Efeitos do laser de baixa potência na síndrome de ardência bucal: revisão sistemática
Data
2021-08
Autores
Okuhara, Monica Reiko 
Orientadores
Macedo, Cristiane Rufino de
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Avaliar a efetividade e segurança do laser de baixa potência na síndrome de ardência bucal comparado a placebo, não laser, clonazepam e ácido alfa-lipólico. Métodos: Revisão sistemática de ensaios clínicos randomizados. As bases de dados MEDLINE, CENTRAL, LILACS, EMBASE e as bases de registros de ensaios clínicos ClincalTrial.org e WHO-ICTRP, foram utilizadas para recuperar os ensaios publicados até setembro de 2020, que atenderam os critérios de inclusão, além de busca manual de revistas, livros e resumos de conferências relacionados ao tema proposto. Não houve restrição ao idioma e à data de publicação das citações recuperadas. Os desfechos incluíram alívio de dor, mudança na qualidade de vida da saúde bucal, efeitos adversos, mudança na qualidade de vida em relação à ansiedade e depressão. Dois autores, independentes selecionaram os estudos, e avaliaram os riscos de vieses dos ensaios clínicos de acordo com as ferramentas da colaboração Cochrane. A metanálise de efeito randômico foi utilizada para calcular o risco relativo e 95% de intervalo de confiança dos desfechos. Heterogeneidade foi estimada pelo I² e investigada pela análise de subgrupos. Foi utilizado o software Review Manager 5.3 para realizar os cálculos. Resultados: Foram localizadas 389 referências, incluídos 13 estudos, num total de 515 participantes, 7 foram avaliados qualitativamente, e 6 foram agrupados para metanálise de dados de acordo com o tipo de laser utilizado, vermelho ou infravermelho. Foram avaliadas as seguintes comparações: laser versus placebo, laser versus clonazepam e laser versus ácido alfa-lipólico. A dor foi menor de maneira significativa com o uso de laser vermelho versus placebo com diferença de média ponderada (DMP) de -1,18; 95% IC [-2,16 a -0,19]; I²= 61%; N =58; 2 ECRs com baixa qualidade da evidência. Da mesma forma, para a mesma comparação foi melhor para o desfecho qualidade de vida de saúde oral com DMP=-1,08; 95%IC [-1,49 a -0,66]; I²= 0%; N=105; 2 ECRs, a qualidade dessa evidência é baixa. Da mesma forma, a dor também foi menor para o grupo que usou laser infravermelho DMP= -0,46; 95% IC [-1,94 a 1,03]; I²= 90%; N=87; 3 ECRs comparado ao placebo mas sem diferenças significativas. Para a mesma comparação a qualidade de vida da saúde oral foi melhor para o grupo laser e também sem diferenças significativas com DMP= -0,46; 95%IC [-1,70 a 0.78]; I²= 86%; N=87; 3 ECRs. Com qualidade de evidência muito baixa em todos os desfechos, a comparação laser infravermelho versus placebo, também não apresentou diferenças significativas para ansiedade com diferença de média (DM) de 0,11; 95%IC [-2,64 a 2,86]; N=28; 1 ECR e depressão com DM= -0.66; 95%IC [- 3,56 a 3,44]; N=28; 1 ECR entre os grupos. Para a comparação laser versus clonazepam, com qualidade de evidência muito baixa houve melhora a favor do laser nos seguintes desfechos: dor com DM= -0,01; 95%IC [-2,42 a 2,40]; I²= 0%; N=33; 1 ECR; qualidade de vida com DM= -19,65; 95%IC [-45,97 a 6,67]; N=33; 1 EC; ansiedade e depressão com DM= 1,05; 95%IC [-2,83 a 4,93]; N=33; 1 ECR. Conclusão: A dor foi menos comum quando utilizado o laser de baixa potência comparado ao placebo e clonazepam. No entanto a qualidade da saúde oral foi melhor apenas quando o laser foi comparado ao clonazepam. As evidências obtidas são de qualidade baixa e muito baixa, isto significa que o verdadeiro efeito pode apresentar substancialmente diferente da estimativa de efeito. Novos ECR bem conduzidos são necessários a fim de aumentar o grau de certeza da evidência obtida.
Objective: To evaluate the effectiveness and safety of low-power laser in burning mouth syndrome compared to placebo, non-laser, clonazepam and alpha-lipolic acid. Methods: Systematic review of randomized controlled trials. The databases MEDLINE, CENTRAL, LILACS, EMBASE and the clinical trial registry databases ClincalTrial.org and WHO-ICTRP, were used to retrieve the trials published until September 2020, which met the inclusion criteria, in addition to manual search magazines, books and conference abstracts related to the proposed theme. There was no restriction on the language and on the publication date of the retrieved citations. Outcomes included pain relief, change in oral health quality of life, adverse effects, change in quality of life in relation to anxiety and depression. Two independent authors selected the studies and assessed the risks of clinical trial bias according to the Cochrane collaboration tools. The random effect meta-analysis was used to calculate the relative risk and 95% confidence interval for the outcomes. Heterogeneity was estimated by the I² and investigated by the analysis of subgroups. Review Manager 5.3 software was used to perform the calculations. Results: 389 references were found, including 13 studies, in a total of 515 participants, 7 were evaluated qualitatively, and 6 were grouped for meta-analysis of data according to the type of laser used, red or infrared. The following comparisons were evaluated: laser versus placebo, laser versus clonazepam and laser versus alpha-lipolic acid. The pain was significantly less with the use of a red laser versus placebo with a weighted average difference (DMP) of -1.18; 95% CI [-2.16 to -0.19]; I² = 61%; N = 58; 2 RCTs with low quality of evidence. Likewise, for the same comparison, oral health quality of life was better PMD = -1.08 95% CI [-1.49 to -0.66 ]; I² = 0%; N = 105; 2 RCTs, the quality of this evidence is low. Likewise, the pain was also lower for the group that used infrared laser DMP = -0.46; 95% CI [-1.94 to 1.03]; I² = 90%; N = 87; 3 RCTs compared to placebo but without significant differences. For the same comparison oral health quality of life was better for the laser group but also without significant differences DMP = -0.46; 95% CI [-1.70 to 0.78]; I² = 86%; N = 87; 3 RCTs. With very low quality of evidence in all outcomes, the comparison of infrared laser versus placebo also did not show significant differences for anxiety with a mean difference (DM) of 0.11; 95% CI [-2.64 to 2.86]; N = 28; 1RCT) and depression DM = -0.66; 95% CI [-3.56 to 3.44]; N = 28; 1 RCT between groups. For the laser versus clonazepam comparison, with very low quality of evidence, there was an improvement in favor of the laser in the following outcomes: pain DM = -0.01; 95% CI [-2.42 to 2.40]; I² = 0%; N = 33; 1 ECR); quality of life (DM = -19.65; 95% CI [-45.97 to 6.67]; N = 33; 1 EC); anxiety and depression (DM = 1.05; 95% CI [-2.83 to 4.93]; N = 33; 1 RCT. Conclusion: Pain was less common when using low power laser compared to placebo and clonazepam. However, the quality of oral health was better only when the laser was compared to clonazepam. The evidence obtained is of low and very low quality, this means that the real effect may differ substantially from the effect estimate. New well-conducted RCTs are needed in order to increase the degree of certainty of the evidence obtained.
Objective: To evaluate the effectiveness and safety of low-power laser in burning mouth syndrome compared to placebo, non-laser, clonazepam and alpha-lipolic acid. Methods: Systematic review of randomized controlled trials. The databases MEDLINE, CENTRAL, LILACS, EMBASE and the clinical trial registry databases ClincalTrial.org and WHO-ICTRP, were used to retrieve the trials published until September 2020, which met the inclusion criteria, in addition to manual search magazines, books and conference abstracts related to the proposed theme. There was no restriction on the language and on the publication date of the retrieved citations. Outcomes included pain relief, change in oral health quality of life, adverse effects, change in quality of life in relation to anxiety and depression. Two independent authors selected the studies and assessed the risks of clinical trial bias according to the Cochrane collaboration tools. The random effect meta-analysis was used to calculate the relative risk and 95% confidence interval for the outcomes. Heterogeneity was estimated by the I² and investigated by the analysis of subgroups. Review Manager 5.3 software was used to perform the calculations. Results: 389 references were found, including 13 studies, in a total of 515 participants, 7 were evaluated qualitatively, and 6 were grouped for meta-analysis of data according to the type of laser used, red or infrared. The following comparisons were evaluated: laser versus placebo, laser versus clonazepam and laser versus alpha-lipolic acid. The pain was significantly less with the use of a red laser versus placebo with a weighted average difference (DMP) of -1.18; 95% CI [-2.16 to -0.19]; I² = 61%; N = 58; 2 RCTs with low quality of evidence. Likewise, for the same comparison, oral health quality of life was better PMD = -1.08 95% CI [-1.49 to -0.66 ]; I² = 0%; N = 105; 2 RCTs, the quality of this evidence is low. Likewise, the pain was also lower for the group that used infrared laser DMP = -0.46; 95% CI [-1.94 to 1.03]; I² = 90%; N = 87; 3 RCTs compared to placebo but without significant differences. For the same comparison oral health quality of life was better for the laser group but also without significant differences DMP = -0.46; 95% CI [-1.70 to 0.78]; I² = 86%; N = 87; 3 RCTs. With very low quality of evidence in all outcomes, the comparison of infrared laser versus placebo also did not show significant differences for anxiety with a mean difference (DM) of 0.11; 95% CI [-2.64 to 2.86]; N = 28; 1RCT) and depression DM = -0.66; 95% CI [-3.56 to 3.44]; N = 28; 1 RCT between groups. For the laser versus clonazepam comparison, with very low quality of evidence, there was an improvement in favor of the laser in the following outcomes: pain DM = -0.01; 95% CI [-2.42 to 2.40]; I² = 0%; N = 33; 1 ECR); quality of life (DM = -19.65; 95% CI [-45.97 to 6.67]; N = 33; 1 EC); anxiety and depression (DM = 1.05; 95% CI [-2.83 to 4.93]; N = 33; 1 RCT. Conclusion: Pain was less common when using low power laser compared to placebo and clonazepam. However, the quality of oral health was better only when the laser was compared to clonazepam. The evidence obtained is of low and very low quality, this means that the real effect may differ substantially from the effect estimate. New well-conducted RCTs are needed in order to increase the degree of certainty of the evidence obtained.
Descrição
Citação
OKUHARA, M.R. Efeitos do laser de baixa potência na síndrome de ardência bucal: revisão sistemática. São Paulo, 2021. 186 f. Dissertação (Mestrado em Saúde Baseada em Evidências) - Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). São Paulo, 2021.