Quality of life of dental patients treated with laser surgery: A scoping review

Abstract Background and Aims The use of lasers has been increasing in various surgical procedures. Its specific characteristics have conquered the scalpel used to a major extent in certain surgical procedures. This scoping review aimed to assess the empirical evidence that exists on the quality of life (QoL) of dental patients treated with laser surgery. Methods This scoping review was conducted in accordance with the Arksey and O'Malley's guidelines for scoping reviews. Four electronic databases (PubMed, SCOPUS, CINAHL Complete, and APA PsycInfo) were systematically searched through a stepwise approach, informed by the PEO (Population [P], Exposure [E], and Outcome [O]) framework, to retrieve literatures relevant to the review question. After a two‐staged and Rayyan‐aided screening process, only those literatures meeting the inclusion criteria were included into the review. From the included literatures, data were extracted, collated, summarized, and presented. Results The literature search retrieved 246 articles, of which only 10 articles were selected according to the inclusion criteria. Five of the studies were from the United Kingdom and three were from Italy. Study designs were either cohort (60%) or randomized controlled trials (40%). A vast variation was observed in the study populations. The used QoL instruments were mostly disease/condition‐specific and oral cancer was the most reported disease in the included articles. The patients who underwent laser surgery had better QoL on the 7th day postoperatively, although it was not significant in later days. Conclusion Depending on the indication, Laser is a safe surgical approach that could enhance the clinical outcome as well as the QoL of dental patients. Laser effects were more significant in the domain of postoperative pain. Due to the limited number of studies evaluated in this review, further longitudinal studies are needed to corroborate the findings of this review.


| Background
Since its introduction in the year 1960, research has continued on the use of LASER (Light Amplification by the Stimulated Emission of Radiation) in dentistry. In surgical dental procedures, lasers have been used in a wide range of procedures such as gingivectomy, frenectomy, incisional or excisional biopsies, lesion removal and in making incisions for flap access. 1 Based on the wavelength and other key characteristics, the main types that have been used for surgical procedures are carbon dioxide (CO 2 ), neodymium-yttrium-aluminum-garnet (Nd:YAG), and erbium-yttrium-aluminum-garnet (Er:YAG) lasers and the diode laser. 1 The recent rapid advances in laser technology as well as the expanding knowledge of bio-interactions of various laser systems have broadened the clinical application of lasers in dentistry. 2 Evidence demonstrates enhanced clinical results in laser-assisted surgical procedures with reduced morbidity due to ablation, vaporization, hemostasis, and field sterilization leading to several benefits including minimum bleeding, reduced swelling, less discomfort, and shorter healing times. 3 However, whether these benefits affect the quality of life (QoL) of an individual compared to the other surgical techniques in dentistry is not widely discussed. Similarly, within the field of healthcare, health-related quality of life (HRQOL) is a multidimensional concept that reflects the impact of health status, the treatment's efficacy, and other elements impacting people's lives. 5 Thus, it is usually assessed via various indicators of selfperceived health status as well as physical and emotional well-being.

| Instruments to assess the QoL
Evaluating the QoL is a difficult task that requires a variety of measurements to reflect subjectivity and multidimensionality. Thus, the available instruments are developed based on empirical considerations to assess different domains of the QoL and are mainly classified as generic or condition/disease-specific. 6 Generic instruments target numerous areas of QoL across a variety of patient or illness groups, whereas condition/diseasespecific instruments measure the health parameters that are essential to a specific group of patients. 7 When assessing the QoL, the use of both generic and condition/disease-specific measures would be more beneficial as the general measures may be used to compare QOL across health conditions, while condition/disease-specific measures directly target the health condition and seem to be more clinically relevant. where the combined score will be calculated by averaging all scores.
The three global questions which were included from the version 2 of UW-QOL covers HRQOL before the cancer diagnosis, during the past 7 days and the overall QoL during the past 7 days. 9 In contrast, the OHIP-14 assesses the impact of oral health problems on an individual's life via seven domains; functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap.
Although there is a lack of a conceptual model for the assessment of QoL, it has become a key outcome measure in health-related fields and the systematic review by Pequeno et al. also has shown that the QoL instruments could help make informed decisions about disease management. 10 Furthermore, as QoL is often considered to be an expected health outcome, there are trial models proposed combining the clinical outcomes with the health-related QoL. 11 Thus, this scoping review mainly aimed at finding out the existing literature on the QoL of dental patients treated with laser surgery.

