Cure Pain and Improve Wound Healing using Light! Introducing Photobiomodulation in Dentistry – PDP234

Teaser:
People used to use a point and shoot approach. They just switch on the light pointed at the patient and hope that they get better. And hope is not a scientific strategy. So-

In a 30-second soundbite, are you able to just describe the actual molecular mechanism or the physiology of how it actually gets the results it does? So our current understanding of photo biomodulation mechanisms is- 

Jaz’s Introduction:
Did you know there’s something called PBM, which stands for photo biomodulation and I know what most of you’re thinking. Photo what? Listen, I was as confused as you are and I thought, what is this mumbo-jumbo voodoo science? But then I found out that photo biomodulation or light therapy is already the standard of care when it comes to cancer patients undergoing chemotherapy. And then it reminded me of my physio who uses red light therapy for pain.

And today’s guest, professor Praveen Arany, who does a wonderful job on educating us on this treatment modality explains about the mechanisms in wound healing. So, dear Protruserati, I’m Jaz Gulati and welcome back to your favorite dental podcast. I’m so excited to share this episode with you today for so many reasons.

Number one, a lot of the guests I have on, we talk about restorative dentistry or occlusion, things that I really have an interest in and I know a fair amount about. But then this episode, I came in with nothing. I purposely didn’t do any research ’cause I wanted that magic and the aha moments to be alive.

And I enjoyed this. I enjoyed learning about PBM very much, and I know you will too. Number two is our guest has no financial interest at all. He is a pure academic for the love of it, for the love of research. I even asked him to recommend specific PBM units ’cause trust me, by the end of this episode, you want to know.

And he directed me to like guidelines. And scientific websites, which I absolutely love. So I think you really enjoy this, what I feel is really unbiased and it focused on an emerging technology, which I’m so excited to unpack today with you.

So on Protrusive guidance, our community group. I asked a question a few weeks ago, do you know anything about or actively use photo biomodulation in practice? Okay. And 74% of us were like, what? What is that? We have no idea. 7%, just 7% use PBM. And only 18% have actually heard about PBM and its use in wound healing and in dentistry. And you know, interestingly, one of our members, Lindsay, she said there’s a lot of research being done on PBM at the moment, which you’ll see today.

And then she wrote something fascinating, which is also something that was DMed to me on Instagram when I talked about this on the story, is how it can help you in pain. So for example, with Lindsay’s case, it cured her ruptured vertebral disc symptoms we’re using her laser, and she managed to avoid spinal surgery.

And there’s also some great insight from our resident implant geek Doctor Pav Khaira, like research on PBM to reduce the risk of Alzheimer’s and Dementia. But why I can promise you in today’s episode is that we’re gonna make it very relevant for dentistry. You’ll learn about how PBM works and what indication should it be considered, and what are the protocols and what does the future hold.

Dental Pearl:
Now, before we unpack this topic, I’m gonna give you a Protrusive Dental Pearl. If you’re new to the podcast, welcome, it’s a good one to join. And every PDP episode I give you a tip, a pearl, a hack. Something you can use, you use straightaway. A lot of times’ clinical. Sometimes it’s mindset and nonclinical.

Today’s is very clinical. So Dr. Jack, as he likes to be known on Instagram, DM me this pearl. He noticed that sometimes I mentioned on these episodes that, ah, I’m struggling to find a pearl for today. And so he rescued me. He said, listen, SHEEP, he said, SHEEP, remember the acronym SHEEP? When you want to find out the prognosis of a tooth, you can use SHEEP.

And so let’s talk about this for a few minutes. From his DM, I was a little bit confused about its application. Then I saw Googled it and I found out that actually it’s a legit thing. And there’s an open access paper and the primary dental journal co-authored by the legend, that is Martin Kelleher, which reminds me I need to invite him to podcast, absolute hero, in UK Dentistry.

He’s the guy who wrote the famous article like porcelain pornography and that kind of stuff. And he also famously wrote about the daughter test when we’re considering doing veneers, for example. Anyway, back on topic, SHEEP scoring, a practical tool. So I’ll make this paper available to everyone. But essentially a practical tool for evaluating the prognosis and restorability of compromised teeth.

SHEEP stands for Structure, History, Endodontic, Expertise, and Periodontal. So the way it works is that you look at that tooth in question, let’s say, is a heavily restored lower molar, and we want to inform the prognosis of, let’s say, saving this tooth or keeping this tooth long term. You can now apply SHEEP.

So S stands for Structure and for this particular scenario, because it’s heavily restored, let’s say we give the S a 3 out of 10. So for example, if it’s really low amount of structure, you give it a like a one. If it’s a really good amount of structure, like a virgin tooth, you give it a 10. So we give a heavily filled molar, for example, a three.

The next one is H, which stands for History. So what the paper talks about is, is this the first time this problem has come, like a freak accident, or is it a recurring problem? So for example, if someone is a high caries risk, and like every six months they come with a high, they come with a new caries lesion, and now this tooth has been affected by caries, then you are gonna give it a low rating for history because this patient is a high caries risk patient and history is not on your side here.

Also, the medical issues of this patient, like let’s say they have Xerostomia or something, would also count as history. If this is, let’s say a crack tooth and it’s a painful crack tooth, then that would score lower than an asymptomatic crack tooth. So that’s where you can score on the history.

Then for E, you score the Endodontic prognosis. So is this tooth easy or difficult to treat endodontically? And actually what I like about this system is that it says how easy or difficult is it for you, the treating clinician? Because what I respect is that prognosis varies, right? Like the prognosis of an endo with me in my hands might be 80%, whereas with a specialist it might be 95%.

So that’s interesting. I’m glad they touch on it on this paper. So let’s say, that same lower molar, it’s got really simple canals, nice big pulp chamber. You might give that an eight or a nine because the endodontic prognosis is pretty good.

The next E is Expertise. And again, I really like this because it allows us to reflect honestly on your skill, like your individual skill. So when you are applying this E of Expertise, it’s like based on your skill, how much experience and expertise do you have to be able to do this? So for example, I’m going on a course soon to extrude, broken down premolars. I haven’t done many of these yet, so I would score my expertise on this very lowly.

Maybe in a few years I’m gonna increase my score and therefore my expertise for this tricky implant case or tricky endo, or a tricky wear case will hopefully increase. And so your expertise directly informs the prognosis, right? So this is really, really cool.

And the last one is P, which I’m sure you guessed it, is Periodontal. This is fairly easy because like the less bone support you have, the bigger the problem. If you’ve only lost a little bit of bone, let’s say you know, 10, 20%, then you might still give something a 7 out of 10 prognosis. But if you’ve got significant bone loss, then you might give that like a two or a three for the periodontal aspect of that prognosis.

