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which were matched for age and sex. The patients of acyclovir with PBM group were treated with
acyclovir cream 5% (5 times daily for 5 days) and PBM.

Patients received PBM (Konf™- Konftec Corporation, Taiwan), ( in the symptomatic phase of herpes
lesions. PBM was conducted by mean of a 100 mW, semi-conductor diode laser (InGaAsP) with
wavelength of 940 ± 10 nm. Laser irradiation was performed in one session in the rst 24 to 48 hours
2
after the lesion. The spot size was 0.5 cm and the irritation duration was 20 s. The other patients were
treated by the same regimen of acyclovir cream and diode laser while the device was turned off
(considered as placebo). It should be noted that the protective eyewear was used for the safety of
patients, dentists, and dental assistants.

The lesion size was determined by measuring the two main diameters of the lesion in square millimeters
using a transparent graph paper and graded in range of 0 to 3 (grade 0: no lesion, grade 1: 0.1 to 2.0 mm,

grade 2: 2–5 mm, and grade 3: larger than 5 mm). The pain intensity was evaluated based on the visual
analogue scale (VAS), which 0 represented no pain and 10 represented the most severe pain ever
experienced. At the rst session, the lesion size before treatment and pain intensity before and right after
treatment were evaluated by an oral medicine specialist.

Due to the covid-19 pandemic situation, we applied phone call follow-up in this study. The follow-ups
were applied on the rst, second, and third day after the treatment. In each follow-up the researcher

described the VAS criteria (Fig. 1) clearly to the patients, and then asked them to grade the pain intensity
accordingly.

Also, the size of lesions was measured by an oral medicine specialist by processing photos which have
sent by patients. Data were analyzed by independent T-Test and Chi-square (at a signi cance level of
0.05) by SPSS-21 software.

Results

22 patients with symptomatic RHL were participated in the study A consort owchart was illustrated in

Fig. 2. 12 patients (53.3%) were women and mean age was 27.5 ± 7.08 years old.

As Table 1 shows, the t-test demonstrated that the mean pain score based on VAS was not signi cantly

different between the two groups, before treatment, right after, and the rst day after treatment (p = 0.43,
p = 0.55, and p = 0.12, respectively). But the second day, and the third day after treatment acyclovir with
the PBM group had a signi cantly lower mean pain score than acyclovir without laser (p < 0.001 both

days) (Fig. 3).

The chi-square test showed that there was no signi cant difference between the groups in terms of

frequency of various grades of lesions size before treatment, rst day, and third day after treatment (p =
0.45, p = 0.28, and p = 0.69, respectively) (Table 2). It is worth mentioning that, in acyclovir with PBM

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