| Review design
The design of this study was based on the stepwise procedure for conducting scoping reviews; developed by Arksey  framework formed the search strategy adopted in this scoping review. 13 The population of interest was dental patients, the exposure was laser dental surgery, and the outcome was QoL.
The scoping search was performed on January 21, 2023, to retrieve relevant literature from the PubMed, SCOPUS, CINAHL Complete, and APA PsycInfo databases. This search was conducted using the terms "laser," "dental surgery," "oral surgery," "maxillofacial surgery," "periodontal surgery," "quality of life," and "wellbeing," and with the aid of Boolean operators ("AND" and "OR"). Tables A1-A3 show the search strings used for the search from each of the selected databases.
F I G U R E 1 Flowchart of the article selection process.

| Deduplication
The citations of the literature obtained from the database search were exported into the Rayyan software for deduplication. Following deduplication, based on the selection criteria, the retrieved literature was screened for inclusion in the review.

| Screening and selection
The screening process was two-staged, aided by the Rayyan software. In the first stage, two reviewers screened all papers independently by title and abstract while the second stage involved full-text screening. Disagreements among the reviewers were discussed and clarified. However, on occasions where disagreements were not amendable, a third reviewer was invited to make the final decision. Only the literature that met the inclusion criteria was included in the scoping review.

| Data extraction and analysis
From the yielded literature, the following data were extracted; citation details (names of authors, article title, and the year of publication), country of origin, study type, aims of the study, study population size and characteristics, Instrument tools used for the QoL measurement, type of the laser used and key findings relevant to the scoping review question. Extracted data were analyzed through narrative synthesis. Meta-analysis was not done in this study due to heterogeneity of data.

| Search results
A total of 262 publications (PubMed = 11, SCOPUS = 247, APA PsycINFO = 0, and CINAHL Complete = 4) were retrieved from the database search. Of these 262 publications, 16 were found to be duplicates and were removed. The remaining 246 publications were screened and only 10 articles were found relevant for inclusion in the review. Figure 1 illustrates the article selection process in accordance with the PRISMA diagram.

| Characteristics of the included studies
Of the included studies, 90% were from Europe that had been conducted in three different European countries ( According to the study designs, the majority were prospective cohort designs or randomized controlled designs ( Table 2). All studies were mostly related to the adult population.

| Assessment outcomes of QoL in patients that underwent laser-assisted surgeries
The surgical procedures that have been considered were involved with the removal of oral/oro-pharyngeal carcinoma, 14 Table 2 In literature, the terms HRQOL and QoL frequently appear interchangeably. However, it is crucial to record and explicitly specify whether overall QoL or HRQOL was assessed. 25 Among the different methods to assess QoL/HRQOL, self-administered questionnaires completed by the patient are now considered to be the most practical form of assessment. 26 The majority of the included studies measured HRQOL while only a few have assessed the overall QoL aspects using the generic and disease-specific scales.
In the selected literature for the review, the majority of the study populations were based on oro-pharyngeal cancer patients. The QoL of such patients is a crucial aspect. Due to the nature of the lesions and the management modalities including the surgical approach, there is a higher chance of compromising vital functions such as speech, swallowing, speech, taste sensation, and smell. Therefore, following surgical excision of the lesions, QoL may be affected specially in relation to the physical, psychological, social, and emotional well-being. 27 QoL/HRQOL is increasingly being utilized in clinical studies, frequently to assess the outcome of an intervention or a therapy in complementary to traditional endpoints. 28 It was interesting to note that four studies included in the review were randomized controlled trials. In clinical trials, the inclusion of QoL will also allow the clinician to compare different treatment modalities thereby assessing the benefits of the applied medical management.
This scoping review demonstrates the beneficial effects on the QoL of dental patients treated with a laser-assisted surgical procedure.