Okay, so what do you do with all those numbers? So let’s say there’s 1, 2, 3, 4, 5, 5 letters in sheep. Each one you score at 10, maximum score is 50. You double it. So if someone scores 10 in each letter, then 50 and you double it, it’s a hundred percent prognosis for this tooth. In our made up example, let’s say we get something like 31, you double that, you get 62%.

It’s like a rule of thumb. It’s a nice way to give a number to it. Sometimes you go by our gut, but I like the idea that now we can go through this logical sequence and give it a percentage, which I think is useful in your consent procedure and also allows you to reflect on that case. So, Jack, thanks so much for bringing that to my attention, and I will make that paper available in the show notes.

The best place to grab all these things is on the Protrusive Guidance app. Wherever you’re looking at this episode, scroll down. The PDF will be there, the link will be there. Team Protrusive, like to look after your geeky side, and we’ll make that available to you. Thanks again, Dr. Jack. Hey, enjoyed this episode on PBM. I’ll catch you in the outro.

Main Episode:
Professor Praveen Arany live in Barcelona. You are right now at the IADR. So, absolute privilege honor that you’re able to make time for this podcast whilst you’re on your travels, and spreading the good word about something that I tell you, I just don’t know anything about. And I refrained from doing a deep dive ’cause I wanted to just hear from you and be a very candid learner today. So Professor Praveen, tell us about yourself. 

[Praveen]
Thank you, Jaz. Thank you for having me. And I’ve heard a lot about this podcast and the popularity, so I hope we can get the word out on this really innovative treatment that has so much promise for healthcare, not just clinical dentistry.

So I guess when I start talks like this or you know, introductions like this, I always point to the fact that I began in this field as a disbeliever. I did not think that you could use light in a therapeutic manner on people. We are not plants. We don’t do photosynthesis. So how can you do light treatments on people?

Although you will notice, and I think all of us are aware that the ancient civilizations were aware of the therapeutic effects of light and specifically sunlight, but there was never a medical or a therapeutic manner in which they could do these treatments. So if you look at the absolute basic fact that the human body does not have a photo sensor, but we can see there is no camera in our eye, right?

So the fact that the human body has evolved to have rhodopsin in your eye, that enables vision, it is not too much of a stretch to imagine that there are other non-visual ways that the body can use light. So if you start with that basic premise that there are certain biological molecules that can interpret light and use light.

Then the extension to using light as a therapeutic agent doesn’t seem so farfetched. So I always like to start with this because I think it gives people some orientation and I remember when I was first introduced to it, I was very skeptical. I’m like, come on. How can people ever- 

[Jaz]
I have to say since we were introduced by email, I was also a little bit like, hey, wait a minute, is this legit? Is this like some woo woo stuff? But then, the source that connected us, he’s so credible. He’s so good. And I saw about your institutional role, professorship. So to tell us more about you as like your journey, your professor in New York? 

[Praveen]
In Buffalo, New York. 

[Jaz]
A little bit about you and how you fell into PBM, being a non-believer initially, and now presenting in Barcelona and talking about it so much. How’d that happen? 

[Praveen]
So, I think, like I said, the story began when I was looking at using light in a therapeutic manner in dentistry and in dentistry- 

[Jaz]
But is this something that was just like assigned to you as like a trainee and you were like, oh, have to do this, or was it like you chased it? Like how did you even fall into that? 

[Praveen]
Right. That itself is the fascinating story that I think began my journey in research. So you don’t hear of many dentists, especially, people who are focused on clinical to be thinking about research and molecules and molecular mechanisms.

So it all began actually when I was doing my residency in oral pathology. I just finished dentistry. And all of us want to do something cool, right? We wanna distinguish ourselves. And so I was reading this book on pathology, and I think we all do in our dental training.

But as a resident, I think you take even more interest right on what you’re reading about. And very interestingly, there was this book chapter on wound healing in pathology. So, most of us have trained on Shafer and Sook Bin-Woo, right? So when you look at the textbook of oral pathology, there is a whole chapter on wound healing.

And intuitively you would think that wounds should be thought in physiology, not in pathology. So why is this chapter in wound healing? And I kept digging into that and I think, oh, that’s pretty cool that you have wound in our textbook of pathology. And interesting enough, if you put a piece of wound tissue under the microscope, it looks exactly like a tumor.

It has the same number of disorganization, vascular inflammatory components that you see in a tumor that you would see in a wound. So I began my research career in a very naive manner. I was looking for a way to improve wound healing. Because people had made parallels between wounds and tumors, and the idea there was if you can control wound healing, then maybe someday we could control tumors at the molecular level.

That’s how I started my journey, and I came across this fascinating paper by Endre Mester in the late sixties that had shown that using low par laser light, they could stimulate wound healing. And again, I told you about my disbelief and my skepticism about that. Interestingly enough, this work has been around for more than 60 years now.

And when you think about what people have noticed in the clinic, you always talk about a clinical human phenotype, right? So people who have actually experienced something in the clinic is telling you something that is real. And that’s why I began my first clinical study looking at extraction wounds, tooth extraction wounds, and I was doing light treatments to see if I can replicate this phenotype, this phenomena that people had noticed.

And surely enough, again, as a dentist, and as a beginner, I wanted to obviously be, look at the lucrative part of that, which is can we put implants faster? Can we do dentures faster? Can we rehabilitate faster? So that was, I’m gonna admit, was part of my motivation. But when I started looking at the molecular aspect of that, I was so fascinated that light could be used in such a therapeutic manner.

[Jaz]
You mentioned the sort of almost comparison, like we are not plants, right? We don’t photosynthesize, I’m just imagining like this study you’re doing and these patients, these poor patients are like staying open while there’s like a, some sort of a light beam on their socket and so how did it actually work and for how long did they have to have this light therapy to actually have clinical effect?

[Praveen]
So I think the best parallel is to think about how we do curing of composites, right? You remember how we, I mean I’m sure we do that actively even now. So you use a blue light, you shine it at the composite that you’re stuck into the prep and then you cure it. Think of it very similar to that.

So it takes between three to seven, maybe less than 15 minutes to actually do that kind of treatment. And most of the treatments are less than five minutes. So in our study we did five minutes of infrared, 810 nanometer light that we were painting the socket with so that when you pull out the teeth, you have a complex, three-dimensional socket, right?

So there’s a soft tissue, there’s heart tissue inside. So we were painting that for five minutes with light, with infrared light, and we were able to show that the healing was significantly improved in the socket that was treated. And we randomized it. So not always the lower jaw, not always the upper jaw. So we randomized that in our- 

[Jaz]
And you had a control group that had no light therapy or placebo light-

[Praveen]
That was the key part. So in that study, we used the patient as their own control. So these are full mouth rehabs that come from multiple extractions. So you assign one randomly to the control, which is non-treated, and the other one you treat.

So one of the key parameters of wound healing, because all of us have different oral habits, nutritional demands, and parafunctional, oral functions. So, it is always appropriate to compare healing within the same person to get a true measure of whether a intervention is helpful. So we use- 

[Jaz]
So kind of like a split mouth? 

