Is antimicrobial photodynamic therapy a useful therapeutic protocol for oral decontamination? A systematic review and meta-analysis.

BACKGROUND The aim of the present systematic review and meta-analysis was to assess the efficacy of antimicrobial photodynamic therapy (aPDT) as a therapeutic protocol for oral decontamination. METHODS In order to address the focused question: Is aPDT a useful therapeutic protocol for oral decontamination?, an electronic search without time or language restrictions was conducted up to July 2017 in indexed databases using the combination of different key words including photochemotherapy, lasers, photodynamic therapy, disinfection, mouth, saliva and oral. The exclusion criteria included reviews, case-reports, case-series, commentaries, letters to the editor, interviews, and updates. Four randomized control trials were included and processed for data extraction. RESULTS All studies reported that aPDT was effective in reducing the overall oral microbial load in saliva. Considering the effects of aPDT+photosensitizer (PS) compared with PS alone, there was no heterogeneity noticed for aPDT+PS (Q value=0.15, P=0.69, I2=0%). The overall mean difference for bacterial count in CFU/ml between aPDT+PS and PS alone was also not significant (weighted mean difference=-0.41, 95% CI=-1.12 to 0.29, p=0.24) at follow-up. CONCLUSION The efficacy of aPDT for oral decontamination remains unclear. Further well-designed randomized clinical trials assessing the efficacy of aPDT reducing the oral microbial load are need.