Efficacy of Low-Level Laser, Hard Occlusal Appliance and Conventional Pharmacotherapy in the Management of Myofascial Pain Dysfunction Syndrome; A Preliminary Study
Journal of Lasers in Medical Sciences,
Vol. 11 No. 1 (2020),
18 Dey 2020
,
Page 37-44
Abstract
Introduction:Myofascial pain dysfunction syndrome (MPDS) is a common temporomandibular joint disorder. Due to its multifactorial etiology, treatment usually involves more than one modality to obtain complementary results. The purpose of this study was to compare the combined effect of low level laser, hard occlusal appliance and conventional pharmacotherapy versus pharmacotherapy only in the management of patients with MPDS.
Methods: In this randomized clinical trial, 15 MPDS patients were diagnosed and randomly assigned to 3 groups (n=5). Subjects in Group 1 were treated with pharmacotherapy (PT), Group 2 received active laser (940 nm Gallium Arsenide) every other day for a total of 10 sessions, plus pharmacotherapy (PTL) and Group 3 were given hard occlusal splint 12 h/day for 4 weeks plus pharmacotherapy (PTO). The intensity of pain was measured using visual analog scale (VAS) prior to treatment, 2 and 4 weeks after treatment onset and 2 weeks later. Maximum painless mouth opening and pain intensity at muscle palpation was also recorded. Comparisons were made between groups in 4 treatment sessions via repeated measure analysis of variance (ANOVA) (P < 0.05).
Results: Pain relief, in subjective VAS was observed in both laser and appliance groups in the third and fourth examination sessions, though occlusal appliance significantly showed to provide the best results between the three groups (p<0.05). No statistically significant reduction in pain was noted using pharmacotherapy only. Maximum painless mouth opening and muscle tenderness was not significantly different among the three groups (p>0.05).
Conclusion: Both Laser and occlusal appliance combined with pharmacotherapy proved to be effective for pain reduction. The 3 groups however failed to result in significant improvement in maximum mouth opening or tenderness of the muscles of mastication.
- Myofascial pain dysfunction syndrome
- Laser therapy
- Low-level
- Occlusal splint
How to Cite
References
Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(4):453-62. doi: 10.1016/j.tripleo.2011.04.021.
De Kanter RJ, Truin GJ, Burgersdijk RC, Van 't Hof MA, Battistuzzi PG, Kalsbeek H, Käyser AF. Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder. J Dent Res. 1993;72(11): 1509-18.doi: 10.1177/00220345930720110901
Laskin DM, Block S. Diagnosis and treatment of myofacial pain-dysfunction (MPD) syndrome. J Prosthet Dent. 1986;56(1):75-84. doi: 10.1016/0022-3913(86)90287-8
Mikhail M, Rosen H. History and etiology of Myofascial Pain Dysfunction syndrome. J Prosthet Dent. 1980 Oct;44(4):438-44. doi: 10.1016/0022-3913(80)90105-5
Okeson JP. Management of temporomandibular disorder and occlusion. 6th ed. St. Louis: Mosby CO; 2008.Chapter 7, Etiology of Functional Disturbances in the Masticatory System; P:130-163.
Chisnoiu AM, Picos AM, Popa S, Chisnoiu PD, Lascu L, Picos A, Chisnoiu R. Factors involved in the etiology of temporomandibular disorders - a literature review. Clujul Med. 2015;88(4):473-8. doi: 10.15386/cjmed-485
Ong KS, Keng SB. The biological, social, and psychological relationship between depression and chronic pain. Cranio. 2003;21(4):286-94. doi: 10.1080/08869634.2003.11746264
Okeson JP. Management of temporomandibular disorders and occlusion. 6 th ed. St. Louis: Mosby; 2008. Chapter 11, General Considerations in the Treatment of Temporomandibular Disorders; P.?
Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res. 2018; 11:571-587. doi: 10.2147/JPR.S127950
Catapano S, Gavagna M, Baldissara S, Baldissara P. Pharmacologic therapy of cranio-cervico-mandibular disorders: Review of the literature. Minerva Stomatol. 1998 Jun;47(6):265-71. [ In Italian]
Brazeau GA, Gremillion HA, Widmer CG, Mahan PE, Benson MB, Mauderli AP, et al. The role of pharmacy in the management of patients with temporomandibular disorders and orofacial pain. J Am Pharm Assoc (Wash). 1998; 38(3):354-61.
Hersh EV, Balasubramaniam R, Pinto A. Pharmacologic management of temporomandibular disorders. Oral Maxillofac Surg Clin North Am. 2008 May; 20(2):197-210.
Naikmasur V, Bhargava P, Guttal K, Burde K. Soft occlusal splint therapy in the management of myofascial pain dysfunction syndrome: a follow-up study. Indian J Dent Res. 2008 Jul-Sep;19(3):196-203. doi: 10.4103/0970-9290.42950
Wright E, Anderson G, Schulte J. A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain. J Orofac Pain. 1995;9(2):192-9.
Xu GZ, Jia J, Jin L, Li JH, Wang ZY, Cao DY. Low-Level Laser Therapy for Temporomandibular Disorders: A Systematic Review with Meta-Analysis. Pain Res Manag. 2018; 2018:4230583.
Herranz-Aparicio J, Vázquez-Delgado E, Arnabat-Domínguez J, España-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. 2013;18(4): e603-12. doi: 10.4317/medoral.18794
Ahrari F, Madani AS, Ghafouri ZS, Tunér J. The efficacy of low-level laser therapy for the treatment of myogenous temporomandibular joint disorder. Lasers Med Sci. 2014;29(2):551-7. doi: 10.1007/s10103-012-1253-6.
Ebrahimi H, Najafi S, Khayamzadeh M, Zahedi A, Mahdavi A. Therapeutic and Analgesic Efficacy of Laser in Conjunction with Pharmaceutical Therapy for Trigeminal Neuralgia. J Lasers Med Sci. 2018;9(1):63-68. doi: 10.15171/jlms.2018.13.
Shukla D, Muthusekhar MR. Efficacy of low-level laser therapy in temporomandibular disorders: A systematic review. Natl J Maxillofac Surg. 2016;7(1):62-66. doi: 10.4103/0975-5950.196127.
Melis Mvafa, Di Giosia M, Zawawi KH. Low level laser therapy for the treatment of temporomandibular disorders: a systematic review of the literature. Cranio. 2012 Oct;30(4):304-12. doi: 10.1179/crn.2012.045
Emshoff R, Bösch R, Pümpel E, Schöning H, Strobl H. 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. 2008; