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 CO2 laser is one of the earliest lasers used in soft tissue surgery. The strong affinity of the CO2 laser to water makes it a very useful device in surgery for ablation, evaporization, coagulation and cutting the tissues. The properties of the CO2 laser lead to some advantages over steel scalpel surgery such as hemostasis of tiny blood vessels, instant sterilization of the surgical site, reduction of the bacteremia risk, more rapid tissue removal and ablation, reduction of mechanical trauma and a reduction in initial inflammatory responses, discomfort and pain after surgery. This latter characteristic of CO2 laser surgery (pain relieving effects) is often overlooked in practice and literature. Some studies demonstrated that by some provisions, the CO2 laser can be used as a safe, non-thermal, non-invasive photobiomodulation (PBM) laser for instant and significant pain reduction of some oral and mucosal lesions without any visible thermal complications. Due to its non-thermal nature, this PBM technique was termed Non-Thermal CO2 Laser Therapy (NTCLT), This article presents a narrative review about the pain relieving effects of CO2 laser application on painful oral lesions. To provide a comprehensive understanding in this field, these analgesic effects on painful oral lesions will be discussed in two sections: a) application of CO2 laser as a surgical, thermal, ablative device, b) application of CO2 laser as a non-thermal, non-ablative photobiomodulation device (Non-Thermal CO2 Laser Therapy: NTCLT). The advantages, limitations and disadvantages of these laser systems on pain reduction of some painful oral lesions will be discussed.

Keywords: CO2 laser, pain relief, oral lesions, photobiomodulation, low level laser therapy, Laser surgery

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