Impact of Laser Photobiomodulation Therapy on Oral Mucosal Integrity in Patients Undergoing Chemotherapy During Hematopoietic Stem Cell Transplantation

Impact of Laser Photobiomodulation Therapy on Oral Mucosal Integrity in Patients Undergoing Chemotherapy During Hematopoietic Stem Cell Transplantation | 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 Impact of Laser Photobiomodulation Therapy on Oral Mucosal Integrity in Patients Undergoing Chemotherapy During Hematopoietic Stem Cell Transplantation Tomasz Bąk, Jolanta Sikorska, Joanna Wysokińska-Miszczuk, Michał R. Oszwałdowski, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7121739/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Oral mucositis (OM) is the most common acute complication in cancer patients undergoing chemotherapy and radiotherapy. It affects up to 85% of patients undergoing bone marrow transplantation. Prevention of OM is crucial in oncological care, as its occurrence is associated with poorer clinical outcomes and reduced quality of life for patients. Currently, photobiomodulation (PBM) is an effective method for the prevention and treatment of oral mucositis in patients after bone marrow transplantation. Low-level light therapy allows for the modulation of cellular activity and the induction of therapeutic effects. The aim of this study was to compare the effectiveness of conventional methods of treating oral mucositis and a therapeutic technique using laser phototherapy in a group of patients undergoing bone marrow transplantation. The biostimulating laser study was completed in 2019. Methods The study group consisted of 50 patients with chemotherapy complications in the form of severe oral mucositis who underwent hematopoietic cell transplantation. Two different doses of laser radiation were used. The collected data were compared with each other and with a control group. Results It was found that the absence of OM was significantly more frequent in the group treated with laser therapy compared to the control group. After photobiomodulation, 60% of patients in the study group showed no symptoms of OM. Conclusions Photobiomodulation is effective in reducing inflammation symptoms and improving oral health in cancer patients undergoing hematopoietic stem cell transplantation. Chemotherapy Hematopoietic stem cell transplantation Laser therapy Oral mucositis Photobiomodulation Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Leukemia is one of the most aggressive malignant tumors of the hematopoietic system, leading to its complete destruction and immunosuppression in patients. Despite advances in the treatment of malignant tumors, chemotherapy, usually based on several cytostatic drugs, remains the primary treatment method [ 1 ]. It precedes autologous or allogeneic hematopoietic cell transplantation. Stem cells help regenerate the bone marrow after chemotherapy and strengthen the immune system. Although chemotherapy primarily targets cancer cells, it also damages normal cells to a lesser extent. This is especially true for rapidly dividing cells, such as bone marrow and epithelial cells, mainly in the gastrointestinal tract, but also to a significant extent in the epithelial cells lining the oral cavity. The high toxicity and aggressiveness of chemotherapy used in malignant hematopoietic tumors particularly often contributes to morphological and functional changes in the stomatognathic system, significantly impairing the patient's quality of life [ 1 , 2 ]. Oral mucositis (OM) is the most common acute complication in cancer patients undergoing chemotherapy and radiotherapy, affecting more than 60% of patients and up to 85% of those undergoing bone marrow transplantation [ 3 ]. Clinical symptoms usually appear within 7 days of starting chemotherapy [ 4 , 5 ]. The reason for the high sensitivity of mucosal epithelial cells to the cytotoxic effects of chemotherapy is their rapid renewal cycle, which usually occurs every 7–14 days [ 6 ]. Oral mucositis manifests itself in various ways, often intensifying depending on the type of cancer treatment used in the patient, which depends on the type of cancer [ 3 , 7 ], its location, the type, dose, and duration of the cytostatic drug used, and the individual sensitivity of the patient [ 8 , 9 ]. OM begins as an inflammatory process in the basal layer of the oral epithelium, which gradually transforms into erythema and mucosal ulcers [ 10 , 11 ]. The chemotherapy regimen, age, neutrophil count, and oral hygiene of patients undergoing treatment play an important role in the development and severity of oral mucositis. Cytostatics used in the chemotherapy of other malignant tumors can also cause symptoms of mucositis. They occur most often after administration of fluorouracil, methotrexate, doxorubicin, actinomycin D, melphalan, cytarabine, cyclophosphamide, bisulfate, cisplatin, and vinblastine [ 12 ]. The clinical symptoms of OM can manifest as superficial, painful erythema, up to complete ulceration of the mucous membrane [ 3 ]. Patients who develop OM during cancer therapy are more likely to interrupt or delay treatment due to pain, difficulty eating, malnutrition, dehydration, and dysgeusia, leading to a significant deterioration in their quality of life. These symptoms make oral hygiene and eating difficult and cause additional trauma during chewing [ 3 , 7 , 13 – 15 ]. Prevention of OM is crucial in oncological care, as its occurrence is associated with poorer clinical outcomes, reduced quality of life, and increased treatment costs compared to patients without such changes [ 3 , 7 , 16 ]. Mucositis prevention includes hygiene and dietary guidelines, and thorough oral hygiene instruction should cover the selection of an appropriate toothbrushing method and appropriate hygiene products (soft toothbrush, dental floss and tape, mouthwashes) [ 1 ]. The International Society for Oncology Supportive Care recommends modifying the diet to soft foods, using agents such as honey, aloe vera, glutamine, amifostine, cryotherapy, granulocyte colony-stimulating factor, keratinocyte growth factor, antibiotic lozenges or pastes, and sucralfate, as well as anesthetics and mouthwashes to relieve symptoms [ 3 , 13 , 14 , 15 , 17 ]. During cancer treatment, dental care should focus on treating mucositis and aim to reduce and/or eliminate pain, prevent secondary infections, and accelerate the healing of damaged epithelium. During this period, particular attention should be paid to maintaining oral hygiene, as the weakening of the immune system that accompanies chemotherapy promotes infectious complications in the oral cavity. Severe pain in the mouth and gastrointestinal tract may require the administration of narcotic analgesics. Pain reduction allows for oral nutrition, which is important because food stimulates gastrointestinal motility and blood supply to the mucous membrane, which counteracts its atrophy [ 18 ]. Currently, photobiomodulation (PBM) is an effective method for preventing and treating mucositis in patients after bone marrow transplantation. The International Society of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) and the European Society for Medical Oncology (ESMO, Lugano, Switzerland) recommend this method as a preventive measure in patients treated with high doses of cytostatics, especially those preparing for bone marrow transplantation [ 19 ]. Low-level laser therapy (LLLT) is a non-thermal therapeutic method that uses a specific light spectrum (390–1100 nm) to modulate cellular activity and induce therapeutic effects [ 20 , 21 ]. Numerous studies show that PBM does not cause adverse effects on the treated tissues [ 3 , 16 , 22 – 25 ]. It is well tolerated by patients, which gives it an advantage over other methods [ 4 , 26 ]. Photobiomodulation is non-invasive, short-term, and unobtrusive. In the case of biostimulation, the laser has an analgesic effect and promotes proper healing. PBM stimulates collagen synthesis by fibroblasts, angiogenesis, and myofibroblast differentiation, which improves the properties of newly formed tissue [ 27 – 29 ]. Low-power light stimulates the immune system and triggers many changes in cells that affect regeneration and renewal [ 2 ]. The triad of the main effects of photobiomodulation at the tissue level are: analgesic, anti-inflammatory, and tissue regeneration stimulation. In recent years, PBM therapy has been widely described as effective in the treatment of wounds, musculoskeletal disorders, and neuropathic symptoms [ 30 , 31 , 32 ]. Research on the effectiveness of photobiomodulation in the treatment of various dental diseases is still ongoing. Pathological changes such as mucositis within the oral epithelium, which are a consequence of chemotherapy, are particularly common in leukemia patients, hence further research on the effectiveness of laser biostimulation is justified. which aims to alleviate pain that is burdensome for the patient and accelerate the healing and regeneration of damaged oral epithelium. The aim of this study was to compare the effectiveness of conventional methods of treating mucositis and a therapeutic technique using laser phototherapy in a group of patients undergoing bone marrow transplantation. Research using a biostimulating laser was completed in 2019, before the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) proposed the following dosimetric parameters: wavelength 632.8 nm, power density 31.25 mW/cm², energy density 1.0 J/cm² with an exposure time of 40 s per point — for use in patients undergoing hematopoietic stem cell transplantation (HSCT), and wavelength 660 nm, power density 417 mW/cm² and energy density 4.2 J/cm² with an exposure time of 10 s per point — for patients treated with a combination of chemotherapy and radiotherapy in the head and neck area. The results confirmed the effectiveness of photobiomodulation in the treatment of severe oral mucositis in patients undergoing high-dose chemotherapy in autologous and allogeneic hematopoietic stem cell transplantation procedures. Materials and Methods The study group consisted of 50 patients who underwent chemotherapy to destroy bone marrow cancer cells. Chemotherapy preceded autologous or allogeneic bone marrow hematopoietic cell transplantation. Patients with complications of chemotherapy in the form of severe inflammation of the oral mucosa were eligible for the study. Detailed data on the stage of the underlying disease, type of leukemia, performance status, and presence of concomitant oral diseases were obtained from each patient. The group of 50 patients selected for the study came from the Department of Hemato-Oncology and Bone Marrow Transplantation at the Medical University of Lublin. Among them were 20 women and 30 men, aged 27–75. The average age of the study participants was 62.2 years. The control group consisted of 23 patients—8 women and 15 men, aged 31–78. The average age of the control group was 63.43. Written informed consent to participate in the study was obtained from all participants. Ten days after the end of chemotherapy cycles and hematopoietic cell transplantation, each patient underwent a thorough examination was performed to determine the general condition of the oral mucosa, the degree of damage (possible presence of erosions, ulcers), with particular emphasis on the presence and size of inflammatory changes in the epithelium lining the oral cavity. The assessment was performed visually, and the extent of mucosal damage was determined, among other things, using the World Health Organization (WHO) Mucositis Severity Scale, which includes 4 stages of severity: 1 – erythema; 2 – erythema with superficial erosions; 3 – erythema with confluent erosions; 4 – extensive ulcerations. Other scales and indices used in the study include: the WHO scale of criteria for oral mucosal lesions; the scale of oral mucosal moisture – mirror test; pain level on the VAS (Visual