Comparative Study of the Physiotherapeutic and Drug Protocol and Low-Level Laser Irradiation in the Treatment of Pain Associated With Temporomandibular Dysfunction.
- 11 UMR 7365 CNRS-Université de Lorraine, Faculté de Médicine, Vandoeuvre-Les-Noucy-France and Postgraduation Department-Cruzeiro do Sul University, São Paulo, SP, Brasil .
- 22 Departamento de Odontologia-DOD, Rio Grande do Norte Federal University , Natal, Brazil .
- 33 Center for Research and Innovation in Laser, Nove de Julho University , São Paulo, SP, Brasil .
- 44 Biomedicine Engineering, Mogi das Cruzes University , Mogi das Cruzes, São Paulo, Brasil .
- 55 Nove de Julho University , São Paulo, SP, Brasil .
- 66 Department of Medical, Oral and Biotechnological Sciences, “G. d’Annunzio” University , Chieti, Italy .
- 77 UMR 7365 CNRS-Université de Lorraine , Faculté de Médecine, Vandoeuvre-lés-Nancy, France .
- 88 Cruzeiro do Sul University , São Paulo, SP, Brasil.
The temporomandibular joint (TMJ) is a structure of the craniofacial complex affected by neurological diseases. Orthopedic and musculoskeletal changes can also cause temporomandibular disorders (TMD) and pain. Low-level laser (LLL) therapy has been studied in the treatment of temporomandibular jaw (TMJ) dysfunction, and controversial results were obtained.
The objective of this work was comparing the physiotherapeutic and drug protocol (PDP) to LLL therapy in the treatment of pain associated with TMD.
A sample of 60 female patients, 20-50 years of age, TMD triggering agents (stress, parafunctional habits) controlled, was randomly divided into three groups, group 1 (G1)-LLL (780?nm laser, dose of 35.0?J/cm2, for 20?sec, thrice a week, for 4 weeks); group 2 (G2)-PDP (hot packs thrice a day, morning, afternoon, and evening, for 15?min, exercise of opening and closing the mouth, twice a day, myorelaxing and anti-inflammatory drug administration); and group 3 (G3)-Placebo (450?nm halogen lamp, Max LD Gnatus, light curing unit).
Patients were evaluated every return appointment for the presence (P) or absence (A) of pain for 4 weeks and results were statistically analyzed. First week: 60% of G1, 100% G2, and 70% of G3-related pain. Second week: 55% of G1, 15% of G2, and 100% of G3-related pain. Third week: 10% of G1, 15% of G2, and 85% of G3-related pain. Last week: 0% of G1, 0% of G2, and 100% of G3-related pain.
Based on obtained data, we concluded that, compared to PDP, LLL treatment is effective to control pain associated with TMD.
Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up.
- 1Department of Ophtalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine, University of São Paulo, Av. dos Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil.
- 2Craniofacial Research Support Centre, University of São Paulo, São Paulo, Brazil.
- 3Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil.
- 4Department of Ophtalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine, University of São Paulo, Av. dos Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil. email@example.com.
- 5Craniofacial Research Support Centre, University of São Paulo, São Paulo, Brazil. firstname.lastname@example.org.
This study investigated the efficacy of combining low-level laser therapy (LLLT) with oral motor exercises (OM-exercises) for rehabilitation of patients with chronic temporomandibular disorders (TMDs). Eighty-two patients with chronic TMD and 20 healthy subjects (control group) participated in the study. Patients were randomly assigned to treatment groups: GI (LLLT?+?OM exercises), GII (orofacial myofunctional therapy-OMT-which contains pain relief strategies and OM-exercises), and GIII (LLLT placebo?+?OM-exercises) and GIV (LLLT). LLLT (AsGaAl; 780-nm wavelength; average power of 60 mW, 40 s, and 60?±?1.0 J/cm²) was used to promote analgesia, while OM-exercises were used to reestablish the orofacial functions. Evaluations at baseline (T1), after treatment immediate (T2), and at follow-up (T3) were muscle and joint tenderness to palpation, TMD severity, and orofacial myofunctional status. There was a significant improvement in outcome measures in all treated groups with stability at follow-up (Friedman test, P?<?0.05), but GIV did not show difference in orofacial functions after LLLT (P?>?0.05). Intergroup comparisons showed that all treated groups had no difference in tenderness to palpation of temporal muscle compared to GC at follow-up (Kruskal-Wallis test, P?<?0.01). Moreover, GI, GII, and GIII showed no difference from GC in orofacial functional condition (T2 and T3) while they differed significantly from GIV (P?<?0.01). In conclusion, LLLT combined with OM-exercises was more effective in promoting TMD rehabilitation than LLLT alone was. Similar treatment results were verified with the OMT protocol.
Effectiveness of occlusal splints and low–level laser therapy on myofascial pain.
- 1Department of Prosthodontics, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey, email@example.com
The present study was designed to evaluate the effects of low–level laser (Nd:YAG) therapy and occlusal splints in patients with signs and symptoms of temporomandibular disorders (TMD) characterized with myofascial pain (MP). A total of 30 patients were selected after being diagnosed with MP according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TDM). The patients were divided into three groups. The first group was occlusal splint (OS) group A (n=10), the second was low–level laser therapy (LLLT) group B (n=10), and the last group C was placebo (n=10). LLLT (1,064 nm, 8 j/cm2, 250 mW, Fotona) was applied to the patients in the study group once a day for 10 days, for a total of ten sessions. The same parameters and application times were used for placebo group, but the patients were not irradiated. The application was on the trigger points. The patients in the OS group were instructed to wear occlusal splints 12 h/day for 3 weeks. Functional examination was based on RDC/TDM, and pressure pain values were obtained with the Visual Analog Scale. Comparisons were made between the groups before and after the treatment according to Wilcoxon, Mann-Whitney U, and Kruskal-Wallis tests. The pain score values decreased significantly after both LLLT (p<0.05) and occlusal splint therapy (p<0.05) compared to placebo group (p<0.05). There was no significant difference between LLLT and OS groups after treatment (p>0.05). OS and LLLT are effective for decreasing MP. In addition, this particular type of LLLT is as effective as occlusal splint for pain relief.
