One of the most frustrating (and common) problems patients have are apthous ulcers. Patients asked, “what can be done to get relief?” and my general response was, “wait it out for 2-3 weeks or put orabase on it.”
We don’t really know what causes these types of ulcers, but it is thought that Epstein Barr virus may play a role. Generally, trauma to the tissue or stress initiates an inflammatory reaction that causes the tissue to ulcerate. This inflammatory process is taking place at the border/periphery of the ulcer. Lasers help to stimulate healing and angiogenesis which results in getting relief within minutes instead of weeks.
With Solea, I am able to treat this condition in about 20 seconds.
The patient is a 53 year old female that presented in hygiene with pain on her lower left lip. She is on no meds and has no systemic disease. She states that she gets ulcers like these in different places in her mouth every few months and they take “forever” to go away.
Technique using Solea
I dried the tissue with a gauze and applied a compounded topical anesthetic for 3 minutes directly on the ulcer. The procedure was performed using the low power mode setting which allows me to turn the mist to 0. The spot size was set at 1.0 mm and the power to 10%. I began at full power (10%) at approximately 4 cm away from the target tissue. I traced the border of the ulcer a few times while gradually decreasing my distance to approximately 2-2.5 cm away.
With most soft tissue procedures, I start far away and drift closer until I notice the effect that I want to see. I am looking for the tissue to turn white. This indicates that my power setting and distance are good. For ulcer treatments, I am stimulating and ablating the top few cell layers. I trace the border of ulcer (no need to go into the middle) until there is a solid white ring around the lesion.
The key is to keep the laser moving quickly and to not linger in one spot for too long. Circle a small 5 mm lesion once every 2 seconds. Lingering will cause you to char the tissue, turning it brown or black and possibly causing discomfort due to the heat being generated. Remember there is no mist to keep the tissue cool. Also running the laser at too much power or too close of a distance will cause the tissue to char. I am using a contrangle in this case, but a straight handpiece works very well in these situations.
Solea allows me to do simple procedures that make a HUGE difference in my patients’ lives. This patient felt no pain and instant relief. I called her the next day and she said the ulcer had not hurt since we treated her. In fact, within 2 days it was completely gone. I consider this a great add-on procedure and is done in hygiene at their recare visits – without having to move the patient and dirty another room.