Analogue Scale), tongue coating index according to Winkl; gingival sulcus bleeding index (GSBI) and PMA (Papilla-Marginal-Attached Index). After a detailed assessment of the presence and severity of inflammatory changes in patients, photobiomodulation was performed to relieve inflammatory pain and induce immune system cells. Each irradiation treatment was preceded by standard oral hygiene procedures. In addition, after each tooth brushing, patients used mouthwashes containing a 0.2% chlorhexidine solution. This was done to prevent bacterial, fungal, and viral infections. Laser phototherapy was performed in two groups of patients, with different doses of laser radiation. In the first group, 25 patients were treated with a laser containing an InGaAIP diode, enabling the emission of a low dose of laser radiation with a wavelength of 660 nm (power-50 mW and energy-4 J/cm2). Each inflammatory site was irradiated for 15 seconds, allowing for the application of the optimal dose of laser radiation. The laser parameters and irradiation times and cycles were selected in accordance with the guidelines in force before 2019. In the second group, 25 patients with similar clinical characteristics to those in the first group underwent a similar irradiation procedure, using a higher power laser with a wavelength of 820 nm (power-100mW and energy-8J/cm2). In both groups, irradiation treatments were performed every day after oral hygiene procedures. The condition of the oral cavity was assessed daily. The last day after the end of laser therapy proved to be particularly important. The oral cavity was examined visually, and the severity of inflammatory changes was determined, among other things, using the WHO scale, taking into account the dynamics and size of inflammatory changes in the epithelium (reduction, stabilization, or enlargement of inflammatory changes). Next, the condition of the oral cavity was assessed in both groups of patients before and after laser phototherapy. The collected results were compared with the control group, which made it possible to assess the usefulness of this type of treatment in advanced inflammatory conditions of the oral mucosa that may occur during oncological treatment. All data collected during the study were subjected to statistical analysis. They were nominal in nature, therefore, frequency analysis and percentage analysis were used to describe them. Pearson's chi-square test was used to assess differences in frequency distributions. Additionally, when the significance level indicated a statistically significant difference, the V-Cramer coefficient, which takes values from 0 to 1, was calculated. The results of the analyses were presented in tables. The critical level of significance was set at p<0.05. All calculations were performed using Statistica v.13.3. The distributions of quantitative variables were examined using the Shapiro-Wilk test. Descriptive statistics for quantitative variables were presented using measures of central tendency: arithmetic mean (M) and median (Me), as well as measures of position: lower and upper quartiles (Q1–Q3), and measures of dispersion: standard deviation (SD) and minimum and maximum (Min–Max). Qualitative variables were presented using frequencies and percentages. For variables whose distribution was not normal, the non-parametric Mann-Whitney test for two independent samples was used for comparisons. The comparison of two related samples was performed using the Wilcoxon test. To compare more than two related samples (when the same people were evaluated), the Friedman test was used along with post hoc tests. The relationship between the studied variables was assessed using the chi^2 independence test. In order to examine the differences between individual fractions (%), the test of significance of differences between two structure indicators was used. The results of the studied variables were presented in tables and graphs. In this study, a 5% risk of error was assumed, which means that values of p < 0.05 were considered statistically significant. To compare more than two related samples (when the same people were evaluated), the Friedman test was used along with post hoc tests. Results The relationships between selected scales and indicators of oral health and the method of patient treatment are presented in tables and figures. WHO Mucositis Severity Scale and method of patient treatment (Table 1 ): Table 1 Characteristics and examination of the relationship between the severity of Mucositis according to the WHO and the method of patient treatment Mucositis severity scale Groups according to treatment method Chi^2; p* p** Study group Control group No changes 22 (44,00%) 1 (4,00%) 54,744; p < 0,0001 0,0004 Erythema 25 (50,00%) 1 (4,00%) 0,0001 Erythema with superficial erosions 2 (4,00%) 10 (40,00%) 0,0001 Erythema with confluent erosions 1 (2,00%) 11 (44,00%) p < 0,0001 Extensive ulcerations 0 (0,00%) 2 (8,00%) - Total 50 (100,00%) 25 (100,00%) p* - significance level for the chi^2 dependency test, p** - significance level for the test of difference between two structural indicators. The analysis allowed us to conclude that there is a significant correlation between the severity of mucositis and the treatment method used (p < 0.0001). The comparative analysis performed in the next step showed a difference in the frequency of no changes depending on the treatment method (p = 0.0004). The absence of mucositis lesions was significantly more frequent in the group treated with the laser method (44.00%) compared to the control group (4.00%) (Table 1 ). A significant difference in the frequency of erythema was also found between the groups studied (p = 0.0001). There were significantly more cases of erythema in the laser-treated group compared to the control group. However, in the control group, lesions such as erythema with superficial erosions and erythema with confluent erosions were significantly more common compared to patients treated with the laser method. In addition, there were no extensive ulcers in the group of patients treated with laser therapy, unlike in the control group, where they accounted for 8%. Mirror test and patient treatment method (Table 2 ): Table 2 Characteristics and examination of the relationship between the mirror test result and the patient treatment method Mirror test Groups according to treatment method Chi^2; p* p** Study group Control group No resistance 27 (54,00%) 0 (0,00%) 34,145; p < 0,0001 - Low resistance 23 (46,00%) 15 (60,00%) 0,253 Significant resistance 0 (0,00%) 10 (40,00%) - Total 50 (100,00%) 25 (100,00%) p* - significance level for the chi^2 dependency test, p** - significance level for the test of difference between two structure indices There was a statistically significant relationship between the mirror test result and the method of treatment (p < 0.0001). The comparative analysis did not reveal any significant differences in the incidence of low resistance between the study groups. It should be noted that in the group of patients treated with laser, 54% of patients had no resistance, while in the control group there were no such patients (Table 2 ). In addition, in the study group there were no patients with significant resistance when attempting to move the mirror across the mucous membrane, while in the control group the incidence of such patients was 40%. Tongue coating index according to Winkla (Table 3 ): Table 3 Characteristics and examination of the relationship between tongue coating and the method of treatment of patients Tongue coating index Groups according to treatment method Chi^2; p* p** Study group Control group No coating 27 (54,00%) 0 (0,00%) 34,145; p < 0,0001 - Thin, light tongue coating 23 (46,00%) 15 (60,00%) 0,253 Significant, thick coating 0 (0,00%) 10 (40,00%) - total 50 (100,00%) 25 (100,00%) p* - significance level for the chi^2 dependency test, p** - significance level for the test of difference between two structure indicators The analysis allowed us to conclude that there is a correlation between the degree of tongue coating and the method of treatment used in patients (p < 0.0001). The comparative analysis did not indicate a difference in the incidence of thin tongue coating between the study groups (p = 0.253). In the group where patients were treated with a laser dose, as many as 54% of the subjects did not have tongue coating, and there was no significant coating (Table 3 ). In the control group, however, there were no patients without tongue coating, and significant coating was present in approximately 40% of patients. Pocket bleeding index (Table 4 ): Table 4 Characteristics and examination of the relationship between pocket bleeding and the method of treatment of patients Bleeding index Groups according to treatment method Chi^2; p* p** Study group Control group Healthy-looking gums, bleeding on probing 13 (26,00%) 1 (4,00%) 20,452; p < 0,001 0,021 Gingival discoloration, bleeding on probing 15 (30,00%) 4 (16,00%) 0,189 Change in color, slight change in shape, swelling, bleeding during probing 17 (34,00%) 7 (28,00%) 0,600 Discoloration, significant change in gum shape, bleeding during probing 5 (10,00%) 8 (32,00%) 0,018 Gingival bleeding during probing, change in color, significant swelling or ulceration of the gingiva 0 (0,00%) 5 (20,00%) - total 50 (100,00%) 25 (100,00%) p* - significance level for the chi^2 test, p** - significance level for the test of difference between two structural indicators The analysis showed a significant relationship between pocket bleeding and the treatment method used (p < 0.001). The comparative analysis revealed a difference in the incidence of healthy-looking gums bleeding during probing between the patient groups (p = 0.021). Significantly more healthy-looking gums were found in the study group compared to the control group (Table 4 ). In addition, more patients in the control group compared to the laser-treated group had discoloration, significant changes in gum shape, and bleeding during probing. The control group also had bleeding with gum ulceration (20%), whereas in the study group, such changes did not occur. Gingival condition index (Table 5 ): Table 5 Characteristics and examination of the relationship between gingival condition and treatment method of patients Gingival condition index PMA Groups according to treatment method Chi^2; p* p** Study group Control group No pathological changes 30 (60,00%) 7 (28,00%) 22,327; p < 0,0001 0,009 Light inflammation, slight inflammation of the interdental papillae 15 (30,00%) 3 (12,00%) 0,085 Moderate inflammation, inflammation of the papillae and marginal gingiva without tissue hyperplasia 5 (10,00%) 12 (48,00%) 0,0002 Significant inflammation, includes the papilla, marginal part and gingiva proper 0 (0,00%) 3 (12,00%) - total 50 (100,00%) 25 (100,00%) p* - significance level for the chi^2 test of dependence, p** - significance level for the test of difference between two structure indices Based on the results of the analysis, it was found that there are statistically significant relationships between the condition of the gums and the treatment method (p < 0.0001). Comparative analysis showed a difference in the frequency of no pathological changes depending on the treatment method used (p = 0.009). There were significantly more patients without pathological changes in the laser-treated group (60%) than in the control group (28.00%) (Table 5 ). Moreover, statistically significantly, more moderate gingivitis occurred in patients in the control group (48.00%) compared to patients treated with laser (10.00%). In addition, the control group had severe gingivitis, while the study group did not have such advanced inflammation. Comparative analysis of pain on the VAS scale between groups distinguished on the basis of the treatment method used in patients with severe inflammation of the oral epithelium (Table 6 ): Table 6 Descriptive statistics