienced pain reduction with a stronger slope.\u003c/p\u003e\u003cp\u003eThere was no significant evidence that the level of mean inflammation was different according to anxiety (p\u0026thinsp;=\u0026thinsp;0.384). And neither were daily differences in the decrease in inflammation due to anxiety (p\u0026thinsp;=\u0026thinsp;0.711). The patients with an initially better quality of life experienced a marked reduction in the degree of inflammation, just as it was observed with pain (p\u0026thinsp;=\u0026thinsp;0.016).( table 6y7)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMDAS scale, day 0 (T1: basal), day 7 (T2: post-treatment) and difference between them and OHIP14-Sp scale, day 0 (T1: basal), day 7 (T2: post-treatment) and differences between them.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e\u003cp\u003eGROUP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003eTOTAL\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eControl/SHAM\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eTest\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eMDAS BASAL (T1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.477\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMild-none (0\u0026ndash;8)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53(85.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29 (93.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e24(77.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (11.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5 (16.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (2.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eSevere (\u0026gt;\u0026thinsp;15)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eMDAS POST (T2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31(100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMild-none (0\u0026ndash;8)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58 (93.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (96.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28 (90.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e (\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (6.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (9.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOHIP14-SP (T1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.164\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eStandard deviation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOHIP14-SP (T2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eStandard deviation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis of the postoperative complications\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe same rate of appearance of complications was observed in both groups: 22.6%. Likewise, the duration of the surgery, hygiene, and the type of scalpel used were not associated with the risk of having complications. An association with a marginal significance was found between the variable location and the probability of having some complication; when the location of the biopsy was on the lips, it was multiplied by 4 with respect to the reference (gums). The likelihood of having complications when the location was the gums was 13.8%, while when the location was the lips, it was 40%.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMost frequent complications by lesion location: results of the simple logistic regression model: odds ratio (OR) and 95% confidence interval.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLOCATION\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTongue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.51\u0026ndash;18.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.200\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLower lip\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.97\u0026ndash;19.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBuccal mucosa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.05\u0026ndash;8.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.973\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e*p\u0026lt;0.05; **p\u0026lt;0.01; ***p\u0026lt;0.001\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThe results from the present study indicate that a single session of photobiomodulation (PBM) applied immediately after the oral biopsy did not significantly reduce pain nor inflammation during the seven days after the procedure. This finding suggests that although PBM has a biostimulant potential, as shown in other contexts (mucositis, wisdom tooth extraction), its isolated and immediate application may be insufficient for inducing a sustained biological effect.