A comparative evaluation of the effectiveness of low-level laser therapy, ultrasound therapy, and transcutaneous electric nerve stimulation in the treatment of patients with TMDs: a prospective study

  • Akansha BudakotiEmail author
  • Nidhi Puri
  • Manu Dhillon
  • Upasana Sethi Ahuja
  • Akshay Rathore
  • Anuridhi Choudhary
  • Manmeet Kour
Original Article



A temporomandibular disorder (TMD) is considered to be multifactorial with several treatment modalities available to provide symptomatic relief. The use of non-invasive biological techniques with minimal or no side effects is highly recommended. The present study evaluated the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (Th.US), and transcutaneous electric nerve stimulation (TENS) for the management of TMDs.


A total of 45 patients (16 males and 29 females) with an age range between 20 and 50 years having temporomandibular joint (TMJ) disorder with TMJ pain, joint sounds, limited mouth opening, and pain in muscles of mastication were included in the study. The patients were randomly divided into 3 equal groups where group I was given class IV A low-level laser therapy (indium gallium arsenide phosphide [InGaAsP]) at a wavelength of 940 nm biweekly for 4 weeks. Group II was given therapeutic ultrasound in continuous mode at a frequency of 1 MHz and intensity of 1–1.25 W/cm2 for 3 min/session (3 sessions of 3 min each in every visit). The patients in group III were given TENS therapy with low-intensity current for a duration of 30 min, with a pulse rate of 0.11 Hz biweekly. All the patients were followed up twice a week until 1 month corresponding to total eight visits in 4 weeks to check for reduction in pain intensity, number of tender points, joint sounds, and maximal possible mouth opening.


There was a statistically significant greater reduction in pain (p < 0.005), greater increase in mouth opening (p < 0.005), and more reduction in tender points (p < 0.005) in LLLT group. The significant comparative results could be observed in the first week of therapy itself. The results revealed that LLLT provided most significant symptomatic relief followed by therapeutic ultrasound and least improvement was observed in TENS group.


Although all the three physical therapies improved the signs and symptoms of TMDs, LLLT was found to be most effective in relieving pain, improving mouth opening, and reducing the number of tender points from the baseline until the end of the treatment compared with therapeutic ultrasound and TENS. Hence, it can be concluded that LLLT is a safe and clinically effective therapy for managing patients with TMJ pain and reduced mouth opening.


Temporomandibular disorders Low-level laser therapy Therapeutic ultrasound TENS 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institution (ITS Centre for Dental Studies and Research, Muradnagar, Ghaziabad) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Herranz-Aparicio J, Vazquez-Delgado E, Arnabat-Domínguez J (2013) Espana- Tost A, Gay-Escoda C. The use of low level laser therapy in the treatment of temporomandibular joint disorders. Review of the literature. Med Oral Patol Oral Cir Bucal 18(4):603–612CrossRefGoogle Scholar
  2. 2.
    Kulekcioglu S, Sivrioglu K, Ozcan O, Parlak M (2003) Effectiveness of low-level laser therapy in temporomandibular disorder. Scand J Rheumatol 32(2):114–118CrossRefGoogle Scholar
  3. 3.
    Rahimi A, Rabiei S, Mojahedi SM, Kosarieh E (2011) Application of low level laser in temporomandibular disorders. J Lasers Med Sci 2(4):165–170Google Scholar
  4. 4.
    Johnson M. Transcutaneous electrical nerve stimulation. In: Watson T, ed. Electrotherapy: evidence-based practice. Edinburgh: Churchill Livingstone 2008; 253–96Google Scholar
  5. 5.
    Kasat V, Gupta A, Ladda R, Kathariya M, Saluja H, Farooqui AA (2014) Transcutaneous electric nerve stimulation (TENS) in dentistry- a review. J Clin Exp Dent 6(5):562–568CrossRefGoogle Scholar
  6. 6.
    Fouda A (2014) Ultrasonic therapy as an adjunct treatment of temporomandibular joint dysfunction. The Journal of Oral and Maxillofacial Surgery. Photon 117:232–237Google Scholar
  7. 7.
    Catao MHCV, Oliveira PS, Costa RO, Carneiro VSM (2013) Evaluation of the efficacy of low-level laser therapy (lllt) in the treatment of temporomandibular disorders: a randomized clinical trial. Rev Cefac 15(6):1601–1608CrossRefGoogle Scholar
  8. 8.
    Sayed N, Murugavel C, Gnanam A (2013) Management of temporomandibular disorders with low level laser therapy. J Maxillofac Oral Surg 13(4):444–450CrossRefGoogle Scholar
  9. 9.
    Ryalat S, Baqain ZH, Amin WM, Sawair F, Samara O, Badran DH (2009) Prevalence of temporomandibular joint disorders among students of the university of jordan. J Clin Med Res 1(3):158–164PubMedPubMedCentralGoogle Scholar
  10. 10.
    Szentpetery A, Huhn E, Fazekas A (1986) Prevalence of mandibular dysfunction in an urban population in Hungary. Commun Dent Oral Epidemiol 14:177–180CrossRefGoogle Scholar
  11. 11.
    Geissler PR, McPhee PM (1986) Electrostimulation in the treatment of pain in the mandibular dysfunction syndrome. J Dent 14:62–64CrossRefGoogle Scholar
  12. 12.
    Oz S, Gokcen-Rohlig B, Saruhanoglu A, Tuncer EB (2010) Management of myofascial pain: low-level laser therapy versus occlusal splints. J Craniofac Surg 21:1722–1728CrossRefGoogle Scholar
  13. 13.
    Dworkin SF, Huggins KH, LeResche L, Von Korff M, Howard J, Truelove E, Sommers E (1990) Epidemiology of signs and symptoms in temporomandibular disorders: clinical signs in cases and controls. J Am Dent Assoc 120(3):273–281CrossRefGoogle Scholar
  14. 14.
    Isacsson G, Linde C, Isberg A (1989) Subjective symptoms in patients with temporomandibular joint disk displacement versus patients with myogenic craniomandibular disorders. J Prosthet Dent 61:70–77CrossRefGoogle Scholar
  15. 15.
    Jensen R, Rasmussen BK, Pedersen B, Lous I, Olesen J (1993) Prevalence of oromandibular dysfunction in a general population. J Orofac Pain 7:175–182PubMedGoogle Scholar
  16. 16.
    Beaton RD, Egan KJ, Nakagawa-Kogan H, Morrison KN (1991) Self-reported symptoms of stress with temporomandibular disorders: comparisons to healthy men and women. J Prosthet Dent 65:289–293CrossRefGoogle Scholar
  17. 17.
    Laskin DM, Green CS (1972) Influence of the doctor patient relationship on placebo therapy for patient with myofascial pain dysfunction (MPD) syndrome. J Am Dent Assoc 85(4):892–894CrossRefGoogle Scholar
  18. 18.
    Okeson JP (ed) (2005) Signs and symptoms of temporomandibular disorders In: Management of temporomandibular disorders and occlusion, 4th edn. Mosby, Baltiore, pp 165–180Google Scholar
  19. 19.
    Fricton J (2007) Myogenous temporomandibular disorders: diagnostic and management considerations. Dent Clin N Am 51:61–83CrossRefGoogle Scholar
  20. 20.
    Rodrigues D, Siriani AO, Berzin F (2004) Effect of conventional TENS on pain and electromyographic activity of masticatory muscles in TMD patients. Braz Oral Res 18:290–295CrossRefGoogle Scholar
  21. 21.
    Kato MT, Kogawa EM, Santos CN, Conti PC (2006) TENS and lowlevel laser therapy in the management of temporomandibular disorders. J Appl Oral Sci 14:130–135CrossRefGoogle Scholar
  22. 22.
    Rajpurohit B, Khatri SM, Metgud D, Bagewadi A (2010) Effectiveness of transcutaneous electrical nerve stimulation and microcurrent electrical nerve stimulation in bruxism associated with masticatory muscle pain — a comparative study. Indian J Dent Res 21:104–106CrossRefGoogle Scholar
  23. 23.
    Moger G, Shashikanth MC, Sunil MK, Shambulingappa P (2011) Transcutaneous electrical nerve stimulation therapy in temporomandibular disorder: a clinical study. J Indian Acad Oral Med Radiol 23(1):46–50CrossRefGoogle Scholar
  24. 24.
    Kruger LR, van der Linden WJ, Cleaton-Jones PE (1998) Transcutaneous electrical nerve stimulation in the treatment of myofascial pain dysfunction. S Afr J Surg 36:35–38PubMedGoogle Scholar
  25. 25.
    Alvarez-Arenal A, Junquera LM, Fernandez JP, Gonzalez I, Olay S (2002) Effect of occlusal splint and transcutaneous electric nerve stimulation on the signs and symptoms of temporomandibular disorders in patients with bruxism. J Oral Rehabil 29:858–863CrossRefGoogle Scholar
  26. 26.
    Rai S, Ranjan V, Misra D, Panjwani S (2016) Management of myofascial pain by therapeutic ultrasound and transcutaneous electrical nerve stimulation: a comparative study. Eur J Dent 10:46–53CrossRefGoogle Scholar
  27. 27.
    Trakroo A, Sunil MK, Trivedi A, Singla N (2014) TENS versus ultrasonic massage therapy in temporomandibular disorders – a study. J Pearldent 5:20–25CrossRefGoogle Scholar
  28. 28.
    Laat AD, Stappaerts K, Papy S (2003) Counseling and physical therapy as treatment for myofascial pain of the masticatory system. J Orofac Pain 17:42–49PubMedGoogle Scholar
  29. 29.
    Shweta RK, Prashant KP, Siddharth S (2018) Abhay D Impact of ultra sound therapy on myofascial pain dysfunction syndrome along with masticatory muscles. Int J Surg Surgical Tech 2(2):1–6Google Scholar
  30. 30.
    Kavadar GL, Caglar N, Ozen S, Tutun S, Demircioglu D (2015) Efficacy of conventional ultrasound therapy on myofascial pain syndrome: a placebo controlled study. Agri 27(4):190–196PubMedGoogle Scholar
  31. 31.
    Ilter L Efficacy of pulsed and continuous therapeutic ultrasound in myofascial pain syndrome: a randomized controlled study. Am J Phys Med Rehabil 2015;94(7):547-554.CrossRefGoogle Scholar
  32. 32.
    Grieder A, Vinton PW, Cinotti WR, Kangur TT (1971) An evaluation of ultrasonic therapy for temporomandibular joint dysfunction. Oral Surgery Oral Medicine Oral Pathology 31:25–31CrossRefGoogle Scholar
  33. 33.
    Frare JC, Nicolau RA (2008) Clinical analysis of the effect of laser photobiomodulation (GaAs - 904 nm) on temporomandibular joint dysfunction. Brazilian Journal of Physical Therapy 12(1):37–42CrossRefGoogle Scholar
  34. 34.
    Lassemi E, Jafari SM, Motamedi MHK, Navi F, Lasemi R (2008) Low-level laser therapy in the management of temporamandibular joint disorder. J Oral Laser Applications 8:83–86Google Scholar
  35. 35.
    Basili M, Barlattani A, Venditti A, Bollero P (2017) Low-level laser therapy in the treatment of muscle-skelet pain in patients affected by temporo-mandibular disorders. Oral Implantol (Rome) 10(4):406–411CrossRefGoogle Scholar
  36. 36.
    Emshoff R, Bösch R, Pümpel E, Schoning H, Strobl H (2008) 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 105:452–456CrossRefGoogle Scholar
  37. 37.
    De Abreu VR, Camparis CM, De Fátima Zantirato Lizarelli R (2005) Low intensity laser therapy in the treatment of temoromandibular disorders: a double-blind study. J Oral Rehabil 32:800–807CrossRefGoogle Scholar
  38. 38.
    Kannan P (2012) Management of myofascial pain of upper trapezius: a three group comparison study. Global J Health Sci 4(5):46–52CrossRefGoogle Scholar
  39. 39.
    Rezazadeh F, Hajian K, Shahidi S, Piroozi S (2017) Comparison of the effects of transcutaneous electrical nerve stimulation and low-level laser therapy on drug-resistant temporomandibular disorders. J Dent (Shiraz) 18(3):187–192Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Akansha Budakoti
    • 1
    Email author
  • Nidhi Puri
    • 1
  • Manu Dhillon
    • 1
  • Upasana Sethi Ahuja
    • 1
  • Akshay Rathore
    • 1
  • Anuridhi Choudhary
    • 1
  • Manmeet Kour
    • 1
  1. 1.I.T.S Dental CollegeMuradnagarIndia

Personalised recommendations