and comparison of pain on the VAS scale for the study groups at different time points VAS Pain scale Gr. n M SD Me Q 1 – Q 3 Min – Max Z*/U** P Before the start of radiation S 50 5,94 2,17 5,00 4,00–9,00 3,00–9,00 1,208* 0,227 C 25 5,24 2,09 5,00 4,00–7,00 1,00–9,00 On the 1st day of radiation S 50 5,92 2,15 5,00 4,00–9,00 3,00–9,00 1,162* 0,245 C 24 5,33 2,18 5,00 4,00–8,00 1,00–9,00 On the 2nd day of irradiation S 50 5,86 2,08 5,00 4,00–8,00 3,00–9,00 1,452* 0,146 C 24 5,17 2,28 5,00 3,00–8,00 1,00–9,00 On the 3rd day of irradiation S 50 5,26 1,97 5,00 4,00–7,00 2,00–9,00 0,729* 0,466 C 24 4,96 2,20 5,00 3,00–7,00 1,00–9,00 On the 4th day of irradiation S 50 4,80 1,94 4,00 3,00–7,00 2,00–8,00 0,769* 0,442 C 24 4,46 2,11 4,00 3,00–7,00 1,00–8,00 On the 5th day of irradiation S 50 4,40 1,78 4,00 3,00–6,00 2,00–8,00 0,657* 0,511 C 24 4,21 2,13 3,50 3,00–6,50 1,00–8,00 On the 6th day of irradiation S 45 4,09 1,86 3,00 3,00–6,00 2,00–8,00 0,021* 0,983 C 21 4,10 1,87 3,00 3,00–6,00 2,00–8,00 On the 7th day of irradiation S 31 3,65 1,78 3,00 2,00–6,00 2,00–8,00 180,000** 0,883 C 12 3,50 1,68 3,00 2,00–4,50 2,00–7,00 On the 8th day of irradiation S 12 4,08 2,19 3,00 2,00–6,00 2,00–8,00 17,000** 0,195 C 5 2,80 1,79 2,00 2,00–2,00 2,00–6,00 On the 9th day of irradiation S 4 5,50 2,38 6,50 4,00–7,00 2,00–7,00 - - C - - - - - - At the end of irradiation S 50 3,66 1,75 3,00 2,00–6,00 2,00–7,00 2,511* 0,012 C 25 4,80 1,91 5,00 4,00–6,00 1,00–8,00 M – mean, SD – standard deviation, Me – median, Q1 – Q3 – lower and upper quartile, Min – Max – minimum and maximum, Z – value of the Mann-Whitney test, when the number of both groups is greater than 20, U – value of the Mann-Whitney test, when the number of both groups is less than 20, the test probability level for the M-W test. Based on the comparative analysis, it was found that there was a significant difference in the pain assessment on the VAS scale at the end of the irradiation (p = 0.012). Significantly lower pain at the end of the treatment was felt by patients who received laser treatment (Me = 3.00) compared to the control group (Me = 5.00) (Table 6 ). The results are presented in a box-and-whisker graph. The remaining comparisons of pain levels between the groups turned out not to be statistically significant. The local manifestations observed in relation to mucositis (Fig. 1 , 2 , 3 , 4 ): Discussion The study showed a significant correlation between the severity of mucositis, measured by the WHO scale, and the treatment method used (p < 0.0001) (Fig. 1 , 2 ). Subsequent comparative analysis revealed a significant difference in the frequency of absence of mucositis changes, depending on the treatment method (p = 0.0004). Specifically, the absence of mucositis was significantly more frequent in the group treated with laser therapy (44.00%) compared to the control group (4.00%). After treatment, 60% of patients did not show any symptoms of mucositis, which confirmed the effectiveness of laser therapy in reducing the symptoms of inflammation and improving oral health. In addition, there was a significant difference in the occurrence of erythema between the groups (p = 0.0001), with more cases of erythema observed in the laser group than in the control group. The control group experienced significantly more severe conditions, such as redness with superficial erosions and redness with confluent erosions, compared with the laser group. Notably, no patient in the laser group reported extensive ulceration, whereas 8% of the control group did. These results suggest that laser therapy is associated with reduced severity of mucositis symptoms, including a greater likelihood of no lesions and fewer severe erosions or ulcerations. These results support the hypothesis that laser therapy is more effective in treating mucositis than standard care, as patients treated with laser therapy experienced fewer complications and complications of lower severity. These studies have demonstrated the potential of laser therapy as a beneficial adjunct to standard care for pain associated with oral mucositis. There was a significantly higher percentage of patients in the control group who complained of a burning sensation of the tongue during the day compared to the study group (Fig. 3 , 4 ). This suggests that laser treatment may be effective in reducing the intensity and duration of pain, burning in the oral cavity. Furthermore, analysis of the collected data indicated a significant correlation between the intensity of tongue coating and the treatment method used (p < 0.0001). In the group that received laser treatment, 54% of patients had no tongue coating, and none of the patients had severe tongue coating. In the control group, none of the patients had a clean tongue, and 40% of them had a heavy tongue coating. The occurrence of a light, thin tongue coating was similar in both groups, with no statistically significant difference (p = 0.253). These results confirmed that laser therapy is effective in reducing tongue coating in patients undergoing chemotherapy in the hematopoietic cell transplant procedure. In the mirror test, before and after laser treatment in the study group, the results indicated a significant reduction in resistance (p < 0.001). No resistance was more common after laser therapy, while mild resistance was more common before treatment (56% before treatment vs. 28% after laser treatment). The analysis showed that laser therapy facilitates better functional regeneration of the oral mucosa. Additionally, the study showed a significant association between bleeding from pockets and the treatment method used (p < 0.001). The comparison revealed a significant difference in the frequency of healthy-appearing gums that bled on probing between the patient groups (p = 0.021). The group that received laser treatment had significantly more cases of healthy gums compared to the control group. In addition, more patients in the control group showed significant changes in the color and shape of the gums and bleeding on probing compared to the laser group. In the control group, 20% of patients experienced bleeding with ulceration of the gums, whereas in the laser group, no such cases were observed. These results suggest that laser therapy is effective in maintaining gum health and reducing bleeding. As a result of the conducted studies, based on comparative analysis, a significant difference was observed in the pain assessment on the VAS scale at the end of laser irradiation treatments (p = 0.012). Patients who received laser therapy reported significantly lower pain levels at the end of treatment (Me = 3.00) compared to the control group (Me = 5.00). However, other comparisons between groups, conducted at different stages of the treatment process, did not show statistically significant differences. Consistent measurements over time suggest that both groups experienced a reduction in pain, but the laser group saw a more pronounced improvement at the end of therapy. Analysis of hygiene practices in the laser group showed that most patients used the recommended preventive measures, such as cleaning and disinfecting the oral cavity, which probably contributed to the lower incidence of mucositis. In the control group, in contrast to the laser group, fewer patients followed the recommended hygiene practices, which could have contributed to the higher incidence of mucositis symptoms in this group. In general, laser therapy not only reduces the incidence of severe symptoms of oral mucositis, but also prevents the development of the most severe form of mucositis - extensive ulcers, which occurred in the control group. This evidence strengthens the view of the potential of laser therapy as a valuable treatment for oral mucositis in patients undergoing bone marrow transplantation. Conclusions LLLT, regardless of the power used, significantly improves the symptoms of mucositis in patients after chemotherapy, and thus may improve the quality of life of cancer patients. Laser biostimulation contributes to reducing the level of pain associated with mucositis. Studies have shown that low-level laser therapy can prevent the development of severe ulcers in the oral mucosa in patients undergoing chemotherapy. The use of biostimulating laser seems to be the gold standard in the treatment of oral mucositis in patients undergoing chemotherapy for hematological malignancies. Despite such positive results, further research is necessary to optimize laser dosage and treatment frequency in different age groups, especially in children undergoing oncological treatment. Abbreviations OM – oral mucositis PBM – photobiomodulation MASCC- Multinational Association of Supportive Care in Cancer ISOO - International Society of Oral Oncology ESMO - European Society for Medical Oncology LLLT – Low-Level Laser Therapy HSCT – hematopoietic stem cell transplantation WHO - World Health Organization VAS - Visual Analogue Scale GSBI – Gingival Sulcus Bleeding Index PMA- Papilla,-Marginal-Attached Index InGaAIP - Indium Gallium Aluminium Phosphide Declarations Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki and ap-proved by the Bioethics Committee of the Medical University of Lublin (approval number: KE-0254/157/2015). Written informed consent to participate in the study was obtained from all participants. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart, from those disclosed. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors’ contributions All authors made substantial contributions to the gathering, analysis, and interpretation of data. T.B., J.S. and P.M.A. wrote the main manuscript text. T.B. and J.S prepared all figures and tables. All authors are involved in revising it critically for intellectual content. All authors gave final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions relating to the accuracy or integrity of any part of the work are appropriately investigated and resolved Acknowledgements Not applicable. Authors’ information 1Department and Chair of Periodontology, Medical University of Lublin; 20-093 Lublin, Poland. 2 Department of Oral Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland References Kozarzewska M, Daszkiewicz M, Olczak-Kowalczyk D, Dembowska-Bagińska B. Zmiany patologiczne w jamie ustnej u pacjentów poddanych terapii przeciwnowotworowej. Nowa Stomatol. 2009;14(3):59–63. Eilers J, Million R. Clinical update: prevention and management of oral mucositis in patients with cancer. Semin Oncol Nurs. 2011;27(4):1–16. Parra-Rojas S, Velázquez-Cayón RT, Ciortan-Pop ME, Martins MD, Cassol Spanemberg J. Preventive photobiomodulation for chemotherapy-induced oral mucositis: a systematic review of randomized clinical trials. Biomedicines. 2025;13(2):268. Fiwek P, Emerich K, Irga-Jaworska N, Pomiecko D. Photobiomodulation treatment in chemotherapy-induced oral mucositis in young haematological patients—a pilot study. Med (Kaunas). 2022;58(8):1023. Kuhn A, Porto FA, Miraglia P, Brunetto AL. Low-level infrared laser therapy in chemotherapy-induced oral mucositis: A randomized placebo-controlled trial in children. J Pediatr Hematol Oncol. 2009;31:33–7. Naidu MU, Ramana GV, Rani PU, Mohan IK, Suman A, Roy P. Chemotherapy-induced and/or radiation therapy-induced oral mucositis—complicating the treatment of cancer. Neoplasia. 2004;6(5):423–31. Parra-Rojas S, Velázquez-Cayón RT, Borges-Gil A, Mejías-Torrus JL, Cassol-Spanemberg J. Oral complications and management strategies for cancer patients: principles of supportive oncology in dentistry. Curr Oncol Rep. 2024;26:391–9. Jabłoński P, Musiał M, Wiench R, Stefanik N, Olchowy C, Matys J, Skaba D. Grzech-Leśniak K. Photobiomodulation therapy in the treatment of oral mucositis—A case report. Medicina. 2022;58(5):618. Zecha JA, Raber-Durlacher JE, Nair RG, Epstein JB, Sonis ST, Elad S, et al. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: Part 1: mechanisms of action, dosimetric, and safety considerations. Support Care Cancer. 