[Praveen]
Kind of like a split mouth. But this was upper lower jaws. Yes. So we found- 

[Jaz]
What I’m thinking of now is, what actually did you see that and also what benefit above normal wound healing did you get? So, for example, in the medicinal world, I read somewhere that if you take, if you have a cold and you take zinc supplements on average, you’ll like heal or get better one day sooner than if you didn’t.

And so for them, some people are like, yeah, that’s great. It’s evidence-based. You’ll heal one day sooner. So is your socket less likely to get dry socket? Are you seeing that the wound maturation is like, two days ahead, three days ahead, any conclusions you’re able to draw in terms of what actually it tangibly does?

[Praveen]
That’s a great point, Jaz. So the most important part that we pay attention to is the patient comfort, right? Is there any way we can reduce the chances of infection? Can we reduce the number of swelling and pain that the patient has perceived? Now that’s a little subjective because everyone perceives pain very differently.

What is a little more objective, unless you’re doing research, in the clinical scenario, what is very objective is how many pills are they popping, right? How many painkillers are they popping? And surely enough, if you take a drug history very carefully, you will find, and we found that there was less intake of analgesics.

If you also look for swelling in the area as well as healing scores, you can look at healing in many different ways. And in the end, we ended up doing radiographs to look at the bone healing as well. We found that all these parameters were at least 30% to 60% improved. And again, that range is because all of us heal differently. But in every case that we did, we found that this improvement was consistently better when you did this light treatment compared to no light. 

[Jaz]
Amazing. And are there any, I mean, I know I’m jumping ahead now, but I’m actually getting very excited to hear about this. In terms of side effects and negative stuff, like for example, when we look at MRI versus CBCT, we think, okay, well MRI is great because there’s no radiation, but it’s like the fact that you are in a claustrophobic area, the cost of it is prohibitive.

There are still downsides, but maybe not so many huge risks when it comes to MRI. What are we finding with this kind of therapy that purely, let’s start very small where we are now, I’m sure we’re gonna expand into different uses and indications, but purely to improve someone’s wound healing prior to implant therapy, for example. Are there any risks or has it been studied enough to see there’s any adverse effects? 

[Praveen]
So this is a great question to go to. The highlight of, I think this talk and this treatment, which is in cancer patients who are getting chemo and radiation, especially head and neck cancer, this treatment called photobiomodulation is standard of care.

Which means every patient who’s getting chemo or radiation should be getting this treatment before they get chemoradiation and even transplant. So bone marrow transplants, right? So why should they get this? This is based on a systematic review and meta-analysis by three major scientific global organizations called the Multinational Association of Supportive Care in Cancer, the International Society of Oral Oncology and the World Association of PhotoBiomodulation.

So these guys looked at 35 placebo controlled, multicenter, blinded clinical human clinical trials, and found that this treatment was very effective at reducing pain and incidents of oral mucositis, which is the condition that we all, unfortunately the patient get because of taking chemo and radiation- 

[Jaz]
Pain, ulceration, dryness, right? That kind of stuff. 

[Praveen]
So all of that incidences of the severity and the incidence period can be reduced by this treatment. In this study, what they also did was they looked at the tumor incidents that occurs. And remember, these are head and neck cancer patients. So if you do this treatment, do you at any, is there any possibility that you’re increasing recurrences or secondary tumors?

In fact, they found that because you were doing this treatment, everyone was getting almost the complete dose of the prescribed onco treatment, radiation and chemo. That in itself enabled them to get better clinical outcomes, but none of them actually reported any increase in secondary tumors or recurrences.

So in the human studies, we know that this is very clearly safe and effective. People have done more elegant animal studies where you put tumors into the animals and then give them different doses of light, and have also found that the tumor growth is actually reduced. Now, could this be attributed directly to the light or the effect of light on the host immune response remains to be fully investigated? But the bottom line is there are less tumor burdens in animals that were treated with light. 

[Jaz]
Like with radiation, there’s deterministic and stochastic effects. So for example, if you pump up the radiation, you know that you’re gonna get some local damage to cells, for example.

Or there is like a stochastic, like random, they, it could cause mutations. Sounds like what you’re saying is that with this therapy, it didn’t seem to increase any cancer risk on these patients. But if you like pump up the time spent under this PBM or you pump up the sort of, I don’t know, the dose of light, I dunno what the correct term is. Do you get any like deterministic, local side effects, burns, that kind of stuff? 

[Praveen]
Right. So because this treatment can be done both with lasers and LEDs, this has become a key question whether we should only be promoting one versus the other. And unfortunately we don’t have an answer right now, whether we should be doing one or the other.

We know that both are equally effective, but the lasers, as you can imagine, have a lower dose threshold. So they have a smaller therapeutic window before which they can get cause those thermal injuries that you were referring to. But the LEDs, it’s very subtle, so you don’t actually see burns, but you can neutralize your benefit if you increase the temperature too much.

So, although both of them, if used in the right dose range, do not cause damage, the laser obviously has the potential to cause damage even when you’re using a defocused beam. So we have to be careful, but there is no evidence that there are off target or side effects of light.

If you do end up dosing overdosing in your patients, especially if you’re thinking deep tissues like TMD or trigeminal neuralgia, these treatments have been shown to neutralize their benefits. So one of the biggest problems with this field of photo biomodulation has been the inconsistent clinical outcomes. And we believe and I think there is data to back this up now, that unfortunately the motivation of the clinician and the motivation of the patient is to get better sooner, right? So this is one case where too much dosing is actually detrimental and we have to be careful that we don’t overdose the patient. 

[Jaz]
Are you at a point now where you’ve figured out what that sweet spot is in terms of protocolization and so that it is information that can be disseminated to practitioners and primary care and they know which settings to use to get the best outcomes? Has it been studied enough or is this still like, we’re not sure exactly for how long or what intensity to use this technology? 

[Praveen]
So we do have a good handle on a specific application. So one of the problems with this treatment, I would say one of the benefits of this treatment, which is also a problem with this treatment, is there’s a very broad range of applications.

So there are things like mucositis, TMD, trigeminal neuralgia, aphthous ulcers, lichen planus, pemphigus, and you would wonder, even in dentistry, and again, we are not talking about medicine because we have all these major chronic diseases like Alzheimer’s, Parkinson’s, multiple sclerosis, fibromyalgia, where this treatment has been shown to be effective.

So even within dentistry, the fact that it has so many broad applications raises a very important clinical and biological question. How is this possible? How can one treatment be effective? It turns out the way- 

[Jaz]
And I guess the delivery also matters, right? The way you deliver the light in for TMD will differ to a different part of the anatomy. And then therefore, I guess working out what is the best for each disorder for that patient. And so that must be, ’cause it’s such a wide application, I’m already thinking, well how can you protocolize this and how can you then also tune it or make it bespoke for that individual? And I mean, I dunno, does the patient’s weight or their skin color vary and cause a change in how you would treat someone?