\u003c/p\u003e\u003cp\u003eThe progressive decrease in pain and inflammation observed in both groups is in agreement with natural healing processes, which tends to be fast and without relevant complications. In the study by Emperumal et al (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) the authors indicated that the procedure was well tolerated and created minimum levels of anxiety or fear. In addition, the postoperative pain after an oral biopsy was generally low, with a tendency to disappear after the first week (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe findings coincide with the recent literature, which showed that an oral biopsy is a safe and low impact procedure with a fast recovery. Lajolo et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) observed that only 27\u0026ndash;30% of the patients had relevant pain or discomfort (NRS\u0026thinsp;\u0026ge;\u0026thinsp;4; OHIP-14Sp\u0026thinsp;\u0026ge;\u0026thinsp;20) 6 hours after the procedure, which was significantly reduced after 7 days. These authors found a correlation between a worse quality of life and a higher degree of pain perceived, but without an influence from the type of technique or the sample size.\u003c/p\u003e\u003cp\u003eCohen et al. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), in a retrospective study with 695 patients, reported an incidence of chronic pain after the biopsy of only 0.57%, with all the cases being mild and self-limiting. The oral biopsies produce a mild tissue trauma, and they are rarely associated with nerve complications. For this, the potential impact of immediate PBM is difficult to observe in procedures with scarce pain and fast recovery.\u003c/p\u003e\u003cp\u003eOn the other hand, studies on PBM in more invasive procedures have shown favorable results. In wisdom tooth extractions, oral mucositis induced by chemotherapy, or periodontal surgery, multi-session protocols with wavelengths between 660 and 980 nm, significant reductions in pain and edema have been observed (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). These differences could be attributed to the greater surgical trauma of these procedures, together with the repeated use of the laser.\u003c/p\u003e\u003cp\u003eUntil today, no consolidated studies on PBM applied to conventional oral biopsies have been found. The only previous study that is partially comparable is the one by Palaia et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), in which the biopsy was performed with a surgical laser, a technique that produces a tissue response that is different due to its photothermal and hemostatic effect. As a result, the direct comparison is limited. Our results, along with those by Emperumal (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and Lajolo (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e), contribute to the definition of the real clinical profile of the conventional biopsy with a cold scalpel: a well-tolerated procedure with minimum inflammation and self-limiting pain. The use of the cold scalpel in our study ensures comprehensive histological margins and a predictable inflammatory response. On the other hand, Lazzarotto et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), in a review of 1089 biopsies, showed that the size of the fragment \u0026ndash;rather than the cutting technique- was the main determining factor of a concluding diagnosis. In their series, samples\u0026thinsp;\u0026ge;\u0026thinsp;10 mm doubled the probability of obtaining a definite diagnosis. This finding reinforces the importance of prioritizing the representativeness of the tissue as opposed to considerations of postoperative comfort.\u003c/p\u003e\u003cp\u003eThe assessment through the MDAS and OHIP-14Sp scales did not show significant correlations between pre-surgery anxiety, quality of life, and postoperative symptoms. This finding coincides with that described by Emperumal et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) who found mean anxiety/fear scores of 1/10 a week after the procedure, indicating that the emotional memory of the biopsy is mild and transitory. Although in more extensive surgeries pre-surgery anxiety can amplify the perception of pain, in minor procedures such as an oral biopsy, the psychological impact seems to be marginal. From the clinical perspective, the results support the safety of immediate PBM after an oral biopsy, although without demonstrating significant analgesic or anti-inflammatory benefits. The technique is presented as an innocuous alternative that is potentially useful for improving the subjective perception of comfort, especially in patients who are anxious or with a history of exaggerated pain during dental procedures. However, its systematic application does not seem to be justified based on current evidence.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations and future perspectives\u003c/b\u003e\u003c/p\u003e\u003cp\u003eUntil now, no clinical studies have been published that analyzed photobiomodulation applied immediately after a conventional oral biopsy. For this, the results must be interpreted with caution and within the framework of a preliminary exploratory study. The number of cases included responds to the pilot design and does not allow for drawing firm conclusions, although it provides useful information for estimating variability and guiding future assays. The application of a single PBM session limits the assessment of possible cumulative effects described in multi-session protocols. On the other hand, the main variables were obtained through self-informed scales, with the subjectivity they imply. In spite of this, the randomization and standardization of the surgical techniques reinforce the internal validity of the study and justify the performance of multi-center studies with a larger sample size and prolonged follow-up.