Scientific evidence in antimicrobial photodynamic therapy: An alternative approach for reducing cariogenic bacteria.

Abstract

Several studies of antimicrobial photodynamic therapy (aPDT) have been performed to verify the efficiency of this treatment against caries-related microorganisms. Thus, the aim of this study is to describe the characteristics of aPDT and to review the literature regarding its effects on cariogenic microorganisms organized in biofilms and/or caries lesions. The literature was searched for reviews and original papers about aPDT and its outcomes against Streptococcus mutans as well as other caries-associated microorganisms or caries lesions. Moreover, research on photosensitizers and light sources are also reviewed. The publications were selected using PubMed, Web of Science, and manual search of references cited in key papers. The descriptors used were "dental caries" and "photodynamic therapy". The relative efficacy of aPDT to reduce the population of cariogenic bacteria in in vitro biofilms is demonstrated by large number of laboratory studies. Preclinical (in situ models) and clinical studies show a less pronounced bacterial reduction for aPDT than for in vitro models, especially in dentin carious lesions, since the bacteria in dentin caries may be less susceptible to this therapy due to the limited photosensitizer penetration as well as reduced diffusion of light along dentin structures. Although aPDT may be an efficient and less invasive complementary approach to disinfect deep caries lesions, there is insufficient scientific evidence of its efficacy to warrant a clinical recommendation for its use.