2016;24:2781–92. Hafner D, Hrast P, Tomaževič T, Jazbec J, Kavčič M. Photobiomodulation for chemotherapy-induced oral mucositis in pediatric patients. Biomolecules. 2023;13(3):418. Sonis ST. Oral mucositis Anticancer Drugs. 2011;22:607–12. Nicolatou-Galitis O, Sarri T, Bowen J, Di Palma M, Kouloulias VE, Niscola P, Riesenbeck D, Stokman M, Tissing W, Yeoh E, Elad S, Lalla RV. Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21(11):3179–89. Bowen JM, Elad S, Hutchins RD. Methodology for the MASCC/ISOO mucositis clinical practice guidelines update. Support Care Cancer. 2013;21:303–8. Migliorati C, Hewson I, Lalla RV, Antunes HS, Estilo CL, Hodgson B, et al. Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients. Support Care Cancer. 2013;21:333–41. Elad S, Cheng KKF, Lalla RV, Yarom N, Hong C, Logan RM, et al. MASCC/ISOO guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126:4423–31. Parra-Rojas S, Cassol Spanemberg J, Del Mar Díaz-Robayna N, Peralta-Mamani M. Velázquez Cayón RT. Assessing the cost-effectiveness of photobiomodulation for oral mucositis prevention and treatment: a systematic review. Biomedicines. 2024;12:2366. Coppini M, Caponio VCA, Mauceri R, Bizzoca ME, Laino L, Lorenzo-Pouso AI, et al. Efficacy of topical agents in oral mucositis prevention: systematic review and network meta-analysis. Oral Dis. 2024;30:4126–44. Silverman S Jr. Diagnosis and management of oral mucositis. J Support Oncol. 2007;5(2Suppl1):13–21. Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120:1453–61. Fu Q, Jiang H, Yang J, et al. Bypassing the Heat Risk and Efficacy Limitations of Pulsed 630 nm LED Photobiomodulation Therapy for Anti-Primary Dysmenorrhea: A Prospective Randomized Cross-Over Trial. Photonics. 2024;11(2):136. Yang J, Fu Q, Jiang H, Li Y, Liu M. Progress of phototherapy for osteosarcoma and application prospect of blue light photobiomodulation therapy. Front Oncol. 2022;12:1022973. Al-Rudayni AHM, Gopinath D, Maharajan MK, Veettil SK, Menon RK. Efficacy of photobiomodulation in the treatment of cancer chemotherapy-induced oral mucositis: a meta-analysis with trial sequential analysis. Int J Environ Res Public Health. 2021;18:7418. Boris SP, Popruzhenko TV, Kras’Ko OV, Mostovnikov AV, de Karas OV. Photobiomodulation of tissues of the oral cavity for prevention and treatment of mucositis associated with polychemotherapy in children. Photomed Laser Surg. 2016;15:29–33. Silva GB, Sacono NT, Othon-Leite AF, Mendonça EF, Arantes AM, Bariani C, et al. Effect of low-level laser therapy on inflammatory mediator release during chemotherapy-induced oral mucositis: a randomized preliminary study. Lasers Med Sci. 2015;30:117–26. Zecha JA, Raber-Durlacher JE, Nair RG, Epstein JB, Elad S, Hamblin MR, et al. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols. Support Care Cancer. 2016;24:2793–805. Padmini C, Bai KY. Oral and dental considerations in pediatric leukemic patient. Int Sch Res Not. 2014;14:895721. Ramos-Pinto MB, Gusmão TPL, Schmidt-Filho J, Jaguar GC, Martins MD, Alves FA. Intraoral versus extraoral photobiomodulation therapy in the prevention of oral mucositis in HSCT patients: a randomized, single-blind, controlled clinical trial. Support Care Cancer. 2021;29(11):6495–503. Anders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus Photobiomodulation therapy. Photomed Laser Surg. 2015;33(4):183–4. Wagner VP, Curra M, Webber LP, et al. Photobiomodulation regulates cytokine release and new blood vessel formation during oral wound healing in rats. Lasers Med Sci. 2016;31(4):665–71. Cheng K, Martin LF, Slepian MJ, Patwardhan AM, Ibrahim MM. Mechanisms and pathways of pain photobiomodulation: a narrative review. J Pain. 2021;22:763–77. Hu D, Zhu S, Potas JR. Red LED photobiomodulation reduces pain hypersensitivity and improves sensorimotor function following mild T10 hemicontusion spinal cord injury. J Neuroinflammation. 2016;13:200. Khanna R, Patwardhan A, Yang X, Li W, Cai S, Ji Y, et al. Development and characterization of an injury-free model of functional pain in rats by exposure to red light. J Pain. 2019;20:1293–306. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7121739","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493423086,"identity":"43dd4c30-adb7-4437-aa72-7e3188cdbd5c","order_by":0,"name":"Tomasz Bąk","email":"","orcid":"","institution":"Medical University of Lublin","correspondingAuthor":false,"prefix":"","firstName":"Tomasz","middleName":"","lastName":"Bąk","suffix":""},{"id":493423087,"identity":"38a0850c-0dae-454b-9e94-1f6ab565a3e2","order_by":1,"name":"Jolanta Sikorska","email":"data:image/png;base64,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","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":true,"prefix":"","firstName":"Jolanta","middleName":"","lastName":"Sikorska","suffix":""},{"id":493423088,"identity":"49526d56-b9b1-43d3-8240-e5873b613742","order_by":2,"name":"Joanna Wysokińska-Miszczuk","email":"","orcid":"","institution":"Medical University of Lublin","correspondingAuthor":false,"prefix":"","firstName":"Joanna","middleName":"","lastName":"Wysokińska-Miszczuk","suffix":""},{"id":493423089,"identity":"004c6528-c959-4425-b33f-99d0f6b9da4b","order_by":3,"name":"Michał R. Oszwałdowski","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Michał","middleName":"R.","lastName":"Oszwałdowski","suffix":""},{"id":493423090,"identity":"416481f0-1278-41be-a32e-47ff80944851","order_by":4,"name":"Justyna Klempka","email":"","orcid":"","institution":"Medical University of Lublin","correspondingAuthor":false,"prefix":"","firstName":"Justyna","middleName":"","lastName":"Klempka","suffix":""},{"id":493423091,"identity":"9659a69c-9608-4a53-9b74-d82621601f6b","order_by":5,"name":"Paweł M. Aleksandrowicz","email":"","orcid":"","institution":"Medical University of Warsaw","correspondingAuthor":false,"prefix":"","firstName":"Paweł","middleName":"M.","lastName":"Aleksandrowicz","suffix":""}],"badges":[],"createdAt":"2025-07-14 13:38:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7121739/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7121739/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88094045,"identity":"39c6682b-b633-414f-99a7-8a1b3452b901","added_by":"auto","created_at":"2025-08-01 10:45:47","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":84224,"visible":true,"origin":"","legend":"\u003cp\u003eOccurrence of local symptoms associated with mucositis in the laser treatment group.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7121739/v1/42feceaaa03755ada0a75eb0.jpg"},{"id":88095363,"identity":"107fe009-f890-426f-a6f6-bb89834b1ccf","added_by":"auto","created_at":"2025-08-01 10:53:47","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":91200,"visible":true,"origin":"","legend":"\u003cp\u003eOccurrence of local symptoms associated with Mucositis in the control group.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7121739/v1/0d333799c6d9d26b7efb4fa3.jpg"},{"id":88094048,"identity":"30ecd870-cf74-4374-bdc4-3cd87cfad804","added_by":"auto","created_at":"2025-08-01 10:45:47","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":56926,"visible":true,"origin":"","legend":"\u003cp\u003eOccurrence of tongue burning in the study group.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7121739/v1/109d174575d29d6fb754a848.jpg"},{"id":88094046,"identity":"0cbb36df-021d-4292-b919-99b415e2b4cc","added_by":"auto","created_at":"2025-08-01 10:45:47","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":60992,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOccurrence of tongue burning in the control group.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7121739/v1/bad494b9c1d01839dd5c788d.jpg"},{"id":89459965,"identity":"9fd0a801-c379-4f17-be2a-9a9b507808f6","added_by":"auto","created_at":"2025-08-20 07:47:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1122557,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7121739/v1/d0bf8327-0099-48b7-982b-93d11994c711.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Laser Photobiomodulation Therapy on Oral Mucosal Integrity in Patients Undergoing Chemotherapy During Hematopoietic Stem Cell Transplantation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLeukemia is one of the most aggressive malignant tumors of the hematopoietic system, leading to its complete destruction and immunosuppression in patients. Despite advances in the treatment of malignant tumors, chemotherapy, usually based on several cytostatic drugs, remains the primary treatment method [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It precedes autologous or allogeneic hematopoietic cell transplantation. Stem cells help regenerate the bone marrow after chemotherapy and strengthen the immune system. Although chemotherapy primarily targets cancer cells, it also damages normal cells to a lesser extent. This is especially true for rapidly dividing cells, such as bone marrow and epithelial cells, mainly in the gastrointestinal tract, but also to a significant extent in the epithelial cells lining the oral cavity. The high toxicity and aggressiveness of chemotherapy used in malignant hematopoietic tumors particularly often contributes to morphological and functional changes in the stomatognathic system, significantly impairing the patient's quality of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOral mucositis (OM) is the most common acute complication in cancer patients undergoing chemotherapy and radiotherapy, affecting more than 60% of patients and up to 85% of those undergoing bone marrow transplantation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Clinical symptoms usually appear within 7 days of starting chemotherapy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The reason for the high sensitivity of mucosal epithelial cells to the cytotoxic effects of chemotherapy is their rapid renewal cycle, which usually occurs every 7\u0026ndash;14 days [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Oral mucositis manifests itself in various ways, often intensifying depending on the type of cancer treatment used in the patient, which depends on the type of cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], its location, the type, dose, and duration of the cytostatic drug used, and the individual sensitivity of the patient [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. OM begins as an inflammatory process in the basal layer of the oral epithelium, which gradually transforms into erythema and mucosal ulcers [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The chemotherapy regimen, age, neutrophil count, and oral hygiene of patients undergoing treatment play an important role in the development and severity of oral mucositis. Cytostatics used in the chemotherapy of other malignant tumors can also cause symptoms of mucositis. They occur most often after administration of fluorouracil, methotrexate, doxorubicin, actinomycin D, melphalan, cytarabine, cyclophosphamide, bisulfate, cisplatin, and vinblastine [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The clinical symptoms of OM can manifest as superficial, painful erythema, up to complete ulceration of the mucous membrane [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Patients who develop OM during cancer therapy are more likely to interrupt or delay treatment due to pain, difficulty eating, malnutrition, dehydration, and dysgeusia, leading to a significant deterioration in their quality of life. These symptoms make oral hygiene and eating difficult and cause additional trauma during chewing [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrevention of OM is crucial in oncological care, as its occurrence is associated with poorer clinical outcomes, reduced quality of life, and increased treatment costs compared to patients without such changes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Mucositis