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAs a whole, the results from this study confirm that oral biopsies are safe procedures, with a fast recovery and low level of postoperative pain. The immediate application of PBM did not significantly reduce pain or inflammation, but it was well-tolerated and without adverse effects. These findings provide exploratory evidence on a little-studied field and justify the performance of randomized clinical trials with a larger sample size and repeated protocols that allow for the more precise definition of the real role of photobiomodulation as a coadjuvant in an oral biopsy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Declaration\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Declaration\u0026nbsp;\u003c/strong\u003eThe data presented in this study are available on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eConceptualization: Y.C.M., F.P.P., and P.L.-J.; Methodology: P.L.-J., F.P.P.; Software: Y.C.M., F.P.P.; Validation: Y.C.M., F.P.P., and P.L.-J.; Formal Analysis: Y.C.M.; Investigation: Y.C.M.; Resources: Y.C.M., F.P.P., and P.L.-J.; Data Curation: Y.C.M., F.P.P.; Writing \u0026ndash; Original Draft Preparation: Y.C.M.; Writing \u0026ndash; Review \u0026amp; Editing: Y.C.M.; Supervision: F.P.P., P.L.-J.; Project Administration: P.L.-J. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests T\u003c/strong\u003ehe authors declare no competing interests as defined by Springer or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee of the Faculty of Dentistry, University of Murcia, Spain (ID: 2934/2020), and conducted in accordance with the Declaration of Helsinki (2002 version) and institutional ethical guidelines.\u003c/p\u003e\n\u003cp\u003ePatient Consent Statement: Informed consent was obtained from all participants involved in this study\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Disclosure:\u0026nbsp;\u003c/strong\u003eThe authors declare that there is no conflict of interest\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRomeo U, Russo C, Palaia G, Lo Giudice R, Del Vecchio A, Visca P, et al. \u003cem\u003eBiopsy of Different Oral Soft Tissues Lesions by KTP and Diode Laser: Histological Evaluation.\u003c/em\u003e Sci World J. 2014;2014:1-6. \u003c/li\u003e\n\u003cli\u003ePalaia G, Tenore G, Tribolati L, Russo C, Gaimari G, Del Vecchio A, et al. \u003cem\u003eEvaluation of wound healing and postoperative pain after oral mucosa laser biopsy with the aid of compound with chlorhexidine and sodium hyaluronate: a randomized double blind clinical trial\u003c/em\u003e. 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Appl Sci. 2024;14(8):3268. \u003c/li\u003e\n\u003cli\u003eAhrari F, Eshghpour M, Zare R, Ebrahimi S, Fallahrastegar A, Khaki H. \u003cem\u003eEffectiveness of Low-Level Laser Irradiation in Reducing Pain and Accelerating Socket Healing After Undisturbed Tooth Extraction.\u003c/em\u003e J Lasers Med Sci. 2020;11(3):274-9. \u003c/li\u003e\n\u003cli\u003eBourbonne V, Otz J, Bensadoun RJ, Dissaux G, Lucia F, Leclere JC, et al. \u003cem\u003eRadiotherapy mucositis in head and neck cancer: prevention by low-energy surface laser.\u003c/em\u003e BMJ Support Palliat Care. 2022;12(e6): e838-45. \u003c/li\u003e\n\u003cli\u003eDe La Torre F, Alfaro C. \u003cem\u003eTerapia de laser de baja potencia en mucositis oral.\u003c/em\u003e Rev Estomatol\u0026oacute;gica Hered. 2016;26(1):47. \u003c/li\u003e\n\u003cli\u003eCamolesi GCV, Marichalar-Mend\u0026iacute;a X, Pad\u0026iacute;n-Iruegas ME, Spanemberg JC, L\u0026oacute;pez-L\u0026oacute;pez J, Blanco-Carri\u0026oacute;n A, et al. \u003cem\u003eEfficacy of photobiomodulation in reducing pain and improving the quality of life in patients with idiopathic burning mouth syndrome. 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Photobiomodulation Photomed Laser Surg. 2019;37(9):517-26. \u003c/li\u003e\n\u003cli\u003eMontero-Mart\u0026iacute;n J, Bravo-P\u0026eacute;rez M, Albaladejo-Mart\u0026iacute;nez A, Hern\u0026aacute;ndez-Mart\u0026iacute;n LA, Rosel-Gallardo EM. \u003cem\u003eValidation the Oral Health Impact Profile (OHIP-14sp) for adults in Spain\u003c/em\u003e. Med Oral Patol Oral Cirugia Bucal. 2009;14(1):E44-50. \u003c/li\u003e\n\u003cli\u003eEmperumal CP, Veluppillai S, Villa A. \u003cem\u003ePain, anxiety and fear related to oral biopsies: a pilot study.\u003c/em\u003e Oral Surg Oral Med Oral Pathol Oral Radiol. 2024;138(3):377-83. \u003c/li\u003e\n\u003cli\u003eCamacho-Alonso F, Lopez-Jornet P. \u003cem\u003eStudy of pain and swelling after oral mucosal biopsy.