[Praveen]
So these are the intuitive factors that you would imagine as a photobiology with, with 101 basic knowledge of photobiology that we would want to optimize. So these are the concepts that are coming in now, unfortunately, I would say, like, three, four years ago, and previously, people used to use a point and shoot approach, they just switch on the light, point it at the patient and hope that they get better.

And hope is not a scientific strategy, right? So that is one thing that I find as we show more and more of our molecular and non-linear physical phenomena work, you mentioned stochastic and deterministic reactions.

So those kind of very precise dosimetry concepts are still, I think, in the research interface, but they’re coming rapidly to this treatment and that’s gonna significantly improve many of the clinical outcomes that are unfortunately still lacking. 

[Jaz]
Well, the questions I’m getting now, by the way, I’m really enjoying learning about this, but, lasers, right? So lasers are a topic that is actually we need to discuss on the podcast more. But what I get from speaking to people who are into laser. And also what I’m seeing from the people who sell lasers, right, is like, again, very similar to what you’re saying, very widespread application though you can use it for perio, you can use it in the root canal system.

You can use it for these effects. And you can obviously use it in a different way to cut tissue or soft tissue. So it’s such a wide thing. So can you just like dumb it down for me in sense of, okay, you’ve mentioned PBM and you mentioned that laser is one way of delivering that. When we talk about lasers used in perio lasers used in root canal, how does that differ to what you are talking about in terms of PBM or is it the same thing?

[Praveen]
Excellent question. So I think, there are two major topics here. One is lasers in dentistry and lasers in clinical use, and the other one is photo biomodulation. So I think many of my, at least academic talks and my courses that I’d actually end up trying to bring this information to people have focused on differentiating them.

So there is, if you think about light as a physical form of energy and you transfer that energy very quickly into biological tissue, it has nowhere to go, right? That light ends up evaporating or ablating tissue. This is how a surgical laser works. And this is exactly the property we use when we are trying to cut tissue, either heart tissue or soft tissue, and in some cases biofilms, right?

So you can do disinfection with biofilms by simply abating them, evaporating them. Now, there are two other forms of light use, which is not well understood or well talked about. It is well understood, but it is not as much popularized in the media and I guess in our training. One is photodynamic therapy where you’re using a color dye and light to destroy its target, and that comes in two flavors.

You can either destroy tumor cells or you can destroy microbial, polymicrobial films. So this is photodynamic therapy, which is disruptive in nature, you’re trying to destroy your target. In contrast to these two treatments, the surgical laser and photodynamic therapy, another form of light treatment is photo biomodulation.

Now, how is photo biomodulation different? It is a non-surgical, non-thermal way of modulating the biological response. And this very nicely circles back to why is it working in so many diseases? When you use the right amount of light and the right, and you evoke the right molecular mechanism or the signaling pathway, you end up modulating pain and inflammation.

You end up reducing pain and inflammation at the same time. With a different protocol and a different delivery system, you can stimulate wound healing, tissue regeneration, and a positive immune response. And that is why the term photobiomodulation is very appropriate. There are about 350 different terms, everything from low level light treatment to cold laser therapy to infrared or red light therapy, which is becoming a very popular term.

[Jaz]
So these are all the same things because I was gonna ask about red light therapy for TMD, and also low, is it low level laser? How do you say it? 

[Praveen]
Low level light therapy. Yeah. 

[Jaz]
So these are all the synonymous with the photo with PBM? 

[Praveen]
Photo biomodulation, PBM. So if you look up, you know how in academia how we organize stuff, is PubMed, right? So National Library of Medicine at the NIH indexes, the entire scientific literature. So photo biomodulation now is a catchall term that includes all the 350 odd terms that are present for this literature. So all of them, if you look at the science behind it and the mechanisms behind it, is photobiomodulation or PBM.

[Jaz]
Okay, that really helps actually in understanding. Is there like one machine which you can just twist the dials and then you go from it being a cutting laser to then you twist the dial and then it becomes in like low level light and PBM or is that yet to be invented? 

[Praveen]
That is actually one of the most popular questions we get Jaz. So when people, when I give these talks and lectures, they’re like, tell me one laser that I can buy and I can solve all my other problems. And I rightfully so, because these are expensive technologies. So you would like multi-functionality out of them. So when I get that question, I usually ask them a question.

Name one bur or curette that you can do everything in your -. And the answer usually is, I cannot. Right? So you have to think about lasers like that. So every wavelength, every device has a very specific application. There are people who are trying to develop multiple units and there are people who are trying to adapt.

Surgical lasers for PBM and they have had some success. But like everything else in life, you have a sharp pointy thing. You can do a lot of different things with it from, you can remove calculus, you can remove caries, you can reshape soft tissue or hard tissue. But would you be able to do everything effectively with one tool?

And the answer is probably no. And similarly, I think laser technology has evolved like technology, I should say. And you may not need a laser in many of these things. It might be even more, I think one of the big questions in our field is, is it as effective to use an LED as it is to use a laser? And there are pros and cons to that, but I think that question is still very relevant as we are evolving with this technology. Right now, I can tell you both are very effective if you are in the right dose range. 

[Jaz]
Okay. That’s very helpful. Now my own personal experience is like once removed, the physio I work with for TMD patients, her name is Krina, she works in London, she’s brilliant. And she uses, I think she calls it The Velvet, I dunno if that’s a brand name, whatever.

So it is low level light or it’s a red light therapy. And she says she’s getting good results with that. And so that was my first, like, me thinking about it. And then when I started emailing you and stuff, it was very interesting. It reminded me of that. And then someone in the US, Dr. Jamison Spencer, I did his course many years ago and then he was emailing me about it as well.

So I was like, ah, I’ll remember this for when I speak to Prof Praveen. So what are the applications that you see dentists using it for? Yes, for myself, for example, if I was to get it, I would like to use it to help patients with their joints, but I also want my physios to have some role in that, for example.

But should we be using it for wound healing prior to implants? Should we be using it after implant surgery to get better outcomes? Should we using it for, I don’t know, any other acute pain? So, it’s starting to sound like there are so many indications, but can you name, like, make it tangible, some real world indications that you think that general dentists should be considering, if at all?

[Praveen]
So if you’re talking about a laser, I think we have a list of applications. But if you’re talking about PBM specifically, photobiomodulation. I think your question is more directed towards that. Any clinical scenario where you are anticipating pain or inflammation or a lack of healing, that’s the definition of photobiomodulation. We find that we can use it very effect. Is it the only thing you’re gonna use? Absolutely not. So it would be an adjunct to your standard of care, but PBM has a very important role. Every time you anticipate pain or inflammation or a lack of healing. So the most common scenarios that we see, for example, are areas where you’re going to obviously anesthetize, right?