prevention includes hygiene and dietary guidelines, and thorough oral hygiene instruction should cover the selection of an appropriate toothbrushing method and appropriate hygiene products (soft toothbrush, dental floss and tape, mouthwashes) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The International Society for Oncology Supportive Care recommends modifying the diet to soft foods, using agents such as honey, aloe vera, glutamine, amifostine, cryotherapy, granulocyte colony-stimulating factor, keratinocyte growth factor, antibiotic lozenges or pastes, and sucralfate, as well as anesthetics and mouthwashes to relieve symptoms [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDuring cancer treatment, dental care should focus on treating mucositis and aim to reduce and/or eliminate pain, prevent secondary infections, and accelerate the healing of damaged epithelium. During this period, particular attention should be paid to maintaining oral hygiene, as the weakening of the immune system that accompanies chemotherapy promotes infectious complications in the oral cavity. Severe pain in the mouth and gastrointestinal tract may require the administration of narcotic analgesics. Pain reduction allows for oral nutrition, which is important because food stimulates gastrointestinal motility and blood supply to the mucous membrane, which counteracts its atrophy [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCurrently, photobiomodulation (PBM) is an effective method for preventing and treating mucositis in patients after bone marrow transplantation. The International Society of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) and the European Society for Medical Oncology (ESMO, Lugano, Switzerland) recommend this method as a preventive measure in patients treated with high doses of cytostatics, especially those preparing for bone marrow transplantation [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Low-level laser therapy (LLLT) is a non-thermal therapeutic method that uses a specific light spectrum (390\u0026ndash;1100 nm) to modulate cellular activity and induce therapeutic effects [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Numerous studies show that PBM does not cause adverse effects on the treated tissues [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23 CR24\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. It is well tolerated by patients, which gives it an advantage over other methods [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Photobiomodulation is non-invasive, short-term, and unobtrusive. In the case of biostimulation, the laser has an analgesic effect and promotes proper healing. PBM stimulates collagen synthesis by fibroblasts, angiogenesis, and myofibroblast differentiation, which improves the properties of newly formed tissue [\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLow-power light stimulates the immune system and triggers many changes in cells that affect regeneration and renewal [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The triad of the main effects of photobiomodulation at the tissue level are: analgesic, anti-inflammatory, and tissue regeneration stimulation. In recent years, PBM therapy has been widely described as effective in the treatment of wounds, musculoskeletal disorders, and neuropathic symptoms [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch on the effectiveness of photobiomodulation in the treatment of various dental diseases is still ongoing. Pathological changes such as mucositis within the oral epithelium, which are a consequence of chemotherapy, are particularly common in leukemia patients, hence further research on the effectiveness of laser biostimulation is justified. which aims to alleviate pain that is burdensome for the patient and accelerate the healing and regeneration of damaged oral epithelium.\u003c/p\u003e\u003cp\u003eThe aim of this study was to compare the effectiveness of conventional methods of treating mucositis and a therapeutic technique using laser phototherapy in a group of patients undergoing bone marrow transplantation. Research using a biostimulating laser was completed in 2019, before the Multinational Association of Supportive Care in Cancer (MASCC) and the International Society for Oral Oncology (ISOO) proposed the following dosimetric parameters: wavelength 632.8 nm, power density 31.25 mW/cm\u0026sup2;, energy density 1.0 J/cm\u0026sup2; with an exposure time of 40 s per point \u0026mdash; for use in patients undergoing hematopoietic stem cell transplantation (HSCT), and wavelength 660 nm, power density 417 mW/cm\u0026sup2; and energy density 4.2 J/cm\u0026sup2; with an exposure time of 10 s per point \u0026mdash; for patients treated with a combination of chemotherapy and radiotherapy in the head and neck area.\u003c/p\u003e\u003cp\u003eThe results confirmed the effectiveness of photobiomodulation in the treatment of severe oral mucositis in patients undergoing high-dose chemotherapy in autologous and allogeneic hematopoietic stem cell transplantation procedures.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe study group consisted of 50 patients who underwent chemotherapy to destroy bone marrow cancer cells. Chemotherapy preceded autologous or allogeneic bone marrow hematopoietic cell transplantation. Patients with complications of chemotherapy in the form of severe inflammation of the oral mucosa were eligible for the study. Detailed data on the stage of the underlying disease, type of leukemia, performance status, and presence of concomitant oral diseases were obtained from each patient. The group of 50 patients selected for the study came from the Department of Hemato-Oncology and Bone Marrow Transplantation at the Medical University of Lublin. Among them were 20 women and 30 men, aged 27\u0026ndash;75. The average age of the study participants was 62.2 years. The control group consisted of 23 patients\u0026mdash;8 women and 15 men, aged 31\u0026ndash;78. The average age of the control group was 63.43. Written informed consent to participate in the study was obtained from all participants.\u003c/p\u003e\u003cp\u003eTen days after the end of chemotherapy cycles and hematopoietic cell transplantation, each patient underwent a thorough examination was performed to determine the general condition of the oral mucosa, the degree of damage (possible presence of erosions, ulcers), with particular emphasis on the presence and size of inflammatory changes in the epithelium lining the oral cavity. The assessment was performed visually, and the extent of mucosal damage was determined, among other things, using the World Health Organization (WHO) Mucositis Severity Scale, which includes 4 stages of severity: 1 \u0026ndash; erythema; 2 \u0026ndash; erythema with superficial erosions; 3 \u0026ndash; erythema with confluent erosions; 4 \u0026ndash; extensive ulcerations. Other scales and indices used in the study include: the WHO scale of criteria for oral mucosal lesions; the scale of oral mucosal moisture \u0026ndash; mirror test; pain level on the VAS (Visual Analogue Scale), tongue coating index according to Winkl; gingival sulcus bleeding index (GSBI) and PMA (Papilla-Marginal-Attached Index). After a detailed assessment of the presence and severity of inflammatory changes in patients, photobiomodulation was performed to relieve inflammatory pain and induce immune system cells. Each irradiation treatment was preceded by standard oral hygiene procedures. In addition, after each tooth brushing, patients used mouthwashes containing a 0.2% chlorhexidine solution. This was done to prevent bacterial, fungal, and viral infections.\u003c/p\u003e\u003cp\u003eLaser phototherapy was performed in two groups of patients, with different doses of laser radiation. In the first group, 25 patients were treated with a laser containing an InGaAIP diode, enabling the emission of a low dose of laser radiation with a wavelength of 660 nm (power-50 mW and energy-4 J/cm2). Each inflammatory site was irradiated for 15 seconds, allowing for the application of the optimal dose of laser radiation. The laser parameters and irradiation times and cycles were selected in accordance with the guidelines in force before 2019. In the second group, 25 patients with similar clinical characteristics to those in the first group underwent a similar irradiation procedure, using a higher power laser with a wavelength of 820 nm (power-100mW and energy-8J/cm2). In both groups, irradiation treatments were performed every day after oral hygiene procedures.\u003c/p\u003e\u003cp\u003eThe condition of the oral cavity was assessed daily. The last day after the end of laser therapy proved to be particularly important. The oral cavity was examined visually, and the severity of inflammatory changes was determined, among other things, using the WHO scale, taking into account the dynamics and size of inflammatory changes in the epithelium (reduction, stabilization, or enlargement of inflammatory changes). Next, the condition of the oral cavity was assessed in both groups of patients before and after laser phototherapy. The collected results were compared with the control group, which made it possible to assess the usefulness of this type of treatment in advanced inflammatory conditions of the oral mucosa that may occur during oncological treatment.\u003c/p\u003e\u003cp\u003eAll data collected during the study were subjected to statistical analysis. They were nominal in nature, therefore, frequency analysis and percentage analysis were used to describe them. Pearson's chi-square test was used to assess differences in frequency distributions. Additionally, when the significance level indicated a statistically significant difference, the V-Cramer coefficient, which takes values from 0 to 1, was calculated. The results of the analyses were presented in tables. The critical level of significance was set at p\u0026amp;lt;0.05. All calculations were performed using Statistica v.13.3.\u003c/p\u003e\u003cp\u003eThe distributions of quantitative variables were examined using the Shapiro-Wilk test. Descriptive statistics for quantitative variables were presented using measures of central tendency: arithmetic mean (M) and median (Me), as well as measures of position: lower and upper quartiles (Q1\u0026ndash;Q3), and measures of dispersion: standard deviation (SD) and minimum and maximum (Min\u0026ndash;Max). Qualitative variables were presented using frequencies and percentages.\u003c/p\u003e\u003cp\u003eFor variables whose distribution was not normal, the non-parametric Mann-Whitney test for two independent samples was used for comparisons. The comparison of two related samples was performed using the Wilcoxon test. To compare more than two related samples (when the same people were evaluated), the Friedman test was used along with post hoc tests. The relationship between the studied variables was assessed using the chi^2 independence test. In order to examine the differences between individual fractions (%), the test of significance of differences between two structure indicators was used.\u003c/p\u003e\u003cp\u003eThe results of the studied variables were presented in tables and graphs. In this study, a 5% risk of error was assumed, which means that values of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e\u003cp\u003eTo compare more than two related samples (when the same people were evaluated), the Friedman test was used along with post hoc tests.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe relationships between selected scales and indicators of oral health and the method of patient treatment are presented in tables and figures.