Photobiomulation and the Opioid Crisis

In November 2019, as a member of the editorial board of Photobiomodulation, Photomedicine and Laser Surgery, I was asked to write an editorial on the topic of Photobiomodulation Treatment (PBMT) as a possible answer to the opioid crisis. (1) I started using PBMT in my small-town dental practice in 1993 and have eliminated using post-operative opioid prescriptions ever since. In today’s world, you can’t open any newspaper without finding an article on the opioid crisis and so many of addictions started with people being prescribed opiates after dental treatments. In this article, I will discuss the problem and show how PBMT can be a big part of the solution.



The Opioid Crisis 

According to the CDC, in 2017, there were 72,300 drug overdose deaths in the United States and of those, 47,600 were due to opioid overdose. Many of those deaths were related to prescriptions of narcotic pain killers after dental surgery.  In Canada, the situation is the same with 3996 drug overdose deaths. Canada has  1/10 the population of the US so death rates are almost equal. In an article by Harbaugh et al, published in JAMA in August 2018 “Persistent opioid use after wisdom tooth extraction”, the authors reported that between 2009 and 2015, there were 70,942 wisdom tooth extractions and  56,686 of those patients were given prescriptions of opioids for pain relief. (2) They also state that many of these patients are associated with persistent opioid use.  In November 2019, a study published in JAMA by Suda et al, “Comparison of opioids prescribed by dentists in the United States vs England”, reported that in 2016, 11.4 million opioid prescriptions were written in the US versus 28,082 in England; this represents 37 times greater opioid prescriptions written in the US. (3)



Use of PBMT for Post-operative Pain Control 

When using PBMT in dentistry, the major factor in successful treatment is using the correct dose. An article by Huang et al “The Biphasic Dose Response”, explained how the selection of treatment dose can be determined using the Arndt-Schultz curve (4) (Figure 1). The Arndt Schultz curve indicates that a low dose provides a stimulation effect and high dose gives an inhibition effect. The practical application of this can be seen with the following clinical techniques: 




After extraction, the PBM unit is applied directly into the socket before suturing, using an inhibition dose of 8J/cm2 (in larger molars, 8J/cm2 is applied down each root) (Figure 2). For surgical extractions, a higher dose of 16J/cm2 is applied. In some situations, you may not have a device that allows it to be applied in the mouth so it can be applied extra-orally. Less of the energy gets to the target at a greater distance so doses should be doubled. In a study by Kahraman et al, “The effects of transcutaneous and intraoral laser therapy after extraction of lower 3rd molars: a randomized placebo controlled dual center study”, the authors compared laser application intra-orally and extra-orally on one side against a placebo on the other side. They found both laser applications were superior to the control, but intraoral application gave superior results. (5)


Following suturing, a low dose of 4J/cm2 is applied along the suture line to give faster wound closure (6). In the past several years there have been numerous studies using preconditioning to set the site up for ideal post surgical results. I use a dose of 4J/cm2 applied to the Submandibular and Maxillary lymph nodes. (7). 



PBMT has been the key to eliminating opioid prescriptions in my dental practice. These same dosing techniques can also be applied to other techniques in dentistry such as dry socket treatment, TMD pain relief, implants, periodontal and implant surgery.




  1. Ross G. Photobiomodulation Therapy, a Possible Answer to the Opioid Crisis (2019). Photobio., Photomed. And Laser Surg. 37(11) pp 667-668
  2. Harbaugh Persistent Opioid use after Wisdom Tooth Extraction in the United States JAMA August 2018 320(5) pp504-506 
  3. Suda. K. J., Durkin M. J., Calip G, S., Gellad W. F., Kim H., Lochart P. B., Rowan S. A. and  Thornhill M. H., (2019)  Comparison of Opioid Prescribing by Dentists in the United States and England. JAMA Network  May 2019
  4. Huang Y. Y., Chen A. C. H., Carroll J. and Hamblin M Biphasic  Dose Response in Low Level Light Therapy. (2009). Dose Response, 7(4), pp 358-383
  5. Kahraman S. A., Cetiner S., and Strauss R. The effects of Transcutaneous and intraoral laser therapy after extraction of lower third molars: a randomized single blind placebo controlled dual center study. (2017). Photomed. And Laser Surg. 35(8) pp 401-407
  6. Houreld N. and Abrahamse H. (2009). In Vitro exposure of wounded diabetic fibroblast cells to a Helium-Neon laser at 5 and 16J/cm2.Photomed. and Laser Surg. 25(2), pp192-196
  7. Lopes L. A., Lopes A., Tuner J. and Calderhead R. G. The use of Laser Therapyin the Treatment of Inflammation through Lymphatic Drainage  (2003). Lasers Med. Sci. 18 pp 02-08
  8. Aras M. H. and  Gungormus M. (2009). The effect of low-energy laser therapy on trismus and facial swelling following surgical extraction of a lower third molar. Photomed. and Laser Surg.. 27(1), pp 21-24 
  9. Ferrante M., Petrini M., Trentini P. and Perfetti (2013). Effect of low-level laser therapy after extraction of impacted third molars. Lasers Med. Sci.  28 .845-849
  10. Fesilhan E. and Eroglu C. N. (2019) Can photobiomodulation therapy  bean alternative to Methylprednisolone in reducing pain swelling and trismus after removal of impacted third Molars. Phobiomod, Photomed. And Laser Surg.  37(11) pp 700-705 
  11. Chow R. (2016) Photobiomodulation: Implication for Anaesthesia and Pain Relief Photomed. And Laser Surg. 34(12) pp 599-609 


  1. Laser Therapy Clinical Practice and Scientific Background  (2014) Tuner J. and Hode L. Prima Books 
  2. Handbook of Low-Level Laser Therapy (2017) Hamblin M., Pires de Sousa M. and Agrawal T. Pan Stanford Publishing
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