So, which is pretty much every clinical procedure if you irradiate that site, I shouldn’t use the term irradiate, I should say treat that site with photo biomodulation. 

[Jaz]
Should you not say illuminate? Is that not the correct term? 

[Praveen]
Illuminate is a better word. I mean, we try to avoid irradiate because that normally brings in concept, thoughts of ionizing radiation and this is not ionizing. So that is the big misconception that we try not to promote. So we use the term illuminate or treat, which is a better term. Yeah, absolutely.

So, I think if you can use your, if you use the PBM before you do anesthesia, that’s I think absolutely 101 in every clinical procedure, you’ll find that the patient is much more comfortable and will recover- 

[Jaz]
During anesthesia. So I’m thinking like a palatal injection, which is commonly, we think that that’s gonna be a painful one for our patients. Are you suggesting that by doing some PBM, the perception of pain from that palatal injection, which is just moments away is gonna be less? Has that been proven? 

[Praveen]
That is true. 

[Jaz]
Am I thinking correctly?

[Praveen]
That is absolutely true, and I think we have the strongest evidence with wisdom teeth, third molar extractions, where you do the light treatment for the biomodulation and then people find that you have to give them less anesthesia. They are more comfortable during the procedure. And then you come back after you finish the procedure, which is the extraction, and then you do the healing protocol.

So one of the nuances I think, of what we understand now is that the pain control is a slightly different protocol than the healing protocol. So even though you might end up using the same device and maybe the same handpiece, you’re gonna do slightly different protocols for getting different biological responses.

So in the first case, you wanna reduce pain. The second case, you wanna reduce inflammation and promote healing. So it’s gonna be slightly different. So that is pretty much, I think 80% of things we do, which is either anesthesia or some kind of a surgical procedure. And then of course there are these patients who come to you with aphthous ulcers, pemphigus lichen planus is very common, right?

These are situations that unfortunately are very managed very empirically, right? And it’s effective. I mean, the reason we are still practicing dentistry is because our treatments are effective. But there is always that odd 5%, 10% cases that are not responsive. And if you go- 

[Jaz]
So anything surgical, it just makes a total sense. How about this scenario? I’ve just thought of like a patient who’s keeping their mouth open for, let’s say a root canal treatment or a crown, but they’re the kind who just is getting a lot of tension in their masseters, in their jaw joint. They’re feeling like they’re in a lot of pain, perhaps before the treatment, using that. And during, is that a protocol that you guys, that you’ve studied? 

[Praveen]
Absolutely. So there’s actually a whole term for that in physical therapy called DOMS. Right dos, which is basically the muscle fatigue that you get because of continued strain. And obviously you can imagine the masseter and the temporalis and all the other masticatory muscles are subjected to a given position.

And when you do a procedure like, you know, keeping your mouth open for a filling, you are obviously putting them in a lot of stress and fatigue. So, if you do the treatment photo biomodulation before you start the procedure and even during the procedure, you will find that the patient is much more comfortable and you really feel the difference in the following day, 24 to 48 hours after the procedure, that’s when the real pain kicks in, right?

So in the initial fatigue I think, they can manage because usually they’re anesthetized and they don’t, they’re paying more attention to the procedure, but the next day they start feeling the discomfort. And that’s what I think you will find if you start taking histories or even a lot of people now have apps where you can report things like this. A quick text saying, you know, are you comfortable? Do you need more treatments? If you wanna come in for another dose of PBM.

And now there are so many of these PBM devices that are available to take home as well, the LED ones at least. So you can potentially, you know, have them take it home and take it home and treat themselves. So that’s also becoming a larger and larger possibility.

[Jaz]
Okay. And I’m just thinking of like the various, like if you do a really like deep crown and you had to remove some tissues and to use it then to help with their recovery. But let’s talk about ulcers, right, because I think that’s gonna help me help to make it tangible. If someone has an aphthous ulcer and it’s a very nasty one, and often they might come in and show you, or sometimes you notice it at that checkup, right?

Do we have any data on how many days of difference it actually makes or any sort of perception of pain reduction or quality of life improvement surrounding the use of PBM on an absolute ulcer, which is not the worst thing in the world, right? It’s the first like, first world problem in a way, but it’s still unpleasant. It ruins your appetite. It can be very painful to eat certain foods and just annoys you, right? So how does it actually help? 

[Praveen]
Yeah, so that is one of the biggest practice builders, if you will, if you’re trying to bring this technology in, the ulcer is not going to disappear. You’re not actually zapping the ulcer out of existence.

That’s not happening with PBM. Right? But when you do the treatment, your patient will tell you in the chair that they’re feeling better, right? So you can actually perceive the improvement within seconds. And this has been a major part of my lab’s interest in trying to understand how are you getting local anesthetic effects with light, which is non-ablative, non-surgical.

These patients are comfortable in your chair, right? And there have been several studies looking at both perception of pain and what pain does, it heightens other perceptions. So hot, cold pressure, you know, hyperalgesia. So we can actually measure this very, very objectively with thin to thick filaments of metal, right?

So we poke the patient just like we do, probing after anesthesia. You can actually probe this in a very scientific way and precisely measure how much pressure you’re doing to evoke a pain sensation. So people have done very, very careful measurement. What is still lacking, I think, is at the level of functional MRI kind of studies where we are looking at integration of central signals of pain perception.

But the peripheral signals and peripheral perception of pain has been very well studied. And there are several ailments, including fibromyalgia, which just recently got the US FDA approval. So there is actually a device on the market now that is FDA approved for fibromyalgia, which is again, a generalized pain condition.

You can imagine things like burning mouth syndrome, trigeminal neuralgia, and other fines of atypical pain, which are extremely painful. And unfortunately people resort to very severe surgical interventions. Could be at least avoided or prevented for, if you could get symptomatic relief. So I think it’s worth exploring.

And unfortunately there is not like a precise device and a protocol that works. So you’ll have to look at the primary research literature to actually find that right device and the right protocol. But they do exist and there are some very, very good studies for each one of those applications. 

[Jaz]
With that ulcer patient. Again, just to make it really tangible, right? If that patient has an ulcer and they’re at the peak of it, during the laser delivery, sorry, during the illumination delivery in the practice, let’s say five minutes, wherever it might be for the protocol for that ulcer, they’re gonna be feeling better then and there. Do we know if that ulcer is gonna end up healing actually faster or the percentage improvement in quality of life? Or do we not have that data yet? 

[Praveen]
It does resolve faster. So if you have a painful ulcer and you do nothing to it, it usually takes 48 to 72 after ulcer. So 48 to 7- 

[Jaz]
But major ulcers are real and my mother-in-law gets em right and they’re really nasty. And they can be there for a while. I can really think of a good application for major would be something like this, right? 