\u003c/p\u003e\u003cp\u003eWHO Mucositis Severity Scale and method of patient treatment (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e):\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\u003eCharacteristics and examination of the relationship between the severity of Mucositis according to the WHO and the method of patient treatment\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\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMucositis severity scale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroups according to treatment method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi^2;\u003c/p\u003e\u003cp\u003ep*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudy group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo changes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (44,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (4,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e54,744;\u003c/p\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0,0004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eErythema\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25 (50,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (4,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0,0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eErythema with superficial erosions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (4,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (40,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0,0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eErythema with confluent erosions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (44,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtensive ulcerations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (8,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (100,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (100,00%)\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\u003ep* - significance level for the chi^2 dependency test,\u003c/p\u003e\u003cp\u003ep** - significance level for the test of difference between two structural indicators.\u003c/p\u003e\u003cp\u003eThe analysis allowed us to conclude that there is a significant correlation between the severity of mucositis and the treatment method used (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The comparative analysis performed in the next step showed a difference in the frequency of no changes depending on the treatment method (p\u0026thinsp;=\u0026thinsp;0.0004). The absence of mucositis lesions was significantly more frequent in the group treated with the laser method (44.00%) compared to the control group (4.00%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). A significant difference in the frequency of erythema was also found between the groups studied (p\u0026thinsp;=\u0026thinsp;0.0001). There were significantly more cases of erythema in the laser-treated group compared to the control group. However, in the control group, lesions such as erythema with superficial erosions and erythema with confluent erosions were significantly more common compared to patients treated with the laser method. In addition, there were no extensive ulcers in the group of patients treated with laser therapy, unlike in the control group, where they accounted for 8%.\u003c/p\u003e\u003cp\u003eMirror test and patient treatment method (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\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\u003eCharacteristics and examination of the relationship between the mirror test result and the patient treatment method\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\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMirror test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroups according to treatment method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi^2;\u003c/p\u003e\u003cp\u003ep*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudy group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo resistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (54,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e34,145;\u003c/p\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow resistance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (46,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (60,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,253\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSignificant resistance\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (40,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (100,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (100,00%)\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\u003ep* - significance level for the chi^2 dependency test,\u003c/p\u003e\u003cp\u003ep** - significance level for the test of difference between two structure indices\u003c/p\u003e\u003cp\u003eThere was a statistically significant relationship between the mirror test result and the method of treatment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The comparative analysis did not reveal any significant differences in the incidence of low resistance between the study groups. It should be noted that in the group of patients treated with laser, 54% of patients had no resistance, while in the control group there were no such patients (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In addition, in the study group there were no patients with significant resistance when attempting to move the mirror across the mucous membrane, while in the control group the incidence of such patients was 40%.\u003c/p\u003e\u003cp\u003eTongue coating index according to Winkla (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\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\u003eCharacteristics and examination of the relationship between tongue coating and the method of treatment of patients\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\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTongue coating index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroups according to treatment method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi^2;\u003c/p\u003e\u003cp\u003ep*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudy group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo coating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27 (54,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e34,145;\u003c/p\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThin, light tongue coating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (46,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (60,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,253\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSignificant, thick coating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (40,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003etotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (100,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (100,00%)\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\u003ep* - significance level for the chi^2 dependency test,\u003c/p\u003e\u003cp\u003ep** - significance level for the test of difference between two structure indicators\u003c/p\u003e\u003cp\u003eThe analysis allowed us to conclude that there is a correlation between the degree of tongue coating and the method of treatment used in patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The comparative analysis did not indicate a difference in the incidence of thin tongue coating between the study groups (p\u0026thinsp;=\u0026thinsp;0.253). In the group where patients were treated with a laser dose, as many as 54% of the subjects did not have tongue coating, and there was no significant coating (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In the control group, however, there were no patients without tongue coating, and significant coating was present in approximately 40% of patients.\u003c/p\u003e\u003cp\u003ePocket bleeding index (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e):\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\u003eCharacteristics and examination of the relationship between pocket bleeding and the method of treatment of patients\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\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBleeding index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroups according to treatment method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi^2;\u003c/p\u003e\u003cp\u003ep*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudy group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealthy-looking gums, bleeding on probing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (26,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (4,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e20,452;\u003c/p\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0,021\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGingival discoloration, bleeding on probing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (30,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (16,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,189\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChange in color, slight change in shape, swelling, bleeding during probing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (34,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (28,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,600\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiscoloration, significant change in gum shape, bleeding during probing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (10,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (32,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0,018\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGingival bleeding during probing, change in color, significant swelling or ulceration of the gingiva\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (20,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003etotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (100,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (100,00%)\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\u003ep* - significance level for the chi^2 test,\u003c/p\u003e\u003cp\u003ep** - significance level for the test of difference between two structural indicators\u003c/p\u003e\u003cp\u003eThe analysis showed a significant relationship between pocket bleeding and the treatment method used (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The comparative analysis revealed a difference in the incidence of healthy-looking gums bleeding during probing between the patient groups (p\u0026thinsp;=\u0026thinsp;0.021). Significantly more healthy-looking gums were found in the study group compared to the control group (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In addition, more patients in the control group compared to the laser-treated group had discoloration, significant changes in gum shape, and bleeding during probing. The control group also had bleeding with gum ulceration (20%), whereas in the study group, such changes did not occur.