Efficacy of red and infrared lasers in treatment of temporomandibular disorders–a double-blind, randomized, parallel clinical trial.
Low-level laser therapy has still not been well established, and it is important to define a standardized protocol for the treatment of temporomandibular disorders (TMDs) using low level laser. There is no consensus on controlled clinical trials concerning the best option for laser therapy with regard to wavelength. The aim of this study was to evaluate the efficacy of red and infrared laser therapy in patients with TMD, using a randomized parallel-group double-blind trial.
Each hemiface of 19 subjects was randomized to receive intervention, in a total of 116 sensitive points. Pain was measured at baseline and time intervals of 24 hours, 30 days, 90 days, and 180 days after treatment. Irradiation of 4 J/cm2 in the temporomandibular joints and 8 J/cm(2) in the muscles was used in three sessions.
Both treatments had statistically significant results (P<0.001); there was statistical difference between them at 180 days in favor of the infrared laser (P=0.039). There was improvement in 24 hours, which extended up to 180 days in both groups.
Evaluation of orofacial function in temporomandibular disorder patients after low-level laser therapy.
Department of Prosthodontics, Faculty of Dentistry, Istanbul University , Istanbul , Turkey.
Abstract Objective. To evaluate the effect of low-level laser therapy on occlusal contact area, occlusal pressure and bite force in temporomandibular disorder patients.
Patients and method. Twenty patients (14 women, six men, mean age 33.1 ± 3.8 years) diagnosed with myofascial pain according to the Research Diagnostic Criteria for Temporomandibular Disorder (RDC/TMD) participated in the study. Twenty healthy individuals, matched in age and gender, served as a control group. Low-level laser was applied to the mastication muscles three times per week, for a total of 10 sessions. The mandibular mobility range was evaluated. The maximum bite force, occlusal contact area and occlusal pressure were measured bilaterally with a dental pre-scale before and after treatment. All variables were analyzed descriptively. Changes in the masticatory muscle tenderness, mandibular movements, maximum bite force, occlusal contact area and occlusal pressure were compared by paired-sample Student’s t-tests.
Results. There was a significant increase in the pressure pain threshold of the examined muscles. Mandibular movements were significantly improved in all patients. There was also a significant decrease in pain by palpation after laser exposure. However, no significant change was found in the maximum bite force, occlusal contact area or occlusal pressure after the treatment and also the values after the treatment were still significantly lower than those of the healthy individuals.
Conclusion. This particular type of LLLT is effective at relieving pain but does not provide physical improvement.
Low level laser therapy as an adjunctive technique in the management of temporomandibular disorders.
Department of Restorative Dentistry, Dental School of Ribeirão Preto, University of São Paulo, Brazil. firstname.lastname@example.org
The purpose of this study was to assess the effect of low level laser therapy on subjects with intra-articular temporomandibular disorders (IA-TMD), and to quantify and compare severity of signs and symptoms before, during, and after the laser applications. The sample consisted of 45 subjects randomly divided into three groups (G) of 15 subjects each: G-I: 15 individuals with IA-TMD submitted to an energy dose of 52.5 J/cm2; G-II: dose of 105.0 J/cm2; and G-III: placebo group (0 J/cm2). In all groups, the applications were performed on condylar points on the masseter and anterior temporalis muscles. Two weekly sessions were held for five weeks, totaling 10 applications. The assessed variables were: mandibular movements and painful symptoms evoked by muscle palpation. These variables were measured before starting the study, then immediately after the first, fifth, and tenth laser application, and finally, 32 days after completing the applications. The results showed that there were statistically significant differences for G-I and G-II at the level of 1% between the doses, as well as between assessments. Therefore, it was concluded that the use of low level laser increased the mean mandibular range of motion and reduced painful symptoms in the groups that received effective treatment, which did not occur in the placebo group.
Lasers Med Sci. 2012 Nov 10. [Epub ahead of print]
Evaluation of low-level laser therapy effectiveness on the pain and masticatory performance of patients with myofascial pain.
Health Science Program, Federal University of Sergipe, Sergipe, Brazil.
This study investigated the effect of low-level laser therapy (LLLT) on the masticatory performance (MP), pressure pain threshold (PPT), and pain intensity in patients with myofascial pain. Twenty-one subjects, with myofascial pain according to Research Diagnostic Criteria/temporomandibular dysfunction, were divided into laser group (n=12) and placebo group (n=9) to receive laser therapy (active or placebo) two times per week for 4 weeks. The measured variables were: (1) MP by analysis of the geometric mean diameter (GMD) of the chewed particles using Optocal test material, (2) PPT by a pressure algometer, and (3) pain intensity by the visual analog scale (VAS). Measurements of MP and PPT were obtained at three time points: baseline, at the end of treatment with low-level laser and 30 days after (follow-up). VAS was measured at the same times as above and weekly throughout the laser therapy. The Friedman test was used at a significance level of 5 % for data analysis. The study was approved by the Ethics Committee of the Federal University of Sergipe (CAAE: 0025.0.107.000-10). A reduction in the GMD of crushed particles (p<0.01) and an increase in PPT (p<0.05) were seen only in the laser group when comparing the baseline and end-of-treatment values. Both groups showed a decrease in pain intensity at the end of treatment. LLLT promoted an improvement in MP and PPT of the masticatory muscles.
Photomed Laser Surg. 2012 May;30(5):275-80.