[Praveen]
So not only is the immediate pain relief evident, but the resolution of that inflammatory response is also quite well documented. So you will see, the problem with these things is it keeps coming back.

So you wonder if the treatment is actually not just laser treatment or photo biomodulation, but any treatment will it work. So I keep emphasizing when we talk about photo biomodulation that you cannot substitute standard of care. You do need a good diagnosis and the right prescription of the standard of care where PBM can either be used as the main treatment or as an adjunct.

It is not magic. I think that why, I think a lot of people you will talk to try to palm it off. As you know, it’s magical light and it does cool things. It does cool things, but there is a rationale for that. So it’s not going to omit your good practices, and we give this great example.

I’m sure you’ve heard this literature on lasers in perio, right. You know, that lasers have been used in perio for a long time. It’s rather controversial because people thought they could do everything with the laser. Everything from scaling root planing curettage, to disinfection, to healing. Yeah.

[Jaz]
I feel like those who are laser converts, they’re a bit like vegans. If they have a laser, you’ll know. Right? And so sometimes I feel like, and no offense to anyone who uses a laser, ’cause people swear by it and they love it. But I just feel as though, like, is it really that good? It might be, and maybe I’m missing out here, maybe I’ll eat my hat. But and soon to be discovered, but yeah, you tell me more about that. 

[Praveen]
So, lasers in dentistry is a rapidly evolving field, and the great news is, although it has existed from the LA you, the 1980s, it has been formally recognized by the ADA in 2023. So there is clearly a lot of good scientific literature supporting the use of a laser compared to all of our mechanical and rotary tools. So there is clearly a lot of more understanding and information about the superiority of a laser device for any procedure compared to a blade or a scalpel, which arguably is way, way more cheaper.

So why would you buy a fancier tool to do the same job? But the laser does do a lot more. So this is a whole separate discussion on what are the advantages of the surgical laser. But there is nothing like PBM, so there is no tool, maybe the closest you would think of is trans electrical neural stimulation tends right where they use microcurrents to stimulate the analgesics response.

Or there is a little bit, I think, overlaps with ultrasounds, when you’re trying to do photo acoustic signals. But there is a non-invasive way of doing something in the clinic that there is no other alternative to. And photo biomodulation is very, very uniquely placed in that. In fact, we think not very far away, given all the advances in optical diagnostics, that every dental chair will actually have a laser or a light device on your chair, right?

It’ll be one of the things that you pull out and you can do either a light curing is an absolute easy thing to think of, right? But it can also do other things like diagnostics, maybe potentially PBM and maybe some of the PDT stuff. 

[Jaz]
I can just imagine like, those intra oral scanners that we use, they could probably just bolt one onto there. Maybe, it’s a good size head, isn’t it? Like maybe they should have a separate head or combine. It just makes sense that, that I think that kind of access could exist in the future. 

[Praveen]
The form factor Jaz that you’re pointing out is turning out to be the biggest barrier, right? For entry into a clinical market.

We are all trained as clinicians. We are very comfortable with certain technologies. It’s very difficult to move a field if you bring in something which is very different, right? So, you will see that even most of the surgical lasers have handpieces, which look exactly like our surgical handpiece.

You look at any of the major manufacturers, they look exactly like a manual. Okay, you don’t have the tactile feel. That’s definitely a limitation, if you will, from laser surgery, but like every other skill that we have learned, this is something that you get better at practice, right?

One of the funniest thing I should mention here, Jaz, is that we hear this thought about, why bother with a laser? I can pull out a blade or a curate and you know, do this in 10 seconds. Why do I need to set up my laser and do all of this? Lasers are very slow, right? The laser procedure is very slow.

Whether you’re doing a class two prep or anything, class one mini prep, class five preps, there is nothing faster than light in the entire universe. So how can you tell me that the light tool is actually slow? That doesn’t make any sense. So it’s basically your technique, and I think that’s one of the things we keep pointing out.

Yes, there is some setup time, but there are so many advantages of this technology that you would not get with a mechanical plate. And I think this is coming to the forefront. I just came back from another meeting, you can imagine this is really catching on and there’s a lot of interest in different societies and professional organizations.

And I just came back from the American Academy of Oral Medicine and the American Academy of Pain for very different workshops. One, obviously for the pain. We were just discussing how is this thing working? Is it, how is it doing? And I just effect how is it reducing Inflammation has become a big key because once we understand how it works, we can obviously develop protocols that are consistent and reproducible. So that is the motivation there. Well, the thing- 

[Jaz]
Well, just in terms of circling back to how it works though, like I just feel like you mentioned at the very beginning, the wound healing in a 30-second soundbite, are you able to just describe the actual molecular mechanism or the physiology of how it actually gets the results it does? 

[Praveen]
So our current understanding of photo biomodulation mechanisms is threefold. We have identified three separate molecular pathways that light can induce, just like you need to induce rhodopsin, right? You need to change the cyst to trance. If you remember our 101 physiology classes, it has to change its confirmation.

Nightmares. I’m sure, but nonetheless, we made it through, right? So, there has to be a change in the biological system, whether it’s shape confirmation or it’s biochemical change, right? It has to be modified. So when you think about photobiomodulation, there are three well understood mechanisms.

The first one, which is usually the most talked about, is the mitochondria, right? You have cytochrome C oxidase, which is present, which is an enzyme in the mitochondria that’s responsible for electron transport. And when light is absorbed by this molecule, it transiently increases the electron transport function, which makes the cell more resilient and more fit.

It improves the fitness of the cell. You can imagine better mitochondria. Sounds great, right? You would want a better mitochondria no matter what. So you can, so this is one of the most talked about mechanism. It makes a lot of intuitive sense. You’re putting light energy, you’re improving energy in the cell, energy metabolism in the cell.

And that for the longest time that used to be the most cited mechanism, it still is Tiina Karu and Harry Whelan actually showed this mechanism very elegantly in biochemical models. The second mechanism, as we were talking about earlier, is the pain relief. And that’s almost instant, right? So when you do light treatment, you instantly see the improvement in your patient.

So this cannot be long term, transcription translation changes in the signaling. It has to be something as simple as what we get with local anesthesia. So there is something disrupting the neutral conduction instantly. And lo and behold, there are light sensitive receptors and transporters.

So if you shine light at the right intensity of the right color and the right wavelength, right? So you can actually disrupt transiently and reversibly just like local anesthesia, neural conduction. And there has been a lot of very elegant work on different receptors and transporters. Some of the famous names are Opsin and TRPV1.

These are molecular targets. So we have a fitness or resilient mechanism, which is the mitochondria. And then you have the pain mechanism, which is a transporter or a receptor. The third mechanism is the one that I described to you in the beginning, which is the wound healing mechanism.

Turns out that there is a growth factor that is present outside the cell. And this growth factor is called TGF-β1. And that growth factor has very specific amino acids that are light sensitive. So when you shine light of the right wave angle and the right intensity, this amino acid actually senses light.

