Particular photo-therapy with hydrogen peroxide for the treatment of Hairy Tongue: a case report
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1
Private practice, Italy
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2
San Raffaele Hospital (IRCCS), Departement of Dentistry, Italy
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3
University of Milan, Departement of Radiology, Italy
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4
Private practice, Italy
Aim. Black hairy tongue (BHT) is a benign condition characterized by a discolored, hairy appearance of the dorsal tongue. The prevalence of BHT is highly variable among different and dependent on many factors; however, studies have shown that the prevalence may be as high as 11.3% in some populations. BHT is more common in men, elderly patients, smokers, HIV-positive, edentulous patients, and patients with cancer. On a clinical evaluation it appears as a dark film on the tongue, but different colours are reported such as yellow, green, white, anterior to the circumvallate papillae. The lesion does not involve the lateral and the tip site of the tongue, and it reveals hypertrophy and lengthening of the filiform papilla. BHT is a benign, self-limiting condition,often asymptomatic, but sometimes halitosis, tingling or burning sensation were reported. In the literature for its therapy it was been proposed avoiding associated medications, practicing good oral hygiene, discontinuing habits predisposing to BHT, and gentle brushing or scraping of the tongue. Second-line treatments are oral retinoids, antifungals, antibiotics, trichloroacetic acid, topical urea solution, topical triamcinolone acetonide, vitamin B complex, gentian violet, salicylic acid, and thymol. The use of lights in the treatment of this condition is not described in the literature. Association of hydrogen peroxide and diode laser and LED light for the management of periodontal disease is documented. Periodontal bacteria were found in the tongue with BHT. The aim of this study is to report a case of BHT successfully treated with a 460 nm LED light in combination with hydrogen peroxide.
Materials and Methods. A 60 years old female patient with a history of mild hypertension went to the private practice for tingling sensation of the tongue, present from about 3 months. There was a discolored hairy appareance of the tongue and a diagnosis of hairy tongue was made. The patient declared to have performed cleaning of the tongue during this period, without improvement. We decided to treat the condition reducing the bacterial load with application of hydrogen peroxide solution at 3% 12 volumes activated with a 460 nm LED light, with a power of 4 W (FlashMax, CMS Dental, Copenhagen, Denmark). The hydrogen peroxide was applied rubbing a cotton pellet soaked in hydrogen peroxide on the dorsal surface and 15 applications of 3 seconds with the LED light were performed, in the left side of the tongue (that was the symptomatic side). After the hydrogen peroxide was removed with a vacuum cleaner.
Results. One week later there was an important clinical improvement and the patient was asymptomatic. We treated the right side of the tongue with the same protocol, and after another week the patient healed.
Discussion. Previous studies have indicated that the use of hydrogen peroxide associated with Photodynamic Therapy (PDT) gives increased killing of microorganisms, such as S. Mutans, and periodontal bacteria. The results of a study conducted by Feuerstein et al. indicated a synergistic antibacterial effect of noncoherent blue light, often used in restorative dentistry, and hydrogen peroxide (H2O2) on S. mutans under planktonic conditions. The results of this study also suggested a potential bactericidal mechanism in which the synergistic effect on bacterial vitality is the result of the generation of the highly reactive hydroxyl radical. The results of an Iranian study suggested that visible blue light in the presence of hydrogen peroxide would be consider as a potential approach of PDT to kill the main gram negative periodontal pathogens. We proposed a new type of non invasive treatment for this frequent oral disease that could be effective in the management of refractory BHT, without adverse events.
References
1. Gurvits GE, Tan A. Black hairy tongue syndrome. World J Gastroenterol. 2014;20(31):10845–50.
2. Feuerstein O, Moreinos D, Steinberg D. Synergic antibacterial effect between visible light and hydrogen peroxide on Streptococcus mutans. J Antimicrob Chemother 2006;57(5): 872-876.
3. McCullagh C, Robertson PKJ. Photo-dynamic biocidal action of methylene blue and hydrogen peroxide on the cyanobacterium Synechococcus leopoliensis under visible light irradiation. J Photochem Photobiol 2006;83(1):63-68.
Keywords:
Hairy tongue,
Photodynamic therapy,
Treatment for hairy tongue,
Hydrogen peroxide.,
case report
Conference:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.
Presentation Type:
Poster Presentation
Topic:
Oral Diseases
Citation:
Nosotti
M,
Botta
R,
Viganò
L and
Casu
C
(2019). Particular photo-therapy with hydrogen peroxide for the treatment of Hairy Tongue: a case report.
Front. Physiol.
Conference Abstract:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine..
doi: 10.3389/conf.fphys.2019.27.00064
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Received:
05 Nov 2018;
Published Online:
09 Dec 2019.
*
Correspondence:
Dr. Maria Giulia Nosotti, Private practice, Piacenza, Italy, mg.nosotti@gmail.com