BLACK HAIRY TONGUE TREATED BY PHOTODYNAMIC THERAPY

Aim: Black Hairy Tongue is a benign condition, that affects the dorsum of the tongue and presents with yellow-brown coloration and hypertrophy of the filiform papillae. It has a multifactorial etiology and there are predisposing factors such as tobacco intake, alcohol, dark drinks and systemic diseases. A bacterial cause could also be involved in the etiology, so research is moving towards finding solutions without side effects that lower the bacterial load in these conditions. Photodynamic therapy (PDT) is also one of these options. It is a form of phototherapy that uses non-toxic light-sensitive compounds; these, once exposed to the same light source in a selective way, become toxic towards particular cell types. The action mechanism is based on the use of a light source of particular wavelength which can be coherent (laser) or not (LED lamps); a dye (photosensitizer) and the concomitant presence of oxygen. The combination of these elements determines the transformation of the oxygen atoms into oxygen free radicals which have a cytotoxic effect on bacteria and other microorganisms. The aim of this work is to document two cases of BHT successfully treated with a particular type of Photo Dynamic Therapy. Materials and methods: In case 1, a 46-year-old cardiopathic patient with BHT is treated, who was unable to perform a mechanical brushing due to the high risk of suffering from bacterial endocarditis. To overcome this problem, PDT was chosen as treatment with the use of a diode light (LED) with a wavelength of 460 nm and 7 Watt of power (Flashmax, CMS Dental, Copenhagen, Denmark) and a photosensitizer based on curcumin and 3% hydrogen peroxide. First, the photosensitizing gel was applied to the portion of the tongue affected by BHT and then the LED light was delivered for 60 seconds at a distance of one centimeter from the tongue. Subsequently, the gel residues were removed with a vacuum cleaner. In case 2, a 33-year-old patient with a history of treated oral HPV, transient genital infections treated with different drug therapy. She developed BHT with severe itching in the area; treatment with photodynamic therapy was performed in the same way as previously described. Results: In case 1 a complete regression of BHT was found at the follow-up occurred after the treatment, while in case 2, one week after the therapy, the affected mucosa appeared almost completely healed. Conclusion: currently, in the literature, no protocol cases of BHT treated with Photo Dynamic Therapy have been documented and there is no definitive treatment for this condition. The aids that are used (antibiotics, mechanical brushing, mouthwashes, etc.) can lead to a systemic side effect, therefore we have opted for the use of PDT. Specifically, it has been shown that the wavelength used is effective against periodontal pathogens (T. forsythia and P. gingivalis) and especially if associated with hydrogen peroxide, it has demonstrated a bacteriostatic effect. Further studies will be needed to confirm this starting result