User:Cryptolysis

Cryptolysis, or laser cryptolysis, is a minor procedure or, accurately speaking is a minimally invasive procedure that utilizes CO2 laser to treat various etiologies of bad breath, or halitosis.

Basic concept
Laser cryptolysis is a procedure that exploits laser to eliminate one of the most important causes of halitosis. The mucous membrane of the oral cavity possesses unique microscopic pit-like structures that are named crypts. These crypts are most numerous on the tonsillar surface and, less densely, on the gums. The problem with these crypts is that they can accumulate tiny food particles in the their bases which have low oxygen levels.The low oxygen level environment is perfect for hydrogen sulfide producing bacteria such as Veillonella, Actinomyces and Prevotella. Accordingly, when these species of bacteria settle in the bases of the crypts of the tosils and gums, they start decomposing food particles and produce hydrogen sulfide which is a gas that has a very fetid odor.

Laser cryptolysis is designed to eliminate the main predisposing factor for development of halitosis, the crypts. The heat of the laser beam is directed towards the outer surface of the mucous membrane of oral structures such as the tonsils. The mucous membrane heats up which leads to elimination of the crypts. Laser cryptolysis doesn't lead to destruction of the tonsillar tissue. Complete preservation of the function of the tonsils is guaranteed after the procedure. Moreover, the procedure doesn't trigger the synthesis of excessive fibrous tissue; hence, scarring is minimal.

Deletion of the crypts of the tonsils and gums leads to an overall reduction of the surface area of the mucous membrane of the oral cavity which means that the area available for hydrogen sulfide producing bacteria will be reduced. Moreover, elimination of the crypts raises the oxygen tension on the surface of the mucous membrane of the tonsils which renders the environment inappropriate for the growth of those bacteria that essentially need low levels of oxygen to thrive.

Performing laser cryptolysis on patients with treatment resistant halitosis leads to resolution of the problem in more than 96% of cases after no more than 3 treatment sessions.

Indications
After exclusion of systemic causes of halitosis such as liver cell disease, chronic renal failure, diabetes mellitus, chronic supparative lung diseases and other systemic disorders, most of patients have a local cause for their bad breath problem.

Careful selection of cases who have a local cause for halitosis is mandatory. Dental, periodontal and sinonasal causes of halitosis should be carefully investigated and ruled out before laser cryptolysis is planned. Laser cryptolysis should be targeted to patients whose bad breath problems are related to accumulation of hydrogen sulfide producing bacteria which dwell in the base of the crypts of the tonsils, and to a lesser extent, the gums.

Finkelstein's test is useful in selecting patients who would benefit from laser cryptolysis. The test involves massaging both tonsils and smelling the discharge that comes out of the crypts. If the discharge that comes out is foul, this is a sign that the patient would benefit from a laser cryptolysis procedure.

Laser cryptolysis is also indicated for patients with tonsil stones (tonsilloliths) and chronic fetid tonsillitis.

The procedure
Laser cryptolysis, as mentioned earlier, is a minor procedure. It can be performed in an office on outpatient basis. In most cases, the procedure requires no more than topical anesthesia. A laser cryptolysis treatment session usually lasts less than 30 minutes. During the procedure, no pain or discomfort is perceived by patients who undergo the procedure. In most cases, after a laser cryptolysis treatment session, the patient can return to his normal daily activities within a few hours after the procedure is successfully completed.

A recent medical study has shown that about 52% of patients require a single treatment session to completely treat their halitosis problem, 35% require 2 treatment sessions and less than 10% of patients require 3 treatment sessions to completely treat their bad breath problems.

Contraindications
There are no contraindications to laser cryptolysis so long as candidates are carefully selected to ensure they would benefit from the procedure.

Cryptolysis vs. tonsillectomy
Ever since the laser cryptolysis has been introduced, more than 20 years ago, clinicians and patients have been comparing it to tonsillectomy as a line of treatment for halitosis. Although tonsillectomy is mostly indicated for conditions other than halitosis, some physicians perform tonsillectomy as a treatment line for halitosis.

If chronic fetid tonsillitis is the main problem and Finkelstein's test is positive, laser cryptolysis would be the best line of treatment for the patient. On the other hand, if a patient complains from repeated attacks of acute tonsillitis that are keeping him from normally attending to his everyday activities, tonsillectomy should be performed.

Laser cryptolysis is a procedure that eliminates bad breath without sacrificing the tonsillar tissue. The tonsils are important parts of our immune system as they function as antigen presenting organs which present foreign bodies to other parts of the immune system to produce a response. It is well believed that the tonsils are essential for children below the age of four years, so it is not advisable to perform tonsillectomy for children below 4 years of age.It is also not advisable to perform tosillectomy on old patients and on individuals who are immunocompromised.

As compared to the price of tonsillectomy, laser cryptolysis costs no more than 10% of the cost of tonsillectomy. In other words, when laser cryptolysis in indicated, it guarantees the best outcome with a prices that is far less than that of tonsillectomy.