\u003c/em\u003e Br J Oral Maxillofac Surg. 2008;46(4):301-3. doi:10.1016/j.bjoms.2007.11.001\u003c/li\u003e\n\u003cli\u003eLajolo C, Gioco G, Rupe C, Patini R, Rizzo I, Romeo U, et al. \u003cem\u003ePatient perception after oral biopsies: an observational outpatient study.\u003c/em\u003e Clin Oral Investig. octubre de 2021;25(10):5687-97. \u003c/li\u003e\n\u003cli\u003eCohen A, Daod R, Czerninski R, Keshet N, Yanko R, Rettman A, et al.\u003cem\u003e Incidence of Chronic Pain following Oral Soft Tissue Biopsies: A Retrospective Study.\u003c/em\u003e Appl Sci. enero de 2023;13(11):6719. \u003c/li\u003e\n\u003cli\u003eZadik Y, Arany PR, Fregnani ER, Bossi P, Antunes HS, Bensadoun RJ, et al. \u003cem\u003eSystematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines\u003c/em\u003e. Support Care Cancer. 2019;27(10):3969-83. \u003c/li\u003e\n\u003cli\u003eHosseinpour S, Tun\u0026eacute;r J, Fekrazad R. \u003cem\u003ePhotobiomodulation in Oral Surgery: A Review.\u003c/em\u003e Photobiomodulation Photomed Laser Surg. 2019;37(12):814-25. \u003c/li\u003e\n\u003cli\u003eLazzarotto B, Garcia C, Martinelli-Klay C, Lombardi T. \u003cem\u003eBiopsy of the oral mucosa: Does size matter?\u003c/em\u003e J Stomatol Oral Maxillofac Surg. 2022;123(5):e385-9. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"oral biopsy, pain, photobiomodulation, swelling","lastPublishedDoi":"10.21203/rs.3.rs-8051000/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8051000/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate if photobiomodulation (PBM) reduces pain and inflammation in patients subjected to a soft tissue oral biopsy, compared to a sham treatment.\u003c/p\u003e\u003ch2\u003eMaterials and method\u003c/h2\u003e\u003cp\u003eA prospective and randomized clinical study was performed. The oral mucosa biopsy was performed in a standardized manner. The group assignment was performed with a simple randomization. The participants were distributed into two groups: active PBM (n\u0026thinsp;=\u0026thinsp;31) and simulated/sham PBM (n\u0026thinsp;=\u0026thinsp;31). A single intraoral PBM session took place (0.5 W) immediately after the biopsy.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eNo significant differences were observed between the groups with respect to pain or inflammation reduction during the 7 days of follow-up. Both variables decreased over time in both groups, without a group or time-group interaction effect (p\u0026thinsp;=\u0026thinsp;0.279 and p\u0026thinsp;=\u0026thinsp;0.220, respectively).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eA single PBM session after the soft tissue oral biopsy did not show advantages as compared to the sham treatment in the reduction of pain or inflammation after 7 days. Additional studies are recommended to more precisely define the role of PBM in this specific indication.\u003c/p\u003e","manuscriptTitle":"Effect of Immediate Photobiomodulation on Pain and Inflammation After Oral Biopsy: A Randomized Clinical Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-24 10:30:13","doi":"10.21203/rs.3.rs-8051000/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-22T07:45:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-22T07:30:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-03T06:37:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-19T10:00:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242642765464524973369518653637330031896","date":"2025-11-15T07:38:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"183277979209494341192094940191421266394","date":"2025-11-13T09:16:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"230269165226083857131375623881358091179","date":"2025-11-13T07:39:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-13T07:36:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-11T06:57:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-11T06:55:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Oral Investigations","date":"2025-11-06T19:27:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-oral-investigations","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cloi","sideBox":"Learn more about [Clinical Oral Investigations](http://link.springer.com/journal/784)","snPcode":"784","submissionUrl":"https://submission.nature.com/new-submission/784/3","title":"Clinical Oral Investigations","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f4f975fa-06f4-4f3e-adf1-9ff48dd809ad","owner":[],"postedDate":"November 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T16:08:30+00:00","versionOfRecord":{"articleIdentity":"rs-8051000","link":"https://doi.org/10.1007/s00784-026-06791-1","journal":{"identity":"clinical-oral-investigations","isVorOnly":false,"title":"Clinical Oral Investigations"},"publishedOn":"2026-02-24 15:58:21","publishedOnDateReadable":"February 24th, 2026"},"versionCreatedAt":"2025-11-24 10:30:13","video":"","vorDoi":"10.1007/s00784-026-06791-1","vorDoiUrl":"https://doi.org/10.1007/s00784-026-06791-1","workflowStages":[]},"version":"v1","identity":"rs-8051000","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8051000","identity":"rs-8051000","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}