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Lasers in Medical Science

, Volume 31, Issue 5, pp 945–954 | Cite as

Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up

  • Barbara Cristina Zanandréa Machado
  • Marcelo Oliveira Mazzetto
  • Marco Antonio M. Rodrigues Da Silva
  • Cláudia Maria de FelícioEmail author
Original Article

Abstract

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.

Keywords

Temporomandibular disorders Oral motor therapy Low-level laser therapy Rehabilitation Orofacial functions 

Notes

Acknowledgments

This work was supported by Provost’s Office for Research of the University of São Paulo, Brazil, and the first author received a fellowship from the National Council for Scientific and Technological Development (CNPq).

Compliance with ethical standards

The study was approved by the institutional ethics committee (Process N. 4118/2013) and all the exams were undertaken with the understanding and written consent of each subject according to the ethical principles.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Bakke M, Hansdottir R (2008) Mandibular function in patients with temporomandibular joint pain: a 3-year follow-up. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106(2):227–234CrossRefPubMedGoogle Scholar
  2. 2.
    Van der Bilt A (2011) Assessment of mastication with implications for oral rehabilitation: a review. J Oral Rehabil 38:754–780CrossRefPubMedGoogle Scholar
  3. 3.
    Ferreira CL, Machado BC, Borges CG, Rodrigues da Silva MA, Sforza C, De Felício CM (2014) Impaired orofacial motor functions on chronic temporomandibular disorders. J Electromyogr Kinesiol 24:565–571CrossRefPubMedGoogle Scholar
  4. 4.
    Michelotti A, Iodice G, Vollaro S, Steenks MH, Farella M (2012) Evaluation of the short-term effectiveness of education versus an occlusal splint for the treatment of myofascial pain of the jaw muscles. J Am Dent Assoc 143:47–53CrossRefPubMedGoogle Scholar
  5. 5.
    Chen J, Huang Z, Ge M, Gao M (2015) Efficacy of low-level laser therapy in the treatment of TMDs: a meta-analysis of 14 randomised controlled trials. J Oral Rehabil 42:291–299CrossRefPubMedGoogle Scholar
  6. 6.
    de Moraes Maia ML, Ribeiro MA, Maia LG, Stuginski-Barbosa J, Costa YM, Porporatti AL et al (2014) Evaluation of low-level laser therapy effectiveness on the pain and masticatory performance of patients with myofascial pain. Lasers Med Sci 29:29–35CrossRefPubMedGoogle Scholar
  7. 7.
    Chantaracherd P, John MT, Hodges JS, Schiffman EL (2015) Temporomandibular joint disorders’ impact on pain, function, and disability. J Dent Res 94(3 Suppl):79S–86SCrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Niemelä K, Korpela M, Raustia A, Ylöstalo P, Sipilä K (2012) Efficacy of stabilisation splint treatment on temporomandibular disorders. J Oral Rehabil 39:799–804CrossRefPubMedGoogle Scholar
  9. 9.
    Gomes CA, Politti F, Andrade DV, de Sousa DF, Herpich CM, Dibai-Filho AV et al (2014) Effects of massage therapy and occlusal splint therapy on mandibular range of motion in individuals with temporomandibular disorders: a randomized clinical trial. J Manip Physiol Ther 37:164–169CrossRefGoogle Scholar
  10. 10.
    Gomes CA, El Hage Y, Amaral AP, Politti F, Biasotto-Gonzalez DA (2014) Effects of massage therapy and occlusal splint therapy on electromyographic activity and the intensity of signs and symptoms in individuals with temporomandibular disorder and sleep bruxism: a randomized clinical trial. Chiropr Man Ther 15(22):43CrossRefGoogle Scholar
  11. 11.
    Haketa T, Kino K, Sugisaki M, Takaoka M, Ohta T (2010) Randomized clinical trial of treatment for TMJ disc displacement. J Dent Res 89:1259–1263CrossRefPubMedGoogle Scholar
  12. 12.
    Yoshida H, Sakata T, Hayashi T, Shirao K, Oshiro N, Morita S (2011) Evaluation of mandibular condylar movement exercise for patients with internal deragement of the temporomandibular joint on initial presentation. Br J Oral Maxillofac Surg 49:310–313CrossRefPubMedGoogle Scholar
  13. 13.
    Nagata K, Maruyama H, Mizuhashi R, Morita S, Hori S, Yokoe T, Sugawara Y (2015) Efficacy of stabilisation splint therapy combined with non-splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial. J Oral Rehabil 42:890–899CrossRefPubMedGoogle Scholar
  14. 14.
    Venancio RA, Camparis CM, Lizarelli RFZ (2005) Low intensity laser therapy in the treatment of temporomandibular disorders: a double-blind study. J Oral Rehabil 32:800–807CrossRefGoogle Scholar
  15. 15.
    Çetiner S, Kahraman SA, Yucetas Ş (2006) Evaluation of low level laser therapy in the treatment of temporomandibular disorders. Photomed Laser Surg 24:637–641CrossRefPubMedGoogle Scholar
  16. 16.
    Gökçen-Röhlig B, Kipirdi S, Baca E, Keskin H, Sato S (2013) Evaluation of orofacial function in temporomandibular disorder patients after low-level laser therapy. Acta Odontol Scand 71:112–117CrossRefGoogle Scholar
  17. 17.
    Salmos-Brito JAL, Menezes RF, Teixeira CE, Gonzaga RKM, Braz BHMR, Bessa-Nogueira RV et al (2013) Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders. Lasers Med Sci 28:57–64CrossRefPubMedGoogle Scholar
  18. 18.
    Dermikol N, Sari F, Bulbul M, Dermikol M, Simsek I, Usumez A (2015) Effectiveness of occlusal splints and low-level laser therapy on myofascial pain. Lasers Med Sci 30:1007–1012CrossRefGoogle Scholar
  19. 19.
    Sancakli E, Gökçen-Röhlıg B, Balık A, Öngül D, Kıpırdı S, Keskın H (2015) Early results of low-level laser application for masticatory muscle pain: a double-blind randomized clinical study. BMC Oral Health 23(15):131. doi: 10.1186/s12903-015-0116-5 CrossRefGoogle Scholar
  20. 20.
    Madani AS, Ahrari F, Nasiri F, Abtahi M, Tunér J (2014) Low-level laser therapy for management of TMJ osteoarthritis. Cranio 32:38–44CrossRefPubMedGoogle Scholar
  21. 21.
    Avivi-Arber L, Martin R, Lee JC, Sessle BJ (2011) Face sensorimotor cortex and its neuroplasticity related to orofacial sensorimotor functions. Arch Oral Biol 56:1440–1465CrossRefPubMedGoogle Scholar
  22. 22.
    Melchior MO, Venezian GC, Machado BCZ, Borges RF, Mazzetto MO (2013) Does low intensity therapy reduce pain and change orofacial myofunctional conditions? Cranio 31:133–139CrossRefGoogle Scholar
  23. 23.
    Hodges PW, Smeets RJ (2015) Interaction between pain, movement, and physical activity: short-term benefits, long-term consequences, and targets for treatment. Clin J Pain 31:97–107CrossRefPubMedGoogle Scholar
  24. 24.
    Boudreau SA, Farina D, Falla D (2010) The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Man Ther 15:410–414CrossRefPubMedGoogle Scholar
  25. 25.
    De Felício CM, de Oliveira MM, da Silva MA (2010) Effects of orofacial myofunctional therapy on temporomandibular disorders. Cranio 28:249–259CrossRefPubMedGoogle Scholar
  26. 26.
    De Felício CM, Medeiros AP, de Oliveira MM (2012) Validity of the ‘protocol of oro-facial myofunctional evaluation with scores’ for young and adult subjects. J Oral Rehabil 39:744–753CrossRefPubMedGoogle Scholar
  27. 27.
    Fuentes CJP, Armijo-Olivo S, Magee DJ, Gross DP (2011) Effects of exercise therapy on endogenous pain-relieving peptides in musculoskeletal pain: a systematic review. Clin J Pain 27:365–374CrossRefGoogle Scholar
  28. 28.
    Dworkin SF, LeResche L (1992) Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 6:301–355PubMedGoogle Scholar
  29. 29.
    De Felício CM, Melchior MO, Da Silva MA (2009) Clinical validity of the protocol for multi-professional centers for the determination of signs and symptoms of temporomandibular disorders. Part II. Cranio 27:62–67CrossRefPubMedGoogle Scholar
  30. 30.
    Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum, New JerseyGoogle Scholar
  31. 31.
    Emshoff R, Bosch R, Pumpel E, Schoning H, Strobl H (2008) Low-level laser therapy for treatment of temporomandibular joint pain: a double-blind and placebo-controlled trial. Oral Med Oral Pathol Oral Radiol Endod 105:452–456CrossRefGoogle Scholar
  32. 32.
    Ahrari F, Madani AS, Ghafouri ZS, Tunér J (2014) The efficacy of low-level laser therapy for the treatment of myogenous temporomandibular joint disorder. Lasers Med Sci 29:551–557CrossRefPubMedGoogle Scholar
  33. 33.
    Benedetti F (2014) Placebo effects: from the neurobiological paradigm to translational implications. Neuron 5(84):623–637CrossRefGoogle Scholar
  34. 34.
    Kisaalita NR, Robinson ME (2012) Analgesic placebo treatment perceptions: acceptability, efficacy, and knowledge. J Pain 13:891–900CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Cote JN, Hoeger Bement MK (2010) Update on the relation between pain and movement: consequences for clinical practice. Clin J Pain 26:754–762CrossRefPubMedGoogle Scholar
  36. 36.
    Takada K, Yashiro K, Sorihashi Y, Morimoto T, Sakuda M (1996) Tongue, jaw, and lip muscle activity and jaw movement during experimental chewing efforts in man. J Dent Res 75:1598–1606CrossRefPubMedGoogle Scholar
  37. 37.
    Logemann JA (2012) Clinical efficacy and randomized clinical trials in dysphagia. Int J Speech Lang Pathol 14:443–446CrossRefPubMedGoogle Scholar
  38. 38.
    Steele CM, Bailey GL, Polacco RE, Hori SF, Molfenter SM, Oshalla M, Yeates EM (2013) Outcomes of tongue-pressure strength and accuracy training for dysphagia following acquired brain injury. Int J Speech Lang Pathol 15:492–502CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Mangilli LD, Sassi FC, de Medeiros CG, de Andrade CR (2012) Rehabilitative management of swallowing and oral-motor movements in patients with tetanus of a public service in Brazil. Acta Trop 122:241–246CrossRefPubMedGoogle Scholar
  40. 40.
    Maffei C, Garcia P, de Biase NG, de Souza CE, Vianna-lara MS, Grégio AM et al (2014) Orthodontic intervention combined with myofunctional therapy increases electromyographic activity of masticatory muscles in patients with skeletal unilateral posterior crossbite. Acta Odontol Scand 72:298–303CrossRefPubMedGoogle Scholar
  41. 41.
    Kaede K, Kato T, Yamaguchi M, Nakamura N, Yamada K, Masuda Y (2015) Effects of lip-closing training on maximum voluntary lip-closing force during lip pursing in healthy young adults. J Oral Rehabil. doi: 10.1111/joor.12358 PubMedGoogle Scholar
  42. 42.
    Svensson P, Romaniello A, Wang K, Arendt-Nielsen L, Sessle BJ (2006) One hour of tongue-task training is associated with plasticity in corticomotor control of the human tongue musculature. Exp Brain Res 173:165–173CrossRefPubMedGoogle Scholar
  43. 43.
    Arima T, Yanagi Y, Niddam DM, Ohata N, Arendt-Nielsen L, Minagi S, Sessle BJ, Svensson P (2011) Corticomotor plasticity induced by tongue-task training in humans: a longitudinal fMRI study. Exp Brain Res 212:199–212CrossRefPubMedGoogle Scholar
  44. 44.
    Iida T, Komiyama O, Obara R, Baad-Hansen L, Kawara M, Svensson P (2014) Repeated clenching causes plasticity in corticomotor control of jaw muscles. Eur J Oral Sci 122:42–48CrossRefPubMedGoogle Scholar
  45. 45.
    Komoda Y, Iida T, Kothari M, Komiyama O, Baad-Hansen L, Kawara M, Sessle B, Svensson P (2015) Repeated tongue lift movement induces neuroplasticity in corticomotor control of tongue and jaw muscles in humans. Brain Res 19:70–79CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Barbara Cristina Zanandréa Machado
    • 1
    • 2
  • Marcelo Oliveira Mazzetto
    • 3
  • Marco Antonio M. Rodrigues Da Silva
    • 2
    • 3
  • Cláudia Maria de Felício
    • 1
    • 2
    Email author
  1. 1.Department of Ophtalmology, Otorhinolaryngology, and Head and Neck SurgerySchool of Medicine, University of São PauloRibeirão PretoBrazil
  2. 2.Craniofacial Research Support CentreUniversity of São PauloSão PauloBrazil
  3. 3.Department of Restorative Dentistry, School of DentistryUniversity of São PauloSão PauloBrazil

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