\u003c/p\u003e\u003cp\u003eGingival condition index (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e):\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 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics and examination of the relationship between gingival condition and treatment method of patients\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\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGingival condition index PMA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eGroups according to treatment method\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eChi^2;\u003c/p\u003e\u003cp\u003ep*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStudy group\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl group\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo pathological changes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30 (60,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (28,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e22,327;\u003c/p\u003e\u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0,009\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLight inflammation, slight inflammation of the interdental papillae\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (30,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (12,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,085\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate inflammation, inflammation of the papillae and marginal gingiva without tissue hyperplasia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (10,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (48,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0,0002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSignificant inflammation, includes the papilla, marginal part and gingiva proper\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (12,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003etotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (100,00%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25 (100,00%)\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\u003ep* - significance level for the chi^2 test of dependence,\u003c/p\u003e\u003cp\u003ep** - significance level for the test of difference between two structure indices\u003c/p\u003e\u003cp\u003eBased on the results of the analysis, it was found that there are statistically significant relationships between the condition of the gums and the treatment method (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Comparative analysis showed a difference in the frequency of no pathological changes depending on the treatment method used (p\u0026thinsp;=\u0026thinsp;0.009). There were significantly more patients without pathological changes in the laser-treated group (60%) than in the control group (28.00%) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Moreover, statistically significantly, more moderate gingivitis occurred in patients in the control group (48.00%) compared to patients treated with laser (10.00%). In addition, the control group had severe gingivitis, while the study group did not have such advanced inflammation.\u003c/p\u003e\u003cp\u003eComparative analysis of pain on the VAS scale between groups distinguished on the basis of the treatment method used in patients with severe inflammation of the oral epithelium (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e):\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 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics and comparison of pain on the VAS scale for the study groups at different time points\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVAS Pain scale\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGr.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMe\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eQ\u003csub\u003e1\u003c/sub\u003e \u0026ndash; Q\u003csub\u003e3\u003c/sub\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMin \u0026ndash; Max\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eZ*/U**\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eBefore the start of radiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1,208*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,227\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4,00\u0026ndash;7,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOn the 1st day of radiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1,162*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,245\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOn the 2nd day of irradiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1,452*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,146\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOn the 3rd day of irradiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4,00\u0026ndash;7,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,729*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,466\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3,00\u0026ndash;7,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1,00\u0026ndash;9,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOn the 4th day of irradiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3,00\u0026ndash;7,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,769*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,442\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3,00\u0026ndash;7,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOn the 5th day of irradiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3,00\u0026ndash;6,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,657*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,511\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3,00\u0026ndash;6,50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOn the 6th day of irradiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3,00\u0026ndash;6,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,021*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,983\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3,00\u0026ndash;6,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOn the 7th day of irradiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,00\u0026ndash;6,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e180,000**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,883\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,00\u0026ndash;4,50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;7,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOn the 8th day of irradiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,00\u0026ndash;6,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;8,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e17,000**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0,195\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2,80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,00\u0026ndash;2,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;6,00\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOn the 9th day of irradiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5,50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2,38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6,50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4,00\u0026ndash;7,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;7,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAt the end of irradiation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3,66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2,00\u0026ndash;6,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2,00\u0026ndash;7,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e2,511*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003e0,012\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4,80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4,00\u0026ndash;6,00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1,00\u0026ndash;8,00\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\u003eM \u0026ndash; mean, SD \u0026ndash; standard deviation, Me \u0026ndash; median, Q1 \u0026ndash; Q3 \u0026ndash; lower and upper quartile, Min \u0026ndash; Max \u0026ndash; minimum and maximum, Z \u0026ndash; value of the Mann-Whitney test, when the number of both groups is greater than 20, U \u0026ndash; value of the Mann-Whitney test, when the number of both groups is less than 20, the test probability level for the M-W test.\u003c/p\u003e\u003cp\u003eBased on the comparative analysis, it was found that there was a significant difference in the pain assessment on the VAS scale at the end of the irradiation (p\u0026thinsp;=\u0026thinsp;0.012). Significantly lower pain at the end of the treatment was felt by patients who received laser treatment (Me\u0026thinsp;=\u0026thinsp;3.00) compared to the control group (Me\u0026thinsp;=\u0026thinsp;5.00) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The results are presented in a box-and-whisker graph. The remaining comparisons of pain levels between the groups turned out not to be statistically significant.\u003c/p\u003e\u003cp\u003eThe local manifestations observed in relation to mucositis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e,\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e):\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study showed a significant correlation between the severity of mucositis, measured by the WHO scale, and the treatment method used (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Subsequent comparative analysis revealed a significant difference in the frequency of absence of mucositis changes, depending on the treatment method (p\u0026thinsp;=\u0026thinsp;0.0004). Specifically, the absence of mucositis was significantly more frequent in the group treated with laser therapy (44.00%) compared to the control group (4.00%). After treatment, 60% of patients did not show any symptoms of mucositis, which confirmed the effectiveness of laser therapy in reducing the symptoms of inflammation and improving oral health. In addition, there was a significant difference in the occurrence of erythema between the groups (p\u0026thinsp;=\u0026thinsp;0.0001), with more cases of erythema observed in the laser group than in the control group. The control group experienced significantly more severe conditions, such as redness with superficial erosions and redness with confluent erosions, compared with the laser group. Notably, no patient in the laser group reported extensive ulceration, whereas 8% of the control group did. These results suggest that laser therapy is associated with reduced severity of mucositis symptoms, including a greater likelihood of no lesions and fewer severe erosions or ulcerations. These results support the hypothesis that laser therapy is more effective in treating mucositis than standard care, as patients treated with laser therapy experienced fewer complications and complications of lower severity.\u003c/p\u003e\u003cp\u003eThese studies have demonstrated the potential of laser therapy as a beneficial adjunct to standard care for pain associated with oral mucositis. There was a significantly higher percentage of patients in the control group who complained of a burning sensation of the tongue during the day compared to the study group (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e,\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This suggests that laser treatment may be effective in reducing the intensity and duration of pain, burning in the oral cavity.\u003c/p\u003e\u003cp\u003eFurthermore, analysis of the collected data indicated a significant correlation between the intensity of tongue coating and the treatment method used (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In the group that received laser treatment, 54% of patients had no tongue coating, and none of the patients had severe tongue coating. In the control group, none of the patients had a clean tongue, and 40% of them had a heavy tongue coating. The occurrence of a light, thin tongue coating was similar in both groups, with no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.253). These results confirmed that laser therapy is effective in reducing tongue coating in patients undergoing chemotherapy in the hematopoietic cell transplant procedure.\u003c/p\u003e\u003cp\u003eIn the mirror test, before and after laser treatment in the study group, the results indicated a significant reduction in resistance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No resistance was more common after laser therapy, while mild resistance was more common before treatment (56% before treatment vs. 28% after laser treatment). The analysis showed that laser therapy facilitates better functional regeneration of the oral mucosa. Additionally, the study showed a significant association between bleeding from pockets and the treatment method used (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The comparison revealed a significant difference in the frequency of healthy-appearing gums that bled on probing between the patient groups (p\u0026thinsp;=\u0026thinsp;0.021). The group that received laser treatment had significantly more cases of healthy gums compared to the control group. In addition, more patients in the control group showed significant changes in the color and shape of the gums and bleeding on probing compared to the laser group. In the control group, 20% of patients experienced bleeding with ulceration of the gums, whereas in the laser group, no such cases were observed. These results suggest that laser therapy is effective in maintaining gum health and reducing bleeding.\u003c/p\u003e\u003cp\u003eAs a result of the conducted studies, based on comparative analysis, a significant difference was observed in the pain assessment on the VAS scale at the end of laser irradiation treatments (p\u0026thinsp;=\u0026thinsp;0.012). Patients who received laser therapy reported significantly lower pain levels at the end of treatment (Me\u0026thinsp;=\u0026thinsp;3.00) compared to the control group (Me\u0026thinsp;=\u0026thinsp;5.00). However, other comparisons between groups, conducted at different stages of the treatment process, did not show statistically significant differences. Consistent measurements over time suggest that both groups experienced a reduction in pain, but the laser group saw a more pronounced improvement at the end of therapy.\u003c/p\u003e\u003cp\u003eAnalysis of hygiene practices in the laser group showed that most patients used the recommended preventive measures, such as cleaning and disinfecting the oral cavity, which probably contributed to the lower incidence of mucositis. In the control group, in contrast to the laser group, fewer patients followed the recommended hygiene practices, which could have contributed to the higher incidence of mucositis symptoms in this group.\u003c/p\u003e\u003cp\u003eIn general, laser therapy not only reduces the incidence of severe symptoms of oral mucositis, but also prevents the development of the most severe form of mucositis - extensive ulcers, which occurred in the control group. This evidence strengthens the view of the potential of laser therapy as a valuable treatment for oral mucositis in patients undergoing bone marrow transplantation.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eLLLT, regardless of the power used, significantly improves the symptoms of mucositis in patients after chemotherapy, and thus may improve the quality of life of cancer patients. Laser biostimulation contributes to reducing the level of pain associated with mucositis. Studies have shown that low-level laser therapy can prevent the development of severe ulcers in the oral mucosa in patients undergoing chemotherapy. The use of biostimulating laser seems to be the gold standard in the treatment of oral mucositis in patients undergoing chemotherapy for hematological malignancies. Despite such positive results, further research is necessary to optimize laser dosage and treatment frequency in different age groups, especially in children undergoing oncological treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOM \u0026ndash; oral mucositis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePBM \u0026ndash; photobiomodulation\u003c/p\u003e\n\u003cp\u003eMASCC- Multinational Association of Supportive Care in Cancer\u003c/p\u003e\n\u003cp\u003eISOO -\u0026nbsp;International Society of Oral Oncology\u003c/p\u003e\n\u003cp\u003eESMO - European Society for Medical Oncology\u003c/p\u003e\n\u003cp\u003eLLLT \u0026ndash; Low-Level Laser Therapy\u003c/p\u003e\n\u003cp\u003eHSCT \u0026ndash; hematopoietic stem cell transplantation\u003c/p\u003e\n\u003cp\u003eWHO -\u0026nbsp;World Health Organization\u003c/p\u003e\n\u003cp\u003eVAS - Visual Analogue Scale\u003c/p\u003e\n\u003cp\u003eGSBI \u0026ndash; Gingival Sulcus Bleeding Index\u003c/p\u003e\n\u003cp\u003ePMA- Papilla,-Marginal-Attached Index\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInGaAIP\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;- \u003cstrong\u003eIndium Gallium Aluminium Phosphide\u003c/strong\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki and ap-proved by the\u003c/p\u003e\n\u003cp\u003eBioethics Committee of the Medical University of Lublin (approval number: KE-0254/157/2015).\u003c/p\u003e\n\u003cp\u003eWritten informed consent to participate in the study was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart, from those disclosed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made substantial contributions to the gathering, analysis, and interpretation of data. T.B., J.S. and P.M.A. wrote the main manuscript text. T.B. and J.S prepared all figures and tables. All authors are involved in revising it critically for intellectual content. All authors gave final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions relating to the accuracy or integrity of any part of the work are appropriately investigated and resolved\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1Department and Chair of Periodontology, Medical University of Lublin; 20-093 Lublin, Poland. 2 Department of Oral Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKozarzewska M, Daszkiewicz M, Olczak-Kowalczyk D, Dembowska-Bagińska B. Zmiany patologiczne w jamie ustnej u pacjent\u0026oacute;w poddanych terapii przeciwnowotworowej. 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Oral Dis. 2024;30:4126\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilverman S Jr. Diagnosis and management of oral mucositis. J Support Oncol. 2007;5(2Suppl1):13\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2014;120:1453\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFu Q, Jiang H, Yang J, et al. Bypassing the Heat Risk and Efficacy Limitations of Pulsed 630 nm LED Photobiomodulation Therapy for Anti-Primary Dysmenorrhea: A Prospective Randomized Cross-Over Trial. Photonics. 2024;11(2):136.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYang J, Fu Q, Jiang H, Li Y, Liu M. Progress of phototherapy for osteosarcoma and application prospect of blue light photobiomodulation therapy. Front Oncol. 2022;12:1022973.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAl-Rudayni AHM, Gopinath D, Maharajan MK, Veettil SK, Menon RK. Efficacy of photobiomodulation in the treatment of cancer chemotherapy-induced oral mucositis: a meta-analysis with trial sequential analysis. Int J Environ Res Public Health. 2021;18:7418.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoris SP, Popruzhenko TV, Kras\u0026rsquo;Ko OV, Mostovnikov AV, de Karas OV. Photobiomodulation of tissues of the oral cavity for prevention and treatment of mucositis associated with polychemotherapy in children. Photomed Laser Surg. 2016;15:29\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSilva GB, Sacono NT, Othon-Leite AF, Mendon\u0026ccedil;a EF, Arantes AM, Bariani C, et al. Effect of low-level laser therapy on inflammatory mediator release during chemotherapy-induced oral mucositis: a randomized preliminary study. Lasers Med Sci. 2015;30:117\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZecha JA, Raber-Durlacher JE, Nair RG, Epstein JB, Elad S, Hamblin MR, et al. Low-level laser therapy/photobiomodulation in the management of side effects of chemoradiation therapy in head and neck cancer: part 2: proposed applications and treatment protocols. Support Care Cancer. 2016;24:2793\u0026ndash;805.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePadmini C, Bai KY. Oral and dental considerations in pediatric leukemic patient. Int Sch Res Not. 2014;14:895721.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRamos-Pinto MB, Gusm\u0026atilde;o TPL, Schmidt-Filho J, Jaguar GC, Martins MD, Alves FA. Intraoral versus extraoral photobiomodulation therapy in the prevention of oral mucositis in HSCT patients: a randomized, single-blind, controlled clinical trial. Support Care Cancer. 2021;29(11):6495\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus Photobiomodulation therapy. Photomed Laser Surg. 2015;33(4):183\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWagner VP, Curra M, Webber LP, et al. Photobiomodulation regulates cytokine release and new blood vessel formation during oral wound healing in rats. Lasers Med Sci. 2016;31(4):665\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCheng K, Martin LF, Slepian MJ, Patwardhan AM, Ibrahim MM. Mechanisms and pathways of pain photobiomodulation: a narrative review. J Pain. 2021;22:763\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHu D, Zhu S, Potas JR. Red LED photobiomodulation reduces pain hypersensitivity and improves sensorimotor function following mild T10 hemicontusion spinal cord injury. J Neuroinflammation. 2016;13:200.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhanna R, Patwardhan A, Yang X, Li W, Cai S, Ji Y, et al. Development and characterization of an injury-free model of functional pain in rats by exposure to red light. J Pain. 2019;20:1293\u0026ndash;306.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chemotherapy, Hematopoietic stem cell transplantation, Laser therapy, Oral mucositis, Photobiomodulation","lastPublishedDoi":"10.21203/rs.3.rs-7121739/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7121739/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOral mucositis (OM) is the most common acute complication in cancer patients undergoing chemotherapy and radiotherapy. It affects up to 85% of patients undergoing bone marrow transplantation. Prevention of OM is crucial in oncological care, as its occurrence is associated with poorer clinical outcomes and reduced quality of life for patients. Currently, photobiomodulation (PBM) is an effective method for the prevention and treatment of oral mucositis in patients after bone marrow transplantation. Low-level light therapy allows for the modulation of cellular activity and the induction of therapeutic effects. The aim of this study was to compare the effectiveness of conventional methods of treating oral mucositis and a therapeutic technique using laser phototherapy in a group of patients undergoing bone marrow transplantation. The biostimulating laser study was completed in 2019.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThe study group consisted of 50 patients with chemotherapy complications in the form of severe oral mucositis who underwent hematopoietic cell transplantation. Two different doses of laser radiation were used. The collected data were compared with each other and with a control group.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eIt was found that the absence of OM was significantly more frequent in the group treated with laser therapy compared to the control group. After photobiomodulation, 60% of patients in the study group showed no symptoms of OM.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003ePhotobiomodulation is effective in reducing inflammation symptoms and improving oral health in cancer patients undergoing hematopoietic stem cell transplantation.\u003c/p\u003e","manuscriptTitle":"Impact of Laser Photobiomodulation Therapy on Oral Mucosal Integrity in Patients Undergoing Chemotherapy During Hematopoietic Stem Cell Transplantation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-01 10:45:42","doi":"10.21203/rs.3.rs-7121739/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"26413dd6-690b-4dc1-bfb9-a4c232e1dd0e","owner":[],"postedDate":"August 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-20T07:39:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-01 10:45:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7121739","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7121739","identity":"rs-7121739","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}