Treatment of Burning Mouth Syndrome with a Low-Level Energy Diode Laser: Response to Vukoja et al.

W e reviewed the letter to the editor by Vukoja et al. ¹ regarding our recent article on using low-level energy diode laser to treat burning mouth syndrome. ² Although similar criticism has been raised by others when treating temporomandibular joint (TMJ) dysfunction, ³ more authors clearly reported low-level energy laser treatment (LLLT) as a proper alternative treatment for TMJ dysfunction. ^4,5 We appreciated their opinions; however, there are several issues in this Letter to the Editor that need to be carefully discussed.

First, the devices used to treat patients were different: wavelength of 685 nm in their use ¹ versus 800 nm in our article. ² In addition, the energy density used to treat patients was also different: 2 J/cm² in their use ¹ versus 105 J/cm² in our article. ² These differences make it difficult to compare the treatment effects directly.

More importantly, although we cannot deny the possible placebo effect, these authors clearly demonstrated a better analgesic result in the laser-treated group after day 5 (Fig. 1, Vukoja et al.), ¹ even though it was not statistically significant. Therefore, the analgesic effect of diode laser cannot be denied.

Finally, the "burning" sensation is very subjective and varies among patients. Therefore, to calculate mean visual analog scale (VAS) before treatment in each group and statistically compare that to VAS after the treatment will definitely create a large deviation. The authors did not describe how they calculated the scores and the meaning of the Y-axis (Fig. 1, Vukoja et al). ¹

Overall, I believe both our article ² and the reports of others ^4,5 clearly demonstrated a better analgesic effect of diode laser disregarding any placebo effect. Therefore, to say that the reduction in pain scale in burning mouth syndrome patients treated by low-level energy diode laser is only a placebo effect is too arbitrary.