Analgesic effect of low-level laser therapy in temporomandibular disorders patients

Pain localized to masticatory muscle area and/or temporomandibular joint area, followed with an irregular lower jaw movement, is the most prominent symptom of temporomandibular disorders (TMD). Literature data indicate that symptoms and signs of TMD significantly influence the function of the orofacial system, the socio-psychological status and the quality of life of patients. Multidisciplinary approach to treatment arises from the complex and multifactorial etiology of TMD and the significant role of psychosocial factors. Low level laser therapy (LLLT) has been recommended as therapeutic modality aimed at treating TMD because of its analgesic, anti-inflammatory and biostimulative effects. Nevertheless, research results remain contradictory at present and no consensus has been reached regarding the optimal parameters and protocols of laser therapy. The goal of this research was to examine the effects of low level laser therapy on reducing pain intensity in patients with TMD. With the use of the standard protocol for diagnostifying TMD, established by Dworkin and LeResche (RDC/TMD), 63 participants had been selected and randomly constituted into two experimental groups. The first group included 35 participants which have been subjected to low level laser therapy (LLLT) three times a week, in the duration of five weeks (Wavelength: 780 nm; Probe aperture: 1 cm2; Time: 60 sec per point; Number of treated points: 4; Power density: 70 mW/cm2; Radiant energy: 4.2 J; Daily energy delivered: 16,8 J; Energy density (dose): 4,2 J/cm2; Total treatment dose: 16,8 J/cm2; Cumulative dose: 252 J/cm2). The second group included 28 participants subjected to nonsteroidal anti-inflammatory drug therapy - NSAID (ibuprofen) in the duration of two weeks (first three days 3x400mg, remaining time 2x400mg per day). In order to measure the therapy effects, pain intensity evaluation has been conducted via the visual analog scale (VAS), as well as the evaluation of maximal mouth opening range
Bol lokalizovan u mastikatornim mišićima i/ili temporomandibularnim zglobovima praćen neregularnim kretnjama donje vilice, najizraţeniji je simptom temporomandibularnih disfunkcija (TMD). Literaturni podaci ukazuju da simptomi i znaci TMD znaĉajno utiĉu na funkciju orofacijalnog sistema, socio-psihološki status i kvalitet ţivota pacijenata. Multidisciplinarni pristup leĉenju proizilazi iz kompleksne i multifaktorijalne etiologije TMD i znaĉajne uloge psihosocijalnih faktora. Terapija laserom male snage (low level laser therapy - LLLT) predloţena je kao terapijski modalitet u leĉenju TMD zbog svojih analgetiĉkih, antiiflamatornih i biostimulativnih efekata. MeĊutim, rezultati istraţivanja su još uvek kontradiktorni i nije uspostavljen konsenzus oko optimalnih parametara laserskog zraĉenja i optimalnog terapijskog protokola. Cilj istraţivanja bio je da se ispita da li terapija laserom male snage utiĉe na smanjenje intenziteta bola kod osoba sa temporomandibularnim disfunkcijama. Upotrebom standardnog protokola za dijagnostiku temporomandibularnih disfunkcija predloţenog od strane Dworkin i LeResche (RDC/TMD) izdvojeno je 63 ispitanika. Nasumiĉnim izborom formirane su dve eksperimentalne grupe ispitanika. Prvu grupu ĉinilo je 35 ispitanika koji su bili podvrgnuti terapijom laserom male snage (LLLT) tri puta nedeljno tokom pet nedelja (talasna duţina lasera: 780 nm; otvor laserske sonde: 1 cm; trajanje aplikacije: 60 sekundi po jednoj taĉki; broj tretiranih taĉaka: 4; gustina snage (intenzitet): 70 mW/cm2; predata energija po taĉki: 4.2 J; ukupna predata energija u jednoj poseti: 16,8 J; gustina energije (doza): 4,2 J/cm2; doza po tretmanu: 16,8 J/cm2; kumulativna doza: 252 J/cm2). Drugu grupu ĉinilo je 28 ispitanika kod kojih je sprovedena terapija nesteroidnim antiinflamatornim lekovima - NSAID (ibuprofen) tokom dve nedelje (u prva tri dana 3x400mg, preostalo vreme 2x400mg dnevno). U cilju procene efekata terapije, vršeno je merenje intenziteta bola pomoću vizuelno an