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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

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Abstract

Introduction

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.

Methodology

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.

Results

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.

Conclusion

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.

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References

  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):603–612

    Article  Google Scholar 

  2. Kulekcioglu S, Sivrioglu K, Ozcan O, Parlak M (2003) Effectiveness of low-level laser therapy in temporomandibular disorder. Scand J Rheumatol 32(2):114–118

    Article  Google Scholar 

  3. Rahimi A, Rabiei S, Mojahedi SM, Kosarieh E (2011) Application of low level laser in temporomandibular disorders. J Lasers Med Sci 2(4):165–170

    Google Scholar 

  4. Johnson M. Transcutaneous electrical nerve stimulation. In: Watson T, ed. Electrotherapy: evidence-based practice. Edinburgh: Churchill Livingstone 2008; 253–96

  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):562–568

    Article  Google Scholar 

  6. Fouda A (2014) Ultrasonic therapy as an adjunct treatment of temporomandibular joint dysfunction. The Journal of Oral and Maxillofacial Surgery. Photon 117:232–237

    Google Scholar 

  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):1601–1608

    Article  Google Scholar 

  8. Sayed N, Murugavel C, Gnanam A (2013) Management of temporomandibular disorders with low level laser therapy. J Maxillofac Oral Surg 13(4):444–450

    Article  Google Scholar 

  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):158–164

    PubMed  PubMed Central  Google Scholar 

  10. Szentpetery A, Huhn E, Fazekas A (1986) Prevalence of mandibular dysfunction in an urban population in Hungary. Commun Dent Oral Epidemiol 14:177–180

    Article  Google Scholar 

  11. Geissler PR, McPhee PM (1986) Electrostimulation in the treatment of pain in the mandibular dysfunction syndrome. J Dent 14:62–64

    Article  Google Scholar 

  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 21:1722–1728

    Article  Google Scholar 

  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):273–281

    Article  Google Scholar 

  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 61:70–77

    Article  Google Scholar 

  15. Jensen R, Rasmussen BK, Pedersen B, Lous I, Olesen J (1993) Prevalence of oromandibular dysfunction in a general population. J Orofac Pain 7:175–182

    PubMed  Google Scholar 

  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 65:289–293

    Article  Google Scholar 

  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):892–894

    Article  Google Scholar 

  18. Okeson JP (ed) (2005) Signs and symptoms of temporomandibular disorders In: Management of temporomandibular disorders and occlusion, 4th edn. Mosby, Baltiore, pp 165–180

    Google Scholar 

  19. Fricton J (2007) Myogenous temporomandibular disorders: diagnostic and management considerations. Dent Clin N Am 51:61–83

    Article  Google Scholar 

  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 18:290–295

    Article  Google Scholar 

  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 14:130–135

    Article  Google Scholar 

  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 21:104–106

    Article  Google Scholar 

  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):46–50

    Article  Google Scholar 

  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 36:35–38

    PubMed  Google Scholar 

  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 29:858–863

    Article  Google Scholar 

  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 10:46–53

    Article  Google Scholar 

  27. Trakroo A, Sunil MK, Trivedi A, Singla N (2014) TENS versus ultrasonic massage therapy in temporomandibular disorders – a study. J Pearldent 5:20–25

    Article  Google Scholar 

  28. Laat AD, Stappaerts K, Papy S (2003) Counseling and physical therapy as treatment for myofascial pain of the masticatory system. J Orofac Pain 17:42–49

    PubMed  Google Scholar 

  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):1–6

    Google Scholar 

  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):190–196

    PubMed  Google Scholar 

  31. Ilter L et.al. 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.

    Article  Google Scholar 

  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 31:25–31

    Article  Google Scholar 

  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):37–42

    Article  Google Scholar 

  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 8:83–86

    Google Scholar 

  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):406–411

    Article  Google Scholar 

  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 105:452–456

    Article  Google Scholar 

  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 32:800–807

    Article  Google Scholar 

  38. Kannan P (2012) Management of myofascial pain of upper trapezius: a three group comparison study. Global J Health Sci 4(5):46–52

    Article  Google Scholar 

  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):187–192

    Google Scholar 

Download references

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Correspondence to Akansha Budakoti.

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The authors declare that they have no conflict of interest.

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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.

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Budakoti, A., Puri, N., Dhillon, M. et al. 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. Laser Dent Sci 3, 257–267 (2019). https://doi.org/10.1007/s41547-019-00073-8

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  • DOI: https://doi.org/10.1007/s41547-019-00073-8

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