Temporomandibular disorders (TMD)

Fikácková H, Dostálová T, Vosická R, Peterová V, Navrátil L, Lesák J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic. hfikackova@hotmail.com

Photomed Laser Surg. 2006 Aug;24(4):522-7. [PMID: 16942435]

Objective: This case report describes the treatment of a patient with arthralgia of the temporomandibular joint (TMJ) caused by disc displacement.

Background data: The goal of the treatment of TMJ arthralgia is to decrease pain by promotion of the musculoskeletal system’s natural healing ability.

Methods: This report describes the complex treatment of TMJ arthralgia. Low-level laser therapy (LLLT) was chosen for its antiinflammatory and analgesic effects. Laser therapy was carried out using the GaAlAs diode laser with an output power of 400 mW, emitting radiation with a wavelength of 830 nm, and having energy density of 15 J/cm2; the laser radiation was applied by contact mode on four targeted spots in 10 sessions. Physiotherapy was recommended to this patient to prevent the injury of intraarticular tissue caused by incorrect movement during opening of the mouth. Splint stabilization and prosthetic treatment were used to reduce overloading of the TMJ, resulting from unstable occlusion and to help repositioning of the dislocated disc.

Results: Five applications of LLLT led to decrease of pain in the area of the TMJ on the Visual Analog Scale, from 20 to 5 mm. The anti-inflammatory effect of the laser was confirmed by thermographic examination. Before treatment, the temperature differences between the areas of the normal TMJ and TMJ with arthralgia was higher than 0.5 degrees C. However, at the conclusion of LLLT, temperatures in the areas surrounding the TMJ were equalized.

Conclusion: This study showed the effectiveness of complex non-invasive treatment in patients with arthralgia of the TMJ. The analgesic and anti-inflammatory effects of LLLT were confirmed by infrared thermography.

Fikácková H, Dostálová T, Navrátil L, Klaschka J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2007 Aug;25(4):297-303. [PMID: 17803388]

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.

Dostalová T, Hlinakova P, Kasparova M, Rehacek A, Vavrickova L, Navrátil L.

Department of Paediatric Stomatology, 2nd Medical Faculty, Charles University, Prague, Czech Republic. tatjana.dostalova@fnmotol.cz

Photomed Laser Surg. 2012 May;30(5):275-80. [PMID: 22551049]

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.

Salmos-Brito JA, de Menezes RF, Teixeira CE, Gonzaga RK, Rodrigues BH, Braz R, Bessa-Nogueira RV, de Martínez Gerbi ME.

Dental School, University of Pernambuco, Pernambuco, Brazil, janainasalmos@hotmail.com.

Lasers Med Sci. 2012 Feb 25. [Epub ahead of print] [PMID: 22367394]

Abstract: The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥ 6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

Marcelo Oliveira MAZZETTO 1; Takami Hirono HOTTA 1,2; Renata Campi de Andrade PIZZO 1
1) Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil; 2) Dental School, University of Franca, Franca, SP, Brazil

Braz Dent J (2010) 21(4): 356-360 [PMID: 20976388]

Abstract: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) on the improvement of the mandibular movements and painful symptoms in individuals with temporomandibular disorders (TMD). Forty patients were randomly divided into two groups (n=20): Group 1 received the effective dose (GaAlAs laser λ 830 nm, 40 mW, 5J/cm²) and Group 2 received the placebo application (0 J/cm²), in continuous mode on the affected condyle lateral pole: superior, anterior, posterior, and posterior-inferior, twice a week during 4 weeks. Four evaluations were performed: E1 (before laser application), E2 (right after the last application), E3 (one week after the last application) and E4 (30 days after the last application). The Kruskal-Wallis test showed significant more improvements (p<0.01) in painful symptoms in the treated group than in the placebo group. A significant improvement in the range of mandibular movements was observed when the results were compared between the groups at E4. Laser application can be a supportive therapy in the treatment of TMD, since it resulted in the immediate decrease of painful symptoms and increased range of mandibular movements in the treated group. The same results were not observed in the placebo group.

There are a variety of treatment modalities, which can be divided into Phase I and Phase II.

The purpose of Phase I is to eliminate muscle spasms, TMJ swelling, bruxism (grinding of the teeth) and any dislocation, and generally reduce any type of pain. This treatment usually includes the use of the TMJ appliance (mouth splint), exercises, medication, different therapy, and natural muscles relaxants, and Micro-light Cold Laser Treatments (ML830) to relieve TMJ pain. The ML830 ia a non-invasive, non-thermal laser, capable of penetrating deep into tissue. It is one of the most fascinatingnew healing advances, and is FDA CLEARED to treat and manage TMJD pain, muscle and joint pain relief.

Read more at the link below:

Yokoyama K, Oku T.
Department of Anesthesia, School of Dentistry, Kagoshima University Dental Hospital, Sakuragaoka, Japan. yoko@dentc.hal.kagoshima-u.ac.jp

Can J Anaesth. 1999 Jul;46(7):683-7. [PMID: 10442966]

Purpose: To describe a new short-term treatment for pain in rheumatoid arthritis (RA)-affected temporomandibular joint (TMJ).

Clinical features: We investigated four female patients (age 42.8+/-26.0 yr) with chronic rheumatoid arthritis affecting a single TMJ. Patients had received antirheumatic drugs such as sodium aurothiomalate, and as a result showed no symptoms in other body joints. Linear polarized near-infrared radiation using Super Lizer was applied weekly with and/or without jaw movement to the unilateral skin areas overlying the mandibular fossa, anterior articular tubercle, masseter muscle and posterior margin of the ramus of the mandible. The duration of irradiation to each point was two seconds on and ten seconds off per cycle and the intensity at each point was approximately 138 J x cm(-2) at a wavelength of 830 nm. Interincisal distance was measured with maximal mouth opening in the absence and presence of pain before and after each treatment. Additionally, subjective TMJ pain scores assessed using a visual analog scale were performed for painful maximal mouth opening before and after each irradiation. TMJ pain disappeared after only four treatments. Moreover, painless maximal mouth opening without pain after irradiation in three patients was on average improved to 5.3+/-2.1 mm. However, one case was observed where the opening length prior to irradiation did not improve, despite the fact that the RA-affected TMJ pain had disappeared.

Conclusion: Application of linear polarized near-infrared irradiation to patients with RA-affected TMJ pain is an effective and non-invasive short-term treatment.