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Lasers: Treating Herpetic Lesions and Aphthous Ulcers with Diode Dental Lasers Angie Mott, RDH

In the past we, as dental clinicians, have watched our patients enter our offices with painful lesions on their lips and inside their mouths, only to let them know that there were limited options that we could provide. But, as we know in dentistry, things are continuing to change on a daily basis.

Dental lasers have been setting the pace in our offices for quite some time know, and there are several exciting options that soft tissue lasers can provide. Diode soft tissue lasers, for instance, can be utilized in the orthodontic office for treating these unsightly and often painful lesions.

Below are some suggested guidelines to follow when using a diode soft tissue dental laser to treat these areas. First, be sure to check to see if your state dental practice act will allow the use of soft tissue lasers in your state. This is more important if a dental hygienist will be using the laser.

In addition and of utmost importance is laser safety. Please be sure to know the safety parameters of the laser that you operate. If questions arise, please consult your laser manufacturer, the owners’ manual or for further consultation, you can contact the Academy of Laser Dentistry at www.laserdentistry.org.

To begin, make sure to confirm the diagnosis of the lesion that you are going to treat. Typically, no form of anesthesia is necessary however topical anesthesia can be used if needed.

Prepare your laser by using the following parameters: cleave your laser fiber and begin with an uninitiated fiber. Place the fiber approximately 2mm (non-contact mode) above the lesion. This will work for both herpetic and aphthous ulcer lesions.

Continuous wave is the appropriate setting to choose for this application. Starting at 0.5 Watts of power, begin by lasing around the borders of the lesion extending past the borders of the lesion to make sure you are treating the entire lesion. From there simply start “filling in” the area. Once you have completed filling in the area in one direction, place the laser at a 90-degree angle to the pattern you have just completed and in a cross-hatching pattern complete the process again. This process, at this setting, should take anywhere from 45-60 seconds to complete. Next, increase to 0.6 Watts of power and complete this process again for the same time interval. Continue with the same process and time intervals using the following settings, 0.7 Watts, 0.8 Watts and lastly 0.9 Watts of power. Finish the procedure by placing vitamin E on the lesion to help re-hydrate the area and allow it to help with the healing process by keeping the area moist. This prevents the area from drying or cracking thus allowing the lesion to possibly split and spread. With the diode laser, typically, the area will appear to look the same. Occasionally the area might appear to be a little dried out and possibly appear smaller.

Providing post-operative instructions to the patient is necessary as well. The patient can place vitamin E on the area as often as needed. Care should especially be taken for the patients with herpetic lesions reminding the patient of how contagious these areas are. For female patients, care is needed to be cautious in placing make-up (foundation base, lipstick etc.) over those infected areas and spreading the virus to a new area.

Sometimes a couple of applications with the laser may be needed. Typically the sooner we can treat the area it seems to respond better. Treating the area toward the end of the cycle can still reduce the pain involved with the lesion.

Your patients should feel very comfortable during this process and will only feel warmth throughout the procedure. Using high volume suction is mandatory to remove the plume associated with treating these lesions and it will also provide a cooling effect over the area.

Everyone will love this new service that you can provide and it can be used on everyone regardless of age. Be prepared, the news will spread quickly about your new laser!
Angie Mott, RDH, is currently practicing in Tulsa, Oklahoma. She has been using soft tissue lasers for 10 years and currently serves as the auxiliary chair for the Academy of Laser Dentistry. She is a recognized course provider for ALD and can be reached at dabt4cu@aol.com.
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September 2025
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