And it changes its shape, just like rhodopsin and causes biological signaling. So activation of this growth factor, TGF-β1, has been shown to be a pro healing and it can actually recruit local endogenous stem cells to do tissue regeneration. So yeah, more than 30 seconds, but hopefully I give you a load up.

[Jaz]
No, no, it helps. And automatically I’m thinking of something really far fetched. Okay. Something really crazy. You know how people, some people, they will like sit in a chamber that is highly oxygenated, right? And so then in the chamber and so they’re getting more oxygen. They feel like, okay, I’m performing, gonna perform better.

I’m having better oxygenation in my body. Do you think, I dunno if this applies. Is there like a red light chamber they can sit inside at very low level to just gain the health benefits to your total body for no reason, just for preventive medicine? Is that something that exists? 

[Praveen]
A preventive medicine and longitude. So I think the question now is no longer improving lifespan, which I think a lot of people are trying to do, but let’s improve health span. Where you are more functional at least at similar level, if not better. There is so much interest now and not just improving the length of life, but the quality of life really.

Unfortunately, the reality is in the last decade of your life, you are not as functional as you are in the rest of your life. So can we use light along with exercise, nutrition? As well as the right structure. Human beings are social beings, right? So we can’t discount the others, but it is being very rapidly recognized that light in its many forms can be another supplement, if you will. It can be another part of this health and wellness protocol. And- 

[Jaz]
Dammit, I thought I invented something there. 

[Praveen]
The chambers is something that I think a lot of saunas have been modified to do. Very interestingly, there are beds that are available, like beds, just like the tanning beds and-

[Jaz]
That’s exactly what I had in mind actually. But there we are. It’s already been done. 

[Praveen]
Absolutely. So the beds are becoming extremely popular, both the athletes, right. A few microseconds of improvement of their performance is millions of dollars and lots of trophies and wins for them. And you pretty much name any peak athlete right now in any sport, whether it’s swimming, whether it’s cycling, whether it’s football, soccer, all of these guys are using it as a part of their regimen. So you will be shocked that, how many of them- 

[Jaz]
I had no idea. So this has been very educational for me. Not only just dentistry, but it’s in general. If you were to get your crystal ball out, Prof, you get your crystal ball out, right? Where do you see- I mean, it sounds like there’s enough evidence based now you are very enthusiastic about it.

I’m liking what I’m hearing, but where do you see the entry point applications? Where do you see it overcoming the barriers that exist and at what stage you think is gonna take five years, 10 years? What’s your guess? Prediction. 

[Praveen]
I think where it’s going to immediately make an impact is wellness and longevity and better health spans. So the cosmetic and aesthetic and wellness applications are already on autopilot right now. So if you have not already, and we point to the fact that almost every smartphone that we have, smartphone or a digital device now has a blue light filter, right? It is a different part of the research and biology where we talk about circadian rhythm, but the awareness that light has a role in your physiology is very well understood.

So we think PBM will become something very standard in regular wellness. Even when you fly, commercial airlines, you can see that they don’t switch on the light anymore. They actually cycle through red, blue, green, and then switch on the white light. Right? This is just coming from awareness that you don’t want your cranky customers in your home after a long flight, you want to actually cycle them and then the mood gets better.

So, simple things like that, which we may not think of as PBM, have already established light as a critical role in our physiology. So I think the more awareness come everything from the desk, digital screens we are looking at to our digital displays, to the light that is eliminating in our rooms, they will all adapt this technology much, much they are, I think I should tell you, they’re already adapting these technologies.

No lights are no longer just eliminating a space. You can actually have additional wavelengths that come on at a very particular amount of time for a particular duration, to improve your moods and elevate your performance both neurocognitive and skeletal muscular. So there are some, and Jaz, we can talk about this all day, but, there are these assisted living homes where they install these special PBM lights and they found less depression, less falls skill, falling over, which is the number one reason why these people pass away.

Unfortunately, once you have a severe fall, unfortunately it’s downhill from there. So just switching the lights for 15 to 30 minutes of treatment every day has significant health benefits. So I think the wellness and of course you Google, I don’t know, Amazon, Alibaba, you’ll find a thousand different light marks that are available right now.

And if you have children, like I have a teenage daughter, she loves a light mask, so she’ll do all her facial creams, but she loves the light mask as well. So, and there is a lot of cosmetic and aesthetic use that is already very prevalent. I think there’ll be increased awareness that will occur. In terms of the clinical adoption, which I think we are more thinking about.

There are very well done studies, systematic review, meta-analysis, clinical practice guidelines, but they are restricted to specific applications. So, although we know that there’s a lot more that can be done, TMD, trigeminal neuralgia, BMS, all of these ailments, pemphigus, lichen planus, things that we have difficulty managing in our patients.

Those studies are unfortunately not yet fully done, but mucositis is where we have the most evidence. And you need one thing, right, to get the field moving. So we think mucositis is going to be a big break. 

[Jaz]
But, like you said, the cancer world and mucositis sounds like there’s a big tick there, but I think what you’re saying is that the research is on the way to then have clear protocols and guidelines for ulcers management or wound healing after extractions or prior to wisdom tooth surgery, but that’s the next phase of research, you think?

[Praveen]
Yeah, I think those are primary areas for future research and optimization of these protocols. So when we started speaking, we talked about differences in skin color, time of the day, whether you’re a male or a female. All of us respond differently, so the fact that even in medicine now, we largely acknowledge that we can’t do, everyone is not a cookie cutter kind of treatment.

We have to personalize and optimize. This particular treatment is very amenable to that, right? We don’t have to do too many things to change the intensity, change the treatment time. So I think this might actually to in many ways begin our precision, medicine, precision photo medicine, if you will, that would allow us to optimize and personalize for optimal outcomes.

[Jaz]
The Protruserati that listens to this podcast are all over the world. They’re a very geeky bunch, prof. Right? Would you be willing or happy to share some papers that they can just read in their own time? ‘Cause I think when something new like this comes along and naturally everyone’s skeptical, but then, you’ve presented it really well.

But I think everyone always needs to do their due diligence to learn about things. I think it’s a wonderful thing to be able to read and assess literature. Are you happy to send some papers over that I can put on for a while? 

[Praveen]
More than happy. It would be a pleasure. So people, I think, don’t realize that in academia, the reason we publish papers is that people read them, right? So it is something that a lot of people don’t realize that, that that’s the whole point of doing research, right? You may not be able to convert it into a treatment. We all play to our strengths, right? We are dependent on the clinicians and the companies, the stakeholders, to actually convert that into a device or a product or a protocol.

So I’m more than happy to share it. And I think the latest paper that forms the foundation for the ADA approval of photobiomodulation as a discreet kind of treatment. That paper probably is the most updated. And for those of you, like you said, are interested in the molecular mechanisms, I’m happy to send two or three papers across.

