Parathesia Reversal

[Anonymous]

For those who didn’t see this on DT, this is a case we’re pretty excited about in my office. Thanks to Bob and Del for mentioning a similar case at the San Antonio Periolase Training!

40+ YO White Female
Hx of third molar extraction with oral surgeon 2 years ago.
Parathesia lower lip from commisure to midline. Pt descibes lip as hard w/ no feeling. CC -Can’t drink from cup w/o drooling and mother has noticed she ‘hides’ lip when speaking.

Tx- FRVP ND:YAG (Periolase) 3.6W100usec 20HZ. Tip was held at a distance where the patient just felt a slight warmth. Total energy 4000J. During treatment we located a couple ‘hotspots’ that were more heat sensitive. These were rebathed with laser energy until they no longer reacted differently that the other areas. The 3rd molar area was also treated

Pt returned 1 week and reported decrease in numbness and her lip no longer felt hard.
Treatment at 2nd appt was 4500 J and included intra and extra oral application. At this appt we found an additional hot spot intraorally.

Pt. returned for tx at week 3 and reported significant decrease in numbness – she described as greater than 60 % but testing indicated more. Pt also stated she could now drink normally from a cup and her mother asked what she had done because she wasn’t ‘hiding her lip when talking’

Needless to say the patient is pretty happy. We’ll continue retreatment until no more numbness or no more improvement.
As to what’s happening here, I think the normal biostimulation theories come into play.

[dkimmel]

Pretty exciting stuff. Do you think we can see any results with different wavelengths?

DAvid

[Anonymous]

David, I’m not sure but my guess is that there is something special about 1064 and its relation to healing. Bob and Del related to me how when they were developing their laser they had a very difficult time finding out from security companies what wavelength their security systems were reading off of humans (thought they were thieves trying to circumvent motion detectors). They finally found out it was 1064 which is emitted from the body. 1064 is also emitted during injury and some believe putting that wavelength of energy back in helps the body to heal.

I also think that the depth of penetration of 1064 compared to 810 gives it an advantage in this area.

[Robert Gregg DDS]

Ron,

I’ve been out of action on all the forums for quite a while. Sorry Very busy with stuff, SLC, BootCamp, Day 4 and Day 5 in the last two weeks, and my rare travels to lecture in Vancouver, which was a blast to be with Glenn. I developed a brand new presentation on the history of lasers in perio.

Anyway, great, GREAT stuff! Fantastic service to your patient!

Yes, the peak emmission (on a bell graph) of the human body’s IR range of wavelengths in 1064nm. That is the wavelength the IR camera companies use in their night vison cameras (along with some others). One of our patients who works in that technology shared that with us a few years ago. When we tried to independently confirm that, we got some odd looks and the silent treatment. Not the least was a cryptic question, “why do you need to know this?”

First, I congratulate you for trying to implement this for your patients.

Second, thanks for posting your Joules per treatment.

Third, you are brilliant to apply the energy to the “hot spots” on the chin! That is a perfect deduction. I would not, and have not ever done that. Del says he has, but he never tells me anything! Grin;-)

Fourth, you are correct to allow some time for the effects to take place–one or two weeks.

A couple sugggestions:

1. From some experience and now reports from many like yourself, you can use more Joules per treatment–10,000 J which take about 25 minutes. Split the areas up as you did. The healing is in direct relation to the total energy delivered or fluence.

2. If you bump up the average power (AP), you can back away and cover more surface area. In the mouth near the surgery and extraction site, your setting sounds right.

3. Also remember to irradiate under and behind the angle of the jaw (externally). More AP is usually beneficial more efficient.

Thanks for sharing this case on the two forums

Best,

Bob

[Robert Gregg DDS]

Oops,

Forgot to mention the hypothesis why the chin irradiation makes sense–neuronal transmission of the effects of 20Hz, which has been reported as essential in cell-to-cell comunication and biostim/LLLT/HLLT.

“Of course, that makes sense”, I said after I wondered why that would have any effect on the chin site distant from the actual injury.

The “hot spots” tell us that there is nerve conduction back to the area of the injury. Therefore, there is cell axon activity in the form of polarizing the nerve and ion tansport through the axon–directly to the area of inflammation.

It really tells us that there is cell-to-cell communication in the numb areas going back to the area of injury.

“You just can’t see this stuff enough!”

Bob

[mkatz]

With respect to the effect of laser energy application on paresthesias, Do you (anyone reading this) have any experience/information about non:”dental” use? I have a physician friend who has suffered a radial nerve injury during the course of a bypass-graft procedure, presumably as a result of prolonged tissue compression occuring during anesthesia.

[Robert Gregg DDS]

Yes.

[kellyjblodgettdmd]

Bob – how succinct  :biggrin:

(You know I’m dying to hear more)

Kelly

[Robert Gregg DDS]

Kelly,

It require one to drop their drawers………;)

[kellyjblodgettdmd]

Bob- – you’re terrible!

[BNelson]

Ron and Bob,
I am treating a 60+ woman for a very similar dysesthesia. 11yrs duration after a number of implants were placed in mandible. Dr said he damaged the IAN while placing the one in the mand left first molar region. Patient has had no feeling from second bi area to center of chin and gets a severe “electric shock” when touching the gingiva in the bi area. I have treated her 6 times now, 7000-8500j per. The “shocks” stopped after teh first tx and she has an approx 8mm wide area distal to the midline that extends up to the lip and toward the corner of her mouth that still feel numb. She can now put lipstick on and drink normally and is unbelievably happy. I have been treating the entire length of the IAN with additional time on the hot spots near her chin.

So all, it does seem to work in some unbelievable situations.

[Anonymous]

Bruce, that’s awesome!

Are you done treating or will you continue? I stopped when we no longer made any more improvement.

[czeqm8]

Are you charging the patient or is it just good will? If you charge, what ins. codes do you use? It is definitely worth a charge. This a tremendous service to a patient that has suffered for a long time. Congratulations on your success!
Matt Brink

[jetsfan]

MY turn to chime in.
I am treating a 20+ yr old female who developed a parasthesia to lingual nerve on her right side following 3rd molar extraction 2 years ago.
She has no sensation on the dorsum, lateral or ventral surface of tongue. Additionally she says that her lingual gingiva is without feeling.
Using a sharp explorer I determined she was in fact unable to feel pain.
I explained to her what some here have been doing and
told her that I might be able to help her. She of course was willing to try anything.
Using the Lasersmile handpiece, set at 10 W I administered LLLT for 2 min on the dorsum, 2 on lateral surface and 2 on the lingual gingiva. I had patient return 2 days later. She said she definitely started to feel a sensation on the lingual gingiva. I repeated the process and again 2 days later.
She returned today and I repeated process again then I checked all affected areas with a sharp explorer. On all previous numb areas she was able to feel the pin(not the pressure but the sharp pricking). Needless to say she is very happy. I will continue one more visit this week then skip a week and reevaluate.
Any suggestions?

Robert

[Robert Gregg DDS]

Just keep it up until she is no longer numb. Tongues are harder to treat, but do respond in my experience.

Don’t forget to lase the area of the nerve location that was likely injusred and therefore inflamed.

Best of success.

Bob

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