Effectiveness of physiotherapy and GaAlAs laser in the management of temporomandibular joint disorders.
Department of Paediatric Stomatology, 2nd Medical Faculty, Charles University, Prague, Czech Republic. email@example.com
Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT.
LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients’ lives.
MATERIALS AND METHODS:
TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4 J/cm(2)) by semiconductive GaAlAs laser with an output of 280 mW, emitting radiation wavelength of 830 mm. The laser supplied a spot of ~0.2 cm(2).
Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42 mm.
The laser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of pain symptoms.
Effectiveness of Physiotherapy and GaAlAs Laser in the Management of Temporomandibular Joint Disorders.
1 Department of Paediatric Stomatology, 2nd Medical Faculty, Charles University , Prague, Czech Republic .
Abstract Objective: Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT.
Background data: LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients’ lives.
Materials and Methods: TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4?J/cm(2)) by semiconductive GaAlAs laser with an output of 280?mW, emitting radiation wavelength of 830?mm. The laser supplied a spot of?0.2?cm(2).
Results: Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42?mm.
Conclusions: The laser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of pain symptoms.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2011 Aug;29(4):393-5, 399.
Efficacy evaluation of low-level laser therapy on temporomandibular disorder.
State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China.
To evaluate effectiveness of low-level laser therapy (LLLT) on temporomandibular joint (TMJ) pain.
The patients with TMJ pain were randomly assigned laser group (n=21) or control group(n=21), once a day for 6 consecutive days of treatment. TMJ pain and function were measured at baseline, just after treatment course, 1 month and 2 months after the treatment.
The changes of visual analogue scale (VAS) were appearing over time in both groups but presented statistically significant differences between groups (P<0.001). VAS of laser group decreased faster than that of control group. The same tendency occurred for painless maximum vertical opening (MVO), left lateral excursion (LLE) and right lateral excursion (RLE), which increased faster in laser group. There were no statistically significant differences between groups and evaluation times for protrusion excursion (PE), but an interaction between group and evaluation times existed and should be explored further.
LLLT is an appropriate treatment for TMJ pain.
Photomed Laser Surg. 2011 Apr;29(4):245-54.
Evaluation of laser phototherapy in the inflammatory process of the rat’s TMJ induced by carrageenan.
Center of Biophotonics, School of Dentistry, Federal University of Bahia, Salvador, BA, Brazil.
The aim of this study was to evaluate, by light microscopy, the effects of laser phototherapy (LPT) at 780?nm or a combination of 660 and 790?nm, on the inflammatory process of the rat temporomandibular joint (TMJ) induced by carrageen.
Temporomandibular disorders (TMDs) are frequent in the population and generally present an inflammatory component. Previous studies have evidenced positive effects of laser phototherapy on TMDs. However, its mechanism of action on the inflammation of the TMJ is not known yet.
MATERIALS AND METHODS:
Eighty-five Wistar rats were divided into 9 groups: G1, Saline; G2, Saline?+?LPT IR; G3, Saline?+?LPT IR?+?R; G4, Carrageenan; G5, Carrageenan?+?LPT IR; G6, Carrageenan?+?LPT IR?+?R; G7, previous LPT?+?Carrageenan; G8, previous LPT?+?carrageenan?+?LPT IR; and G9, previous LPT?+?carrageenan?+?LPT IR?+?R, and then subdivided in subgroups of 3 and 7 days. After animal death, specimens were taken, routinely cut and stained with HE, Sirius Red, and Toluidine Blue. Descriptive analysis of components of the TMJ was done. The synovial cell layers were counted.
Injection of saline did not produced inflammatory reaction and the irradiated groups did not present differences compared to nonirradiated ones. After carrageenan injection, intense inflammatory infiltration and synovial cell layers proliferation were observed. The infrared irradiated group presented less inflammation and less synovial cell layers number compared to other groups. Previous laser irradiation did not improve the results.
It was concluded that the LPT presented positive effects on inflammatory infiltration reduction and accelerated the inflammation process, mainly with IR laser irradiation. The number of synovial cell layers was reduced on irradiated group.
Schweiz Monatsschr Zahnmed. 2010;120(3):213-25.
Laser acupuncture for myofascial pain of the masticatory muscles. A controlled pilot study.
[Article in English, German]
Katsoulis J, Ausfeld-Hafter B, Windecker-Gétaz I, Katsoulis K, Blagojevic N, Mericske-Stern R.
Department of Prosthodontics, School of Dental Medicine, University of Bern, Bern, Switzerland. firstname.lastname@example.org
PURPOSE: The purpose of this investigation was to evaluate the effectiveness of laser acupuncture within the scope of a pilot study.
METHODS: 108 adult patients were examined and of those eleven patients were included in the prospective pilot study. These patients took part voluntarily and were diagnosed with tendomyopathy of the masticatory musculature with maximum face and jaw pain on a visual analogous scale VAS > or = 30 in the last 14 days. Four patients wanted to be sure not to be assigned to the placebo group and were treated with the laser (group1, verum open, N = 4). The remaining seven were split by means of block randomisation into groups 2 (verum blind, N = 3) and 3 (placebo blind, N = 4). Two local points (ST 6, SI 18) and two distant points (SI 3, LI 4) on both sides of the body were stimulated (groups 1 and 2) or placebo-stimulated (group 3) with the LASERneedle machine for 15 minutes twice a week for three weeks (6 sessions). After three months a clinical follow-up was carried out, which included a standardised questionnaire as to the maximum pain intensity (VAS and verbal scale) and on the need for further treatment. A pain reduction (VAS) of about 50% was evaluated as a success.
RESULTS: Pain decreased on average 40 VAS points for ten of eleven patients. The pain reduction on the VAS in group 1 (verum open) was more than 50% for all four patients, in group 3 (placebo blind) for three of four patients, and in group 2 (verum blind) all remained under 50%. The evaluation on the verbal scale showed a pain reduction from moderate to very strong pains initially, to moderate, light and no pain after three months for all three groups.
DISCUSSION: The range of application of the laser was limited by the narrow inclusion criteria of the pilot study. The laser acupuncture (open and blinded) did not show a negative effect in any group. The pain reduction was strongest with the blinded patients of the placebo group. The worst performance was in the blinded group with laser acupuncture.
CONCLUSION: Due to the low number of participants, no clear conclusion can be drawn. Laser needle acupuncture may be a treatment option for patients with an interest in a noninvasive, complementary therapy. But clarification and treatment planning on an individual basis must take place first.
J Orofac Pain. 2010 Summer;24(3):293-7.
The Anti-inflammatory Effect of Low-Level Laser Therapy on Experimentally Induced Inflammation of Rabbit Temporomandibular Joint Retrodiscal Tissues.
Kucuk BB, Oral K, Selcuk NA, Toklu T, Civi OG.
Aims: To investigate the effect of low-level laser therapy (LLLT) on experimentally induced inflammation in retrodiscal tissues of the rabbit temporo?mandibular joint (TMJ) using scintigraphic imaging. Methods: Eleven male New Zealand rabbits were included in this study. Six randomly selected rabbits were imaged to provide normal joint images (normal group) before the initiation of the experiment. A 5% formalin solution was locally injected into both right and left TMJs of all rabbits. Subsequently, Ga-Al-As laser (wavelength: 815 nm; energy density: 12 J/cm2; output power: 250 mW) was applied for 48 seconds. The treatment was performed six times for 2 weeks to the left TMJ of all rabbits. The right TMJs of the rabbits were used as the control (nontreated) TMJ group, while left TMJs were used as the treated TMJ group. Static images of TMJ were taken at 24 hours, 7 days, and 14 days after the beginning of the treatment. The images of all TMJs were taken in the posteroanterior direction with the rabbit under sedation and its mouth open. The Mann-Whitney U test was used to compare group differences, and intragroup differences were determined by the Friedman test and Wilcoxon sign test. Results: Significant differences were found between normal and both the control and treated TMJ groups. A reduction of inflammation in both treated and control TMJ groups was obtained, but there was no statistically significant difference between the groups. Conclusion: Under the conditions used in this study, quantitative scintigraphic measurements of TMJ inflammation of the treated TMJ group decreased but did not differ significantly from those of the control TMJ group. J Orofac Pain 2010;24:293-297.
Clin J Pain. 2010 Jul 20. [Epub ahead of print]
Effects of Superpulsed Low-level Laser Therapy on Temporomandibular Joint Pain.
Marini I, Gatto MR, Bonetti GA.
*Department of Orthodontics and Gnathology daggerSchool of Dentistry, Alma Mater Studiorum University of Bologna, Bologna, Italy.
OBJECTIVES: A randomized double-blind study was conducted to compare the efficacy of superpulsed low-level laser therapy (SLLLT) with nonsteroidal anti-inflammatory drugs in the treatment of pain caused by temporomandibular joint disorders. METHODS: A total of 99 patients with temporomandibular joint disorders, secondary to disc displacement without reduction or osteoarthritis were randomly divided into 3 groups. Thirty-nine patients received SLLLT in 10 sessions over 2 weeks, 30 patients received ibuprofen 800 mg twice a day for 10 days, and 30 patients received sham laser as placebo in 10 sessions over 2 weeks. Pain intensity was measured by visual analog scale at baseline, 2, 5, 10, and 15 days of treatment. Mandibular function was evaluated by monitoring active and passive mouth openings and right and left lateral motions at baseline, 15 days, and 1 month of treatment. Magnetic resonance imaging was performed at baseline and the end of therapy. RESULTS: Mean visual analog scale pain scores in SLLLT group was significantly lower than in nonsteroidal anti-inflammatory drug group and control group (P=0.0001) from fifth day up to the end of the observation period. As for active and passive mouth openings and right and left lateral motions, superiority of SLLLT was evident 1 month after treatment (interaction time treatment, P=0.0001). DISCUSSION: Mandibular function improved in all SLLLT patients proving the effectiveness in the treatment of pain, as demonstrated by a significant improvement in clinical signs and symptoms of temporomandibular joint disc displacement without reduction and osteoarthritis at the end of treatment and stability over a period of 1 month.
Cranio. 2010 Apr;28(2):84-91.
Low level laser effects on pain to palpation and electromyographic activity in TMD patients: a double-blind, randomized, placebo-controlled study.
Venezian GC, da Silva MA, Mazzetto RG, Mazzetto MO.
Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil.
The purpose of this study was to evaluate the effect of diode laser (GaAIAs – 780 nm) on pain to palpation and electromyographic (EMG) activity of the masseter and anterior temporalis muscles. The laser was applied on the temporalis and masseter muscles twice a week (four weeks). Forty-eight (48) patients with myofascial pain were randomly assigned between actual and placebo treatments and between the energetic doses of 25 J/cm2 and 60 J/cm2, and were evaluated using VAS before, immediately after the final application, and 30 days after the laser treatment. Surface electromyography was performed with maximum dental clenching before and after laser therapy. The results show there were no significant statistical differences in the EMG activity between the groups before and after laser treatment. With regard to the pain at palpation, although both groups presented a significant difference in the symptoms before and after the treatment, only the active doses showed statistically significant reductions in pain level in all the regions of the palpated muscles. However, there was no significant statistical difference between groups (experimental and placebo). In conclusion, low level laser did not promote any changes in EMG activity. The treatment did, however, lessen the pain symptoms in the experimental groups.
Lasers Med Sci. 2010 Mar;25(2):229-32. Epub 2009 Jun 30.
Wavelength effect in temporomandibular joint pain: a clinical experience.
Carvalho CM, de Lacerda JA, dos Santos Neto FP, Cangussu MC, Marques AM, Pinheiro AL.
Laser Center, School of Dentistry, Federal University of Bahia (UFBA), Av. Araújo Pinho, 62, Canela, 40140-110 Salvador, BA, Brazil.
Temporomandibular disorders (TMDs) are common painful multifactorial conditions affecting the temporomandibular joint (TMJ) and whose treatment depends on the type and symptoms. Initially, it requires pain control, and, for this, drugs, biting plates, occlusal adjustment, physiotherapy or their association are used. Lately, laser phototherapy (LPT) has been used in the treatment of pain of several origins, including TMDs. This study reports the treatment of a selected group of 74 patients treated at the Laser Center of the Federal University of Bahia between 2003 and 2008. Following standard anamneses, clinical and imaging examination and with the diagnosis of any type of TMD, the patients were prepared for LPT. No other intervention was carried out during the treatment. Treatment consisted of three sessions a week for 6 weeks. Prior to irradiation, the patients were asked to score their pain using a visual analog scale (VAS). Lasers of wavelength (lambda)780 nm, lambda790 nm or lambda830 nm and/or lambda660 nm were used at each session (30/40 mW; spot (varphi) approximately 3 mm; mean dose per session 14.2 +/- 6.8 J/cm(2); mean treatment dose of 170 +/- 79.8 J/cm(2)). Of the patients, 80% were female ( approximately 46 years old). At the end of the 12 sessions the patients were again examined, and they scored their pain using the VAS. The results were statistically analyzed and showed that 64% of the patients were asymptomatic or had improved after treatment and that the association of both wavelengths was statistically significant (P = 0.02) in the asymptomatic group. It was concluded that the association of red and infrared (IR) laser light was effective in pain reduction on TMJ disorders of several origins.
Lasers Med Sci. 2009 Sep;24(5):715-20. Epub 2008 Nov 12.
Low-level laser therapy and myofacial pain dysfunction syndrome: a randomized controlled clinical trial.
Shirani AM, Gutknecht N, Taghizadeh M, Mir M.
Department of Oral Medicine, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. email@example.com
Myofacial pain dysfunction syndrome (MPDS) is the most common reason for pain and limited function of the masticatory system. The effects of low-level lasers (LLLs) for controlling the discomfort of patients are investigated frequently. However, the aim of this study was to evaluate the efficacy of a particular source producing 660 nm and 890 nm wavelengths that was recommended to reduce of the pain in the masticatory muscles. This was a double-blind and placebo-controlled trial. Sixteen MPDS patients were randomly divided into two groups. For the laser group, two diode laser probes (660 nm (nanometers), 6.2 J/cm(2), 6 min, continuous wave, and 890 nm, 1 J/cm(2) (joules per square centimetre), 10 min, 1,500 Hz (Hertz)) were used on the painful muscles. For the control group, the treatment was similar, but the patients were not irradiated. Treatment was given twice a week for 3 weeks. The amount of patient pain was recorded at four time periods (before and immediately after treatment, 1 week after, and on the day of complete pain relief). A visual analog scale (VAS) was selected as the method of pain measurement. Repeated-measures analysis of variance (ANOVA), the t-test and the paired t-test were used to analyze the data. In each group the reduction of pain before and after the treatment was meaningful, but, between the two groups, low-level laser therapy (LLLT) was more effective (P = 0.031) According to this study, this type of LLLT was the effective treatment for pain reduction in MPDS patients.
Photomed Laser Surg. 2007 Aug;25(4):297-303.
Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study.
Fikácková H, Dostálová T, Navrátil L, Klaschka J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic.
OBJECTIVE: Low-level laser therapy (LLLT) treatment for pain caused by temporomandibular joint disorders (TMD) was investigated in a controlled study comparing applied energy density, subgroups of TMD, and duration of disorders. BACKGROUND DATA: Although LLLT is a physical therapy used in the treatment of musculoskeletal disorders, there is little evidence for its effectiveness in the treatment of TMD. METHODS: The study group of 61 patients was treated with 10 J/cm(2) or 15 J/cm(2), and the control group of 19 patients was treated with 0.1 J/cm(2). LLLT was performed by a GaAlAs diode laser with output of 400 mW emitting radiation wavelength of 830 nm in 10 sessions. The probe with aperture 0.2 cm(2) was placed over the painful muscle spots in the patients with myofascial pain. In patients with TMD arthralgia the probe was placed behind, in front of, and above the mandibular condyle, and into the meatus acusticus externus. Changes in pain were evaluated by self-administered questionnaire. RESULTS: Application of 10 J/cm(2) or 15 J/cm(2) was significantly more effective in reducing pain compared to placebo, but there were no significant differences between the energy densities used in the study group and between patients with myofascial pain and temporomandibular joint arthralgia. Results were marked in those with chronic pain. CONCLUSION: The results suggest that LLLT (application of 10 J/cm(2) and 15 J/cm(2)) can be considered as a useful method for the treatment of TMD-related pain, especially long lasting pain.
Photomed Laser Surg. 2006 Oct;24(5):637-41.
Evaluation of low-level laser therapy in the treatment of temporomandibular disorders.
Cetiner S, Kahraman SA, Yüceta? S.
Department of Oral and Maxillofacial Surgery, School of Dentistry, Gazi University, Ankara, Turkey. firstname.lastname@example.org
OBJECTIVE: The purpose of this study was to assess the effectiveness of low-level laser therapy (LLLT) in the treatment of myogenic originated temporomandibular disorders (TMD).
BACKGROUND DATA: Limited studies have demonstrated that LLLT may have a therapeutic effect on the treatment of TMD.
METHODS: Thirty-nine patients with myogenic TMD-associated orofacial pain, limited mandibular movements, chewing difficulties, and tender points were included in this study. Twenty-four of them were treated with LLLT for 10 sessions per day excluding weekends as test group, and 15 patients with the same protocol received placebo laser treatment as a control group. These parameters were assessed just before, just after, and 1 month after the treatment.
RESULTS: Maximal mouth-opening improvement, and reductions in pain and chewing difficulty were statistically significant in the test group when compared with the control group. Statistically significant improvements were also detected between two groups regarding reduction in the number of tender points.
CONCLUSION: Based on the results of this placebo-controlled report, LLLT is an appropriate treatment for TMD and should be considered as an alternative to other methods.
|J Clin Laser Med Surg. 2003 Dec;21(6):363-7.|
Usefulness of low-level laser for control of painful stomatitis in patients with hand-foot-and-mouth disease.
Toida M, Watanabe F, Goto K, Shibata T.
Department of Oral and Maxillofacial Sciences, Gifu University School of Medicine, Gifu, Japan. email@example.com
OBJECTIVE: The aim of this study was to evaluate the usefulness of low-level laser therapy (LLLT) for the control of painful stomatitis in patients with hand-foot-and-mouth disease (HFMD). BACKGROUND DATA: LLLT has been successfully applied to various painful oral mucosal diseases, although there have been few reports on LLLT for HFMD patients. MATERIALS AND METHODS: Through a randomized double-blind placebo controlled trial, the painful period of HFMD stomatitis was compared between the LLLT group (n=11) and the placebo LLLT one (n=9), which had similar clinical backgrounds. The LLLT parameters supplied were as follows: wavelength of 830 nm, power of 30 mW, frequency of 30 Hz, and energy output of 1.1 J/cm2. Acceptability and safety of the treatment were also evaluated. RESULTS: The painful period was shorter in the LLLT group (4.0 +/- 1.3 days) than in the placebo LLLT one (6.7 +/- 1.6 days) with a statistically significant difference (p<0.005). The treatment was judged acceptable for 90.0% (18 of 20) of patients. No adverse events were observed in any cases. CONCLUSION: LLLT is a useful method to control HFMD stomatitis by shortening the painful period, with its high acceptability and lack of adverse events.
|Stomatologiia (Mosk). 2003;82(3):32-7.|
Treatment of inflammatory pyodestructive processes of the oral cavity, maxillofacial area, and neck by laser and magnetic-laser exposure of the carotid sinus using the Optodan laser apparatus.
[Article in Russian]
Zhizhina NA, Prokhonchukov AA, Vakhtin VI, Geniuk VIa.
This paper presents the priority original methods (patent No. 2101046, Russia) for the treatment of inflammatory pyodestructive processes in the oral cavity, maxillofacial area, and neck (odontogenic abscesses and phlegmons including those complicated by mediastinitis and sepsis), sinusitis, carbuncles and furuncles of face and neck skin, parotitis, sialadenitis, adenophlegmons, lymphadenitis, periotitis, alveolitis, arthritis, arthrosis of the temporomandibular joint, odontogenic and traumatic osteomyelitis, infected purulent traumas (including gunshot ones), fractures of the jaws, etc. making use of Optodan laser (patent No. 2014107, Russia) for laser and magnetic-laser therapy.
N Y State Dent J. 2002 Jun-Jul;68(6):24-6.
Migraine, tension-type headache and facial pain. A common intraoral etiology and treatment.
A maxillary alveolar mucosal inflammation, demonstrated by local tenderness and increased temperature, is present in migraine, tension-type headache and facial pain patients even when the patient is asymptomatic. Research is presented showing effective treatment of these conditions with fewer side effects than with standard medication by local anti-inflammatory methods. These alternative methods include: chilling, application of anti-inflammatory gel and low-level (non-cutting) laser. Local treatment also mediates cervical muscle spasm, adding to its overall effectiveness.
|Stomatologiia (Mosk). 2001;80(6):52-5.|
New potentialities of laser therapy and electrostimulation after cheilorhinoplasty.
[Article in Russian]
Gerasimenko MIu, Filatova EV, Nikitin AA, Spiridonova NZ.
A method for stimulation of the central regulation mechanisms has been used in 53 patients during the early period after cheilorhinoplasty. Electrostimulation by the flickering reflex method is a nonspecific method stimulating sanogenesis which can be used for repair of the neuromuscular function after correction of secondary deformation of the upper lip and palate. Transcerebral laser stimulation indirectly affected the reparative processes in the maxillofacial area by improving metabolism in the cerebrocortical projection zones.
Vopr Kurortol Fizioter Lech Fiz Kult. 2000 Nov-Dec;(6):29-32.
[Physiopuncture therapy of trigeminal neuralgia]
[Article in Russian]
Samosiuk IZ, Kozhanova AK, Samosiuk NI.
137 patients with typical trifacial neuralgia (TN) were divided into four groups. 30 patients of group 1 received EHF therapy, 30 patients of group 2 were exposed to laser, 67 patients of group 3 were treated with combination of laser with EHF-puncture, 10 patients of group 4 were controls on conventional physiotherapy. Patients of all the groups were given drug of choice–carbamazepin. The highest response was registered in group 3, 21(31.3%) patients of which could stop carbamazepin, while 40(59.7%) patients reduced carbamazepin dose by 50-70%. Positive results were due to restoration of self-regulation in pain and antipain systems which are disturbed in TN patients
J Clin Laser Med Surg. 1998 Aug;16(4):223-6.
Low-level laser therapy is an important tool to treat disorders of the maxillofacial region.
Pinheiro AL, Cavalcanti ET, Pinheiro TI, Alves MJ, Miranda ER, De Quevedo AS, Manzi CT, Vieira AL, Rolim AB.
Laser Center, School of Dentistry, Universidade Federal de Pernambuco, Brazil.
OBJECTIVES: The authors report on the effects of low-level laser therapy (LLLT) in the treatment of maxillofacial disorders. SUMMARY AND BACKGROUND DATA: Further to our previous studies, this paper reports the results of the use of LLLT on the treatment of several disorders of the oral and maxillofacial region. This paper presents LLLT as an effective method of treating such disorders. METHODS: Two hundred and five female and 36 male patients ages between 7 and 81 years old (average 38.9 years old), suffering from disorders of the maxillofacial region, were treated with 632.8, 670, and 830 nm diode lasers at the Laser Center of the Universidade Federal de Pernambuco, Recife, Brazil (UFPE). The disorders included temporomandibular joint (TMJ) pain, trigeminal neuralgia, muscular pain, aphatae, inflammation, and tooth hypersensitivity postoperatively and in small hemangiomas. Most treatment consisted of a series of 12 applications (twice a week) and in 15 cases a second series was applied. Patients were treated with an average dose of 1.8 J/cm2. RESULTS: One hundred fifty four out of 241 patients were asymptomatic at the end of the treatment, 50 improved considerably, and 37 were symptomatic. CONCLUSIONS: These results confirm that LLLT is an effective tool and is beneficial for the treatment of many disorders of the maxillofacial region.
J Clin Laser Med Surg. 1997;15(4):181-3.
Low-level laser therapy in the management of disorders of the maxillofacial region.
Pinheiro AL, Cavalcanti ET, Pinheiro TI, Alves MJ, Manzi CT.
School of Dentistry, Universidade Federal de Pernambuco, Recife, Brazil.
OBJECTIVE: The authors analysed the effects of low-level laser therapy (LLLT) on the treatment of maxillofacial disorders. SUMMARY BACKGROUND DATA: Pioneer work published by Mester et al. opened a new frontier in the clinical treatment of many disorders with the use of LLLT. Although LLLT is not well accepted in many places, its use is growing steadily in others, including Europe and more recently in Brazil. METHODS: One hundred forty-one female and 24 male patients, between 7 and 81 years of age (average = 39.2 years old), suffering from disorders of the maxillofacial region were treated with 632.8-nm, 670-nm, and 830-nm diode lasers at the Laser Center of the Universidade Federal de Pernambuco. The disorders included temperomandibular joint pain, trigeminal neuralgia, muscular pain, aphatae, inflammation, and tooth hypersensitivity both postoperatively and in small hemangiomas. Most treatment consisted of a series of 12 applications (twice a week), and in eight cases a second series was applied. Patients were treated with an average dose of 2.5 J/cm2. RESULTS: One hundred twenty out of 165 patients were asymptomatic at the end of the treatment, 25 improved considerably, and 20 were symptomatic. CONCLUSIONS: These preliminary results indicate that LLLT is an important tool and brings many benefits for the treatment of many disorders of the maxillofacial region.
Ann Ital Chir. 1997 Jul-Aug;68(4):505-9.
The treatment of cranio-facial pain by electroacupuncture and laser irradiation.
Costantini D, Delogu G, Lo Bosco L, Tomasello C, Sarra M.
Istituto di Anestesiologia e Rianimazione Università degli Studi di Roma La Sapienza.
Craniofacial neuralgias represent an interesting medical challenge, especially regarding the complex therapeutical aspects. Our study was performed treating more than 700 patients, applying steel inox needles variable in diameters and length for about 20 minutes, with a total application number ranging between 10 and 20. Results have been defined referring to a 4-grades response scale: excellent, good, fairly good and insufficient. It is important to emphasise that the best results have been achieved with patients who chose the acupuncture as the first therapeutic approach, while patients who underwent other previous medical and/or surgical treatment have had a worse response. The authors assert that acupuncture and infrared laser reflex therapy represent a harmless and effective treatment of such a diffuse and invalidating disease.
Masui. 1992 Nov;41(11):1809-13.
[Low reactive-level laser therapy near the stellate ganglion for postherpetic facial neuralgia]
[Article in Japanese]
Ohtsuka H, Kemmotsu O, Dozaki S, Imai M.
Department of Anesthesiology, Hokkaido University School of Medicine, Sapporo.
Low reactive-level laser therapy near the stellate ganglion was given for a 68-year-old female with postherpetic neuralgia, suffering from burning pain in the right forehead for 11 years. Stellate ganglion block and supraorbital nerve block with oral medication were not effective to relieve this pain. The laser irradiation induced warm sensation in her face followed by an excellent pain relief. Thermograms illustrated a remarkable increase from 30.6 degrees C to 31.5 degrees C in temperature of her right face. The irradiation near the right carotid artery also had the similar effect. The results imply that the irradiation with low reactive-level laser of the stellate ganglion and/or the carotid artery increases a facial blood flow and relieves facial neuralgia.
|Stomatologiia (Mosk). 1989 Sep-Oct;68(5):42-5.|
The use of the Uzor laser apparatus for treating inflammatory diseases of the maxillofacial area.
[Article in Russian]
Kireev AK, Evstigneev AR, Voroshnin PA, Aleksandrov MT.
This is a report on the first results of application of “Uzor” laser device in dentistry. Semiconductor lasers are used in it. Bioeffective regimens of magneto-laser therapy were established to treat maxillofacial pathology. A series of techniques is offered to treat some particular diseases: arthritis, alveolitis, sialoadenitis, pericoronitis, jaw fractures.
CAN LOW REACTIVE-LEVEL LASER BE USED IN THE TREATMENT OF NEUROGENIC FACIAL PAIN? A DOUBLE-BLIND, PLACEBO CONTROLLED INVESTIGATION OF PATIENTS WITH TRIGEMINAL NEURALGIA
Arne Eckerdal and and Lehmann Bastian
Department of Oral and Maxillofacial Surgery and Oral Medicine, Odense
University Hospital, Denmark
Neurogenic facial pain has been one of the more difficult conditions to
treat, but the introduction of laser therapy now permits a residual group of
patients hitherto untreatable to achieve a life free from or with less pain.
The present investigation was designed as a double-blind, placebo controlled
study to determine whether low reactive-level laser therapy (LLLT) is
effective for the treatment of trigeminal neuralgia. Two groups of patients
(14 and 16) were treated with two probes. Neither the patients nor the
dental surgeon wereaware of which was the laser probe until the
investigation had been completed. Each patient was treated weekly for five
weeks. The results demonstrate that of 16 patients treated with the laser
probe, 10 were free from pain after completing treatment and 2 had
noticeably less pain, while in 4 there was little or no change. After a one
year follow-up, 6 patients were still entirely free from pain. In the group
treated with the placebo system, i.e. the non-laser probe, one was free from
pain, 4 had less pain, and the remaining 9 patients had little or no
recovery. After one year only one patient was still completely free from
pain. The use of analgesics was recorded and the figures confirmed the fact
that LLLT is effective in the treatment of trigeminal neuralgia. It is
concluded that the present study clearly shows that LLLT treatment, given as
described, is an effective method and an excellent supplement to
conventional therapies used in the treatment of trigeminal neuralgia.
Addressee for Correspondence:
Arne Eckerdal DDS DOS
Consultant,Departmentof Oral and Maxillofacial Surgery & Oral Medicine,
Odense University Hospital,
DK-5000 Odense’ Denmark.
12/96 Rep. US X 8-10-12 LASER THERAPY, 1996:: 8: 247-252
Tandlægebladet. 1994; 98 (2): 526-529.
GaAlAs laser treatment evaluated for trigeminal neuralgia, paresthesia, atypical facial pain and temporo-mandibular joint pain in a 5 year study. –
Eckerdal A, Lehmann Bastian H.
Can low reactive-level laser therapy be used in the treatment of neurogenic facial pain? A double-blind, placebo controlled investigation of patients with trigeminal neuralgia. Laser Therapy. 1996; 8: 247-252. At the Odense University Hospital, Denmark, Arne Eckerdal has evaluated the effect of 830 nm, 30 mW, laser treatment for a number of indications. Patients suffering from trigeminal neuralgia (n = 36) had a positive result in 81% at the end of treatment, 42% at 1-year control. Patients having received previous alcohol blocks (n = 14) responded less favourably to the treatment. 50% were pain free at the end of the treatment period, 20% at 1 year control. Patients with non-specific facial pain (n = 63) were pain free at the end of treatment, 44% at follow up one year later. In a group of 22 patients with paresthesias (n = 22), only 5 were successful at end of treatment , 4 were improved and 13 were not improved. The result at 6 and 12 months were the same. Patients with temporo-mandibular pain (n = 40) were improved in 73% and at 1 year control still 70% were pain free.
LOW INTENSITY LASER THERAPY (LILT) IN THE MAXILLOFACIAL REGION
Paul Bradley The Royal London School of Medicine and Dentistry, London, England
The region of the face and mouth is well suited to Low Intensity Laser Therapy (LILT) in view of ease of access. It is also an area associated with a variety of painful conditions and intractable ulcers which have proved amenable to LILT in a total of around 500 cases. Our practice is based on several postgraduate research projects:
1. Studies of depth penetration of 820nm. These have been undertaken using a CCD camera to demonstrate penetration depths in non vital tissue specimens augmented by observations in the living subject with isotropic detectors.
2. Investigation of vascular response. A thermographic camera has been used for local heating effects while laser doppler has been employed to measure microcirculatory flux. Ultrasound doppler allowed monitoring of arterial status. A variety of wavelengths and fluxes have been investigated.
3. Double blind clinical trial in temporomandibular joint disorder pain. Methods have included algometry for pressure point thresholds, electromyography for muscular activity and sensor tracking for mandibular movement.
4. Study of effect on osseointegration of implants in jaw and femur.
Research methods have involved mechanical push out testing, radiovisiography, x-ray microtomography and histomorphometry in the rabbit experimental model. On the basis of the data acquired clinical practice has been undertaken particularly in the following conditions:
1. Post Herpetic Neuralgia,
2. Temporomandibular Joint Disorder Pain
3. Trigeminal Neuralgia
4. Atypical Facial Pain,
5. Pain from Acute Maxillofacial Trauma
6. Palliation of Pain from Unresectable Orofacial Cancer,
7. Intractable Oral Ulcerations, 8. Nerve Lesions,
9. Cavernous Haemangiomas Of the Facial Region in Infants
The results of this clinical practice are described and analyzed.
PhD dissertation on TMD problems
Dr Sajee Sattayut of The Department of Oral & Maxillofacial Surgery, St Bartholomew’s and the Royal London School of Medicine and Dentistry (professor Paul Bradley) has put forward his PhD thesis on the effect of 820 nm low level laser on patients with TMD (temporo-mandibular-joint-disorders). In a double blind study on 30 female TMD patients one group was given placebo laser, one a low dose from a 60 mW laser and the third a high dose from a 300 mW GaAlAs laser. Three treatments were given during one week. The patients in the high energy density group had significantly increases in Pressure Pain Threshould and EMG amplitude, recorded from voluntary clenching. A significantly greater number of patients recovered from myofacial pain and TMJ arthralgia as assessed clinically in the higher energy group. At a period of 2 to 4 weeks review after LLLT, there was an average 52% reduction of pain as assessed by Symptom Severity Index pain questionnaire. In an in vitro study laser was observed to reduce IL-1 stimulated PGE2 production.