Lasers in Medical Science

, Volume 28, Issue 6, pp 1549–1558 | Cite as

Laser acupuncture in patients with temporomandibular dysfunction: a randomized controlled trial

  • Luciano Ambrosio FerreiraEmail author
  • Rodrigo Guerra de Oliveira
  • Josemar Parreira Guimarães
  • Antonio Carlos Pires Carvalho
  • Marcos Vinicius Queiroz De Paula
Original Article


A prospective, double-blind, randomized, and placebo-controlled trial was conducted in patients with chronic temporomandibular disorder (TMD) to check the analgesic efficacy of infrared low-power GaAlAs diode laser applied to acupuncture points. Forty female subjects, ranging in age from 20 to 40 years, with diagnoses of chronic myofascial pain and arthralgia were randomly allocated to two groups: an experimental group (EG) who received the laser acupuncture as adjunct to reversible occlusal splint therapy and a control group (CG) who received a placebo laser associated with occlusal splint therapy. Both approaches were applied once a week for 3 months. Laser acupuncture was defined by the following parameters: 50-mW continuous radiation for 90 s to acupoints ST6, SI19, GB20, GB43, LI4, LR3, NT3, and EX-HN3; defining 4.5-J energy; 1250-W/cm2 density point; and 112.5-J/cm2 total density. The outcome measurements included a symptom evolution assessment carried out by checking spontaneous and palpation pain intensity, which was indicated on a visual analog scale (VAS). All evaluations were made by an assessor who was blind to the treatment. The symptom reduction was significant in both groups (EG: VAS = 0, n = 20; CG: VAS between 2 and 4, n = 18). The measurements showed significantly faster and lower pain intensity values in the EG (p ≤ 0.002), where there was a higher proportion of patients with remission of symptoms related to the action of laser acupuncture. For patients in whom conservative treatment was adopted, the laser acupuncture is a secure, noninvasive, and effective treatment modality because it improves the chronic pain associated with TMD and has no side effects.


Laser therapy Low level Acupuncture Temporomandibular joint dysfunction syndrome Chronic pain 


  1. 1.
    Greene CS (2001) The etiology of temporomandibular disorders: implications for treatment. J Orofac Pain 15(93):93–105PubMedGoogle Scholar
  2. 2.
    Carrara SV, Conti PCR, Barbosa JS (2010) Termo do 1º Consenso em Disfunção Temporomandibular e Dor Orofacial. Dent Press J Orthod 15(3):114–120CrossRefGoogle Scholar
  3. 3.
    Wong Y, Cheng J (2003) A case series of temporomandibular disorders treated with acupuncture, occlusal splint, point injection therapy. Acupunct Med 21(4):138–149PubMedCrossRefGoogle Scholar
  4. 4.
    Glaros AG (2008) Temporomandibular disorders and facial pain: a psychophysiological perspective. Appl Psychophysiol Biofeedback 33:161–171. doi: 10.1007/s10484-008-9059-9 PubMedCrossRefGoogle Scholar
  5. 5.
    Al-Jundi MA, John MT, Setz JM, Szentpétery A (2008) Meta-analysis of treatment need for temporomandibular disorders in adult nonpatients. J Orofac Pain 22(2):97–107PubMedGoogle Scholar
  6. 6.
    Thilander B, Bjerklin K (2011) Posterior crossbite and temporomandibular disorders (TMDs): need for orthodontic treatment? Eur J Orthod. doi: 10.1093/ejo/cjr095
  7. 7.
    Manfredini D, Winocur E, Ahlberg J, Guarda-Nardini L, Lobezoo F (2010) Psychosocial impairment in temporomandibular disorders patients. RDC/TMD axis II findings from a multicentre study. J Dent 38(10):765–772. doi: 10.1016/j.jdent.2010.06.007 PubMedCrossRefGoogle Scholar
  8. 8.
    Ohrbach R, Turner JA, Sherman JJ, Mancl LA, Truelove EL, Schiffman EL, Dworkin SF (2010) The research diagnostic criteria for temporomandibular disorders. IV: evaluation of psychometric properties of the axis II measures. J Orofac Pain 24(1):48–62PubMedGoogle Scholar
  9. 9.
    Oliveira SB, Siqueira SRDT, Sanvovski AR, Amaral LMTB, Siqueira JTT (2008) Temporomandibular disorder in Brazilizian patients: a preliminary study. J Clin Psychol Med Settings 15:338–343PubMedCrossRefGoogle Scholar
  10. 10.
    Ré JP, Perez C, Darmouni L, Carlier JF, Orthlieb JD (2009) The occlusal splint therapy. Int J Stomat Occlusion Med 2:82–86. doi: 10.1007/s12548-009-0015-y CrossRefGoogle Scholar
  11. 11.
    Dworkin SF, Leresche L (1992) Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 6(4):301–355PubMedGoogle Scholar
  12. 12.
    John MT, Dworkin SF, Mancl LA (2005) Reliability of clinical temporomandibular disorder diagnoses. Pain 118:61–69. doi: 10.1016/j.pain.2005.07.018 PubMedCrossRefGoogle Scholar
  13. 13.
    Alencar júnior F, Becker A (2009) Evaluation of different occlusal splints and counselling in the management of myofascial pain dysfunction. J Oral Rehabil 36:79–85. doi: 10.1111/j.1365-2842.2008.01913.x CrossRefGoogle Scholar
  14. 14.
    Al-Ani Z, Gray RJ, Davies SJ, Sloan P, Path FRC, Glenny AM (2005) Stabilization splint therapy for the treatment of temporomandibular myofascial pain: a systematic review. J Dent Educ 69(11):1242–1250PubMedGoogle Scholar
  15. 15.
    La Touche R, Angulo-Díaz-Parren S, de-la-Hoy JL, Fernández-Carnero J, Ge HU, Linares MT, Sánchez-Gutiérrez J (2010) Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade. J Altern Complement Med 16(1):107–112PubMedCrossRefGoogle Scholar
  16. 16.
    List T, Helkimo M (1992) Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorder. Acta Odontol Scand 50(6):375–385PubMedCrossRefGoogle Scholar
  17. 17.
    Rosted P, Bundgaard M, Pedersen AML (2006) The use of acupuncture in the treatment of temporomandibular dysfunction—an audit. Acupunct Med 24(1):16–22. doi: 10.1136/aim.24.1.16 PubMedCrossRefGoogle Scholar
  18. 18.
    Cidral-Filho FJ, Da Silva MD, Moré AOO, Córdova MM, Werner MF, Santos ARS (2011) Manual acupuncture inhibits mechanical hypersensitivity induced by spinal nerve ligation in rats. Neuroscience 193:370–376. doi: 10.1016/j.physletb.2003.10.071 PubMedCrossRefGoogle Scholar
  19. 19.
    Zhao ZQ (2008) Neural mechanism underlying acupuncture analgesia. Prog Neurobiol 85:355–375. doi: 10.1016/j.pneurobio.2008.05.004 PubMedCrossRefGoogle Scholar
  20. 20.
    Ebneshahidi NS, Heshmatipour M, Moghaddami A, Eghtesadi-Araghi P (2005) The effects of laser acupuncture on chronic tension headache—a randomized controlled trial. Acupunct Med 23(1):13–18. doi: 10.1136/aim.23.1.13 PubMedCrossRefGoogle Scholar
  21. 21.
    Litscher G, Wang L, Wiesner-Zechmeister M (2000) Specific effects of laserpuncture on the cerebral circulation. Lasers Med Sci 15(1):57–62. doi: 10.1007/s101030050048 CrossRefGoogle Scholar
  22. 22.
    Siedentopf CM, Koppelstaetter F, Haala IA, Haid V, Rhomberg P, Ischebeck A, Buchberger W, Felber S, Schlager A, Golaszewski SM (2005) Laser acupuncture induced specific cerebral cortical and subcortical activations in humans. Lasers Med Sci 20:68–73. doi: 10.1007/s10103-005-0340-3 PubMedCrossRefGoogle Scholar
  23. 23.
    Litscher G (2008) High-tech laser acupuncture is Chinese medicine. Med Acupunct 20(4):245–254. doi: 10.1089/acu.2008.0643 CrossRefGoogle Scholar
  24. 24.
    Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F (2004) Acupuncture using laser needles modulates brain function: first evidence from functional transcranial Doppler sonography and functional magnetic resonance imaging. Lasers Med Sci 19(1):6–11. doi: 10.1007/s10103-004-0291-0 PubMedCrossRefGoogle Scholar
  25. 25.
    Schikora D (2008) Laserneedle acupuncture: a critical review and recent results. Med Acupunct 20(1):37–42CrossRefGoogle Scholar
  26. 26.
    Gomes MB, Guimarães FC, Guimarães SMRG, Claro Neves AC (2006) Limiar de dor à pressão em pacientes com cefaléia tensional e disfunção. Braz Dent Sci 9(4):84–91Google Scholar
  27. 27.
    Fornazieri LC (2011) Tratamentos em que a prioridade é a frequência. In: Fornazieri LC (ed) Laser em acupuntura—teoria e prática. Roca, São Paulo, pp 457–470Google Scholar
  28. 28.
    Tunér J, Hode L (2010) The difficult dose and intensity. In: Tunér J, Hode L (eds) The new laser therapy handbook. Prima Books, Grängsberg, pp 505–526Google Scholar
  29. 29.
    Yamamura Y (1995) Pontos de acupuntura dos canais de energia principais. In: Yamamura Y (ed) Acupuntura tradicional: a arte de inserir, 2nd edn. Roca, São Paulo, pp 51–328Google Scholar
  30. 30.
    Macpherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, Moher D (2010) Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT Statement. PLoS Med 7(6):e1000261. doi: 10.1371/journal.pmed.1000261 PubMedCrossRefGoogle Scholar
  31. 31.
    Jones KR, Vojir CP, Hutt E, Fink R (2007) Determining mild, moderate, and severe pain equivalency across pain-intensity tools in nursing home residents. J Rehabil Res Dev 44(2):305–314PubMedCrossRefGoogle Scholar
  32. 32.
    Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8(18):2–9. doi: 10.1136/bmj.c332 Google Scholar
  33. 33.
    Katsoulis J, Ausfeld-Hafter B, Windecker-Gétaz B, Katsoulis K, Blagojevic N, Mericske-Stern R (2010) Laser acupuncture for myofascial pain of the masticatory muscles. A controlled pilot study. Schweiz Monatsschr Zahnmed 120(3):213–225PubMedGoogle Scholar
  34. 34.
    Oral K, Küçük BB, Ebeoğlu B, Dinçer S (2009) Etiology of temporomandibular disorder pain. AĞRI 21(3):89–94PubMedGoogle Scholar
  35. 35.
    Cohen M (2006) Exploring the other side of acupuncture. J Altern Complement Med 12(8):707–708. doi: 10.1089/acm.2006.12.707 PubMedCrossRefGoogle Scholar
  36. 36.
    7Hotta PT, Hotta TH, Bataglion C, Bataglion SA, Coronatto EAS, Regalo SCH (2010) Emg analysis after laser acupuncture in patients with temporomandibular dysfunction (TMD). Implications for practice. Complement Ther Clin Pract 16:158–160. doi: 10.1016/j.ctcp.2010.01.002 PubMedCrossRefGoogle Scholar
  37. 37.
    Rosted P (2001) Practical recommendations for the use of acupuncture in the treatment of temporomandibular disorders based on the outcome of published controlled studies. Oral Dis 7:109–115PubMedCrossRefGoogle Scholar
  38. 38.
    Dorsher PT (2011) Acupuncture for chronic pain. Tech Reg Anesth Pain Manag 15:55–63CrossRefGoogle Scholar
  39. 39.
    Shen X, Zhao L, Ding G, Tan M, Gao J, Wang L, Lao L (2009) Effect of combined laser acupuncture on knee osteoarthritis: a pilot study. Lasers Med Sci 24(2):129–136. doi: 10.1007/s10103-007-0536-9 PubMedCrossRefGoogle Scholar
  40. 40.
    Aigner N, Fialka C, Radda C, Vescei V (2006) Adjuvant laser acupuncture in the treatment of whiplash injuries: a prospective, randomized placebo-controlled trial. Wien Klin Wochenschr 118(3–4):95–99. doi: 10.1007/s00508-006-0530-4 PubMedCrossRefGoogle Scholar
  41. 41.
    Huang YF, Lin JC, Yang HW, Lee YH, Yu CH (2012) Clinical effectiveness of laser acupuncture in the treatment of temporomandibular joint disorder. J Formos Med Assoc. doi: 10.1016/j.jfma.2012.07.039
  42. 42.
    Hopton A, MacPherson H (2010) Acupuncture for chronic pain: is acupuncture more than effective placebo? A systematic review of pooled data from meta-analyses. Pain Pract 10(2):94–102. doi: 10.1111/j.1533-2500.2009.00337.x PubMedCrossRefGoogle Scholar
  43. 43.
    Wang SM, Kain AN, White P (2008) Acupuncture analgesia: I. The scientific basis. Pain Med 106(2):602–610. doi: 10.1213/01.ane.0000277493.42335.7b Google Scholar
  44. 44.
    Gottschling S, Meyer S, Gribova I, Distler L, Berrang J, Gortner L, Graf N, Shamdeen MG (2008) Laser acupuncture in children with headache: a double-blind, randomized, bicenter, placebo-controlled trial. Pain 137:405–412. doi: 10.1016/j.pain.2007.10.004 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  • Luciano Ambrosio Ferreira
    • 1
    • 2
    Email author
  • Rodrigo Guerra de Oliveira
    • 3
  • Josemar Parreira Guimarães
    • 1
  • Antonio Carlos Pires Carvalho
    • 4
  • Marcos Vinicius Queiroz De Paula
    • 5
  1. 1.Diagnostic and Guidance Center for Patients with Temporomandibular DisordersFederal University of Juiz de ForaJuiz de ForaBrazil
  2. 2.Juiz de ForaBrazil
  3. 3.College of Medical Sciences and HealthJuiz de Fora—SUPREMAJuiz de ForaBrazil
  4. 4.Department of Radiology, College of MedicineFederal University of Rio de JaneiroRio de JaneiroBrazil
  5. 5.Department of Dental Clinic, College of DentistryFederal University of Juiz de ForaJuiz de ForaBrazil

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