[Case Study] Low-Level Laser and Its Interface With Sleep Dentistry: Clinical Case Report

Introduction: This study aimed to evaluate and raise the therapeutic hypothesis of the use of low-level laser as a complementary therapy in patients with sleep disorder (SD) in a broad approach involving other pathologies superimposed on this pathology. Methods: This is a clinical case report of a patient with Parkinson's disease (PD) complaining of sleep disorder. The proposed treatment is the use of photobiomodulation (FB) with intraoral application using an innovative dosimetry. SD was assessed using an adapted analogue scale. Results: In the evaluation performed after the last session, there was an improvement in the sleep disorder compared to the pre-treatment evaluation. However, one month after the end of the treatment, it was observed that the quality of sleep remained practically the same. Conclusion: We can conclude that low-potency FB can be a modulator in the production of neurotransmitter substances in a local and systemic way, being a complementary or alternative treatment for patients with sleep disorder (SD).


Introduction
Photobiomodulation (PB) has been used in modern medicine for the treatment of chronic diseases, emerging as an innovative therapy considered complementary or alternative.There are several reports of the use of photobiomodulation in the literature for the treatment of pathologies of neural origin since the last century.The knowledge in photobiomodulation therapies has increased with great scientific evidence and our outpatient clinical experience has indicated that this therapy can bring benefits to the treatment of sleep disorders (SD).PB alone has neural effects with anti-algic effects proven in the literature and our recent research has shown that it is also effective for inducing sleep.PB can also be combined with medications and food supplements, producing synergistic effects to these therapeutic substances, sometimes reducing the dosimetry of these substances, and reducing the adverse effects of these substances on the patient.
We have observed daily and noticed an increase in anxiety in the general population, having as one of the main effects of this disorder the origin of sleep disorder.ften, the dental professional together with medical professionals makes a careful evaluation through Malan Pah index, polysomnography, among other tests to better diagnose the sleep disorder.In this evaluation of this patient with Parkinson's disease with application through the oral cavity of photobiomodulation, we raised the hypothesis of production of neurotransmitters that may benefit the induction of sleep in these patients with SD.
This leads to a greater amount of oxygen to the lungs which will also improve the delivery of oxygen to the brain preventing micro awakenings that cause an increase in the heart rate, promoting long-term cardiovascular disorders in this patient.This clinical condition can lead to death.In addition, DS also decreases your quality of life due to the sleepiness you have during the day due to not having restorative sleep.We suggest, through this clinical case report, the possibility of a complementary therapy, applying photobiomodulation, [10][11] along with other known therapies to improve the quality of life of patients with sleep disorders.

Case Report
Patient R.O.M, 57 years old, female, received at Ambulatory from the Santa Casa de Misericordia de São Carlos in improvements self-reported by the patient were noted.The photobiomodulation treatment was carried out with the iLi2 Infrared Laser DUO MM Optics (São Carlos -SP, Brazil) for 20 minutes inside the oral cavity, which is why we call it intraoral application.Figure 2 shows the exact transpalatal location where the laser spot was applied.The iLi2 Infrared DUO MMO Laser has 150 mW of power and was applied to the intraoral cavity with an infrared wavelength (808 nm) for 20 minutes, delivering a total energy of 180 J per session.The laser beam area was 0,03 cm².
The fluence was 6.000 J/cm2 and irradiance was 5 W/cm2.The treatment protocol consisted of 2 weekly sessions performed for 3 months (33 sessions).
This case report is part of a research project approved by the Ethics Committee of Santa Casa de Misericordia de São Carlos with CAAE: 66448722.2.1001.8148across nº 6.005.480.

Results and Discussion
Before treatment, an adapted assessment for DS was carried out based on a visual analogue scale (VAS), where the PD is a neurodegenerative, progressive, multifactorial and multisystemic disease, characterized by the reduction of dopaminergic neurons. Furthermore, one of the most prevalent non-motor symptoms are sleep disorders, whose etiology is associated with circadian dysregulation, and which have been associated with the rapid deterioration of postural control, impairments in manual dexterity and gait. [16][17]ere is still no treatment capable of reversing the neuronal degeneration resulting from Parkinson's.Existing treatments make it possible to improve or control motor and non-motor symptoms, through pharmacological, non-pharmacological, surgical, and alternative treatments. [15] this context, photobiomodulation has been associated with neuroprotective effects through anti-inflammatory and antioxidant actions.In this context, previous studies have demonstrated that photobiomodulation promotes improvements in sleep duration, efficiency and general sleep quality. [18][19] should be noted that when we apply photobiomodulation for several minutes to oncological patients or those with a previous history of oncological pathologies, the application time must be reduced as much as possible.The literature shows that a systemic effect can occur on the patient through this therapy due to the shutdown of nitrous oxide in the blood circulation, which increases blood supply to tissues and can worsen the cancerous manifestation in organs compromised by this pathology. [20]erefore, the clinical results observed in the present case report corroborate previous studies that postulate the clinical effects of photobiomodulation on sleep disorders.Given these findings, we intend to better evaluate new patients using the Epworth index, widely used for research into DS and because it is an assessment that is easy to complete in responses by patients with different levels of educational learning.However, controlled, and randomized clinical studies must be carried out to strengthen the evidence observed in this case report.

Conclusion
In the present case report, the patient reported improvement in sleep disorders related to Parkinson's disease after the proposed photobiomodulation treatment.

Figure 2 .
Figure 2. Shows an adapted (Medical Illustration Copyright © 2020 Nucleus Medical Media.All rights reserved.)drawing of the exact transpalatal location where the laser spot was applied.
Qeios, CC-BY 4.0 • Article, March 26, 2024 Qeios ID: S6F5JD.2 • https://doi.org/10.32388/S6F5JD.2 4/8 patient assigned a score of 4, where 10 (ten) corresponds to normal sleep and a score of 0 (zero) corresponding to the bad situation relative to normal sleep.Throughout each session, researchers recorded the patient's spontaneous reports of perceived improvements in tremor and muscle stiffness.After the last session, the patient obtained a score of 8 on the adapted visual analogue scale (VAS), which corresponds to better quality of sleep.One month after treatment, the sleep disorder was reassessed and the score given was 9, indicating continued improvement in sleep quality.