Abstract
Temporomandibular joint dysfunction syndrome (TMD), is a collective term characterized by symptoms involving chewing muscles, temporomandibular joint and orofacial structures. The efficacy of low intensity laser (LLLT) Gallium arsenide, in combination with a non-steroidal anti-inflammatory drug (NSAID) was evaluated. The main objective was to evaluate the maximum mouth opening without pain (ABM), arthralgia in the joint capsule through visual analog scale (VAS), laterality, protrusion, joint noises and count of tablets ingested per group. A controlled clinical trial (double-blind-randomized) was carried out in 30 subjects, who presented DTM of arthrogenic etiology; 5 applications of LLLT were made with wavelength of 810 nm, output optical power of 100-200 mw, emission PW=Pulsed (1-10,000Hz), dose of 10 jouls-cm², time of 1.44 minutes in mouth closed and with the mouth half open. One more follow-up appointment per month. There were two groups: experimental and control group, where different variables were analyzed (ABM, laterality, protrusion, VAS and sociodemographic). In the control group, a supposed LT application (not active) was made, for later comparison. Pain-free ABM was assessed in all appointments in addition to the other clinical parameters. Repeated measures analysis was performed with mixed models. Thirty patients were included of which 28 finished the treatment, two of them were lost during follow-up. The groups were similar in all their baseline variables. There were no statistically significant differences when applying the final multiple regression analysis, in the ABM, or in any other of the clinical parameters analyzed. LT was not effective in treating arthrogenic DTM.
References
Carvalho F.R., Barros R.Q., Gonçalves A.S., Freitas P.M. Photobiomodulation therapy on the palliative care of temporomandibular disorder and orofacial/cervical skull pain: study protocol for a randomized controlled clinical trial. Trials 2019; 20 (1): 200.
Sousa D.F.M., Gonçalves M.L.L., Politti F., et al. Photobiomodulation with simultaneous use of red and infrared light emitting diodes in the treatment of temporomandibular disorder: study protocol for a randomized, controlled and double-blind clinical trial. Medicine (Baltimore) 2019; 98 (6): e14391.
Xu G.Z., Jia J., Jin L., Li J.H., Wang Z.Y., Cao D.Y. Low-level laser therapy for temporomandibular disorders: A systematic review with meta-analysis. Pain Res Manag 2018; 2018: 4230583.
Sayed N., Murugavel C., Gnanam A. Management of temporomandibular disorders with low level laser therapy. J Maxillofac Oral Surg 2014; 13 (4): 444-50.
Denucci D.J., Dionne R.A., Dubner R. Identifying a neurobiologic basis for drug therapy in DTMs. J Am Dent Assoc 1996; 127 (5): 581-93.
Masumi S., Kim Y.J., Clark G.T. The value of maximum jaw motion measurements for distinguishing between common temporomandibular disorder subgroups. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93 (5): 552-9.
Yuasa H., Kurita K.; Treatment Group on Temporomandibular Disorders. Randomized clinical trial of primary treatment for temporomandibular joint disk displacement without reduction and without osseous changes: a combination of NSAIDs and mouth-opening exercise versus no treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001; 91 (6): 671-5.
Okeson J.P. Tratamiento de oclusión y afecciones temporomandibulares. España: Edición 5ta. ed. Mosby Elsevier; 2003.
Costa S.A.P., Florezi G.P., Artes G.E., et al. The analgesic effect of photobiomodulation therapy (830 nm) on the masticatory muscles: a randomized, double-blind study. Braz Oral Res 2017; 31: e107.
De Carli M.L., Guerra M.B., Nunes T.B., et al. Piroxicam and laser phototherapy in the treatment of TMJ arthralgia: a double-blind randomised controlled trial. J Oral Rehabil 2013; 40 (3): 171-8.
Leal de Godoy C.H., Motta L.J., Garcia E.J., et al. Electromyographic evaluation of a low-level laser protocol for the treatment of temporomandibular disorder: a randomized, controlled, blind trial. J Phys Ther Sci 2017; 29 (12): 2107-11.
Mazzetto M.O., Hotta T.H., Pizzo R.C. Measurements of jaw movements and TMJ pain intensity in patients treated with GaAlAs laser. Braz Dent J 2010; 21 (4): 356-60.
Machado B.C., Mazzetto M.O., Da Silva M.A., de Felício C.M. Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Lasers Med Sci 2016; 31 (5): 945-54.
Tuner J., Hode L. The laser therapy handbook. Sweden: ed. Prima Books AB; 2004.
Manaf T.A. Low-level laser therapy as a solution in the dental clinic: A review and case report. J Oral Laser Application 2007; 7: 65-73.
Ferreira L.A., de Oliveira R.G., Guimarães J.P., Carvalho A.C., De Paula M.V. Laser acupuncture in patients with temporomandibular dysfunction: a randomized controlled trial. Lasers Med Sci 2013; 28 (6): 1549-58.
Shukla D., Muthusekhar M.R. Efficacy of low-level laser therapy in temporomandibular disorders: A systematic review. Natl J Maxillofac Surg 2016; 7 (1): 62-6.
Marini I., Gatto M.R., Bonetti G.A. Effects of superpulsed low-level laser therapy on temporomandibular joint pain. Clin J Pain 2010; 26 (7): 611-6.
Panhoca V.H., Lizarelli R. de F., Nunez S.C., et al. Comparative clinical study of light analgesic effect on temporomandibular disorder (DTM) using red and infrared led therapy. Lasers MedSci 2015; 30 (2): 815-22.
Demirkol N., Sari F., Bulbul M., Demirkol M., Simsek I., Usumez A. Effectiveness of occlusal splints and low-level laser therapy on myofascial pain. Lasers Med Sci 2015; 30 (3): 1007-12.
Venancio R. de A., Camparis C.M., Lizarelli R. de F. Low intensity laser therapy in the treatment of temporomandibular disorders: a double-blind study. J Oral Rehabil 2005; 32 (11): 800-7.
Madani A.S., Ahrari F., Nasiri F., Abtahi M., Tunér J. Low-level laser therapy for management of TMJ osteoarthritis. Cranio 2014; 32 (1): 38-44.
Emshoff R., Bösch R., Pümpel E., Schöning H., Strobl H. Low-level laser therapy for treatment of temporomandibular joint pain: a double-blind and placebo-controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105 (4): 452-6.
Chen J., Huang Z., Ge M., Gao M. Efficacy of low-level laser therapy in the treatment of DTMs: a meta-analysis of 14 randomised controlled trials. J Oral Rehabil 2015; 42 (4): 291-9.
Shobha R., Narayanan V.S., Jagadish Pai. B.S., Jaishankar H.P., Jijin M.J. Low-level laser therapy: A novel therapeutic approach to temporomandibular disorder - A randomized, double-blinded, placebo-controlled trial. Indian J Dent Res 2017; 28 (4): 380-7.
Chellappa D., Thirupathy M. Comparative efficacy of low-Level laser and TENS in the symptomatic relief of temporomandibular joint disorders: A randomized clinical trial. Indian J Dent Res 2020; 31 (1): 42-7.
Rezazadeh F., Hajian K., Shahidi S., Piroozi S. Comparison of the effects of transcutaneous electrical nerve stimulation and low-level laser therapy on drug-resistant temporomandibular disorders. J Dent (Shiraz) 2017; 18 (3): 187-92.
Carrasco T.G., Guerisoli L.D., Guerisoli D.M., Mazzetto M.O. Evaluation of low intensity laser therapy in myofascial pain syndrome. Cranio 2009; 27 (4): 243-7.
Van den Berghe L.I., de Boever J.A., Schautteet H. Double-blind clinical study of Piroxicam as adjuvant in the treatment of the pain and dysfunction of the temporomandibular joints. Cranio 1986; 4 (4): 351-6.
Khalighi H.R., Mortazavi H., Mojahedi S.M., Azari-Marhabi S., Moradi Abbasabadi F. Low level laser therapy versus pharmacotherapy in improving myofascial pain disorder syndrome. J Lasers Med Sci 2016; 7 (1): 45-50.
Kaptchuk T.J., Goldman P., Stone D.A., Stason W.B. ¿Do medical devices have enhanced placebo effects? J Clin Epidemiol 2000; 53: 786-92.