[Jaz]
That’d be great. 

[Praveen]
The more view of the field 

[Jaz]
Amazing. I can put that on the app for everyone to download. That’d be great. There people will be screaming and typing and say, okay, like, should I just wait and watch as I’m a general? Let’s say you’re a general dentist. You do everything from children to root canals to surgery.

Is it the time to maybe dip your feet in, like everyone’s talking about 3D printing, should I buy a 3D printer now or should I wait a bit? Do you think dentists, are there any obvious products in dentistry that they should be looking at or they should be holding off? What’s your thought on that?

[Praveen]
No, I think, the fact that the FDA has cleared many devices, not approved, but cleared many devices should speak to the safety and value of adding a PBM device to your practice, right? So if you already have a surgical diode laser, you might just have to invest in a handpiece that makes that surgical device into a PBM device.

But if you’re really interested and you’re new to the field and you’re seeing a lot of these patients, you will be amazed at how many devices are available right now that are more- 

[Jaz]
Do you have any financial interest in any of them? 

[Praveen]
None. I don’t endorse any of them. And I think that- 

[Jaz]
And that’s why I appreciate you very much. So, someone might listen to you today and think that, hey, this guy has got a big stake in, in PBM . But I love that. Yeah, you wish, right? But like, look, that’s why I appreciate you so much, as a professor who’s just, your enthusiasm and dedication to this topic, it just shines through.

Are there any brands that you like that, that you think, that have been working well that perhaps a general dentist somewhere should consider as an introduction into PBM? 

[Praveen]
So I think, our yardstick for that has been who’s involved and supporting the field, right? There are many, many devices on the market. You go on Alibaba, Amazon, you’ll find like a hundred thousand devices. But the people who come to our scientific meetings and are contributing to promoting the field, those are devices and people that we know make good, good protocols and good devices.

So my recommendation actually would be to go to the World Association of Photo Biomodulation website, or the North American, all the academy of Laser Dentistry or World Federation of Laser Dentistry, these scientific organizations are supported by several companies that it’s almost like a self-reinforcing prophecy, right? These are people who we trust to come to our meetings and bring good devices. So those are the units that I would say you should look into.

And there are several manufacturers who are very well established and have a good following and are very responsive. If you’re new to the field, after you buy the device, the first thing you wanna do is get the training right. And that becomes unfortunately many people don’t pull that. They try it themselves and sometimes they don’t get good results and they give up on that.

So that is something that we feel, if you’re active about seeking the training, you will benefit a lot more. And these organizations actually are, they don’t endorse any of the manufacturers, but the fact that they are supporting them and they’re being supported by these organizations is a fantastic place to start. And again, I can call out the names of different manufacturers, but that is not, I think the, I mean, I’m sure your readers can very quickly look at that. 

[Jaz]
Well, we’re gonna put the papers on, as you said, and then we’ll put the websites that you mentioned. 

[Praveen]
That would be awesome. 

[Jaz]
That clearly state those manufacturers. And I think it’s a very elegant way to convey that message. And so I’m very grateful for that. Prof, I’ve really enjoyed our time together. We’re coming to the end of the hour mark. Thank you so much for all the research you’re doing, for everything that you are sharing out there and this conversation that we had to really make things tangible for me.

I’m glad I didn’t do any research beforehand ’cause it meant some of the questions I was asking was very much candid and fresh. And so thanks for playing so well with that and engaging so nicely there. Is there anything else that you, I mean, do you have any channels that you want people to support your research or reach out to you or anything like that?

[Praveen]
No. So, I think you will face the book papers, right? So the papers I think has major resource. I think that’s our best advertisement, if you will. And that’s the best kind of advertisement because it gives us a platform to show people where we are and what we are doing. The contact information is on that paper, so you can definitely get in touch it.

We are easy to find on Google as well. The one thing I would say Jaz is, you mentioned this in the podcast today, that people need to differentiate between laser applications and photobiomodulation. And unfortunately because lasers have been around for the longest time, so has PBM. People get confused with, can I buy, the question we were talking about, can I buy one device that does everything?

Unfortunately, I think the answer is no. And when you learn what else it can do. I think that that gives you a better platform. So, PDT unfortunately is not well understood, even though it’s been around for the longest time. It won the 1903 Nobel Prize in medicine and we don’t know much about this treatment, right?

So, if there is interest from your audience and your forum, I would love to come back and talk about surgical laser applications and why it is different than the mechanical ablations. And PDT can be a whole, I may not be the best expert for that. I can recommend some of my colleagues. I think this is the kind of granular information, if you will, for someone who’s bit being bitten by the bug of curiosity in this space. 

[Jaz]
Oh, I think you’d be a most welcome guest again, but I do like engagement when it comes to this. So those who are watching on YouTube or Protrusive Guidance, I want you to comment below. If you’d like to see Prof Praveen again to talk about surgical laser applications, which I would personally love, but I want you to love it as well. Please comment below and then we can do that.

I’ll, of course make the papers available. And yeah, thank you so much. Enjoy the rest of your trip time in Barcelona, presenting for the IADR, yeah, onwards and upwards, sir. Keep up the good work. 

[Praveen]
Thank you, Jaz. Thank you for having me. I really enjoy it. 

Jaz’s Outro:
Thank you so much. Well, there we have it guys. Thanks so much for listening all the way to the end. Look, you’ve done the hard work. Why not get some CPD or CE credits? Protrusive listeners who listen to a new episode every week, they easily get 40 CPD or CE credits every year just from listening to the podcast while they’re on the treadmill or on their commute.

You can just satisfy all your targets. And now we’ve got like core topics like oral cancer, medical emergencies, that kind of stuff as well. Not only do you get the certificate, but you get to answer the quiz and validate your learning and reflect ’cause it’s important to be a reflective practitioner. Of course.

If this sounds good to you, but you all have time for is the podcast, then you should join our podcast CE plan. If however you want access to the podcast, CE Plus all our masterclasses, then you want the ultimate education plan that’s got Sectioning School, VertiPrep for Plonkers, RBB Masterclass. And now recently Splint Course Online.

And how could I forget? The Premium Clinical Videos, step-by-step walkthroughs, you name it. So the best place to check it out is protrusive app. Select your plan and hey, we have a free plan. All you need is to join your tribe, join your community. There’s so much value to be gained. We do have a manual application procedure, is important to us that only dental professionals join our network is how we keep it a safe space. So check out protrusive.app. I want to thank again, Professor Praveen Arany, who will definitely be inviting him back. But please comment below if you’d like that as well. And don’t forget to hit that subscribe button.

It might sound like a small thing, but it actually really helps us a lot to get the right reach and help more dentists. I wanna thank Team Protrusive for the wonderful work they do in the production side. And thanks to you once again, Protruserati for choosing us for your dental education. I’ll catch you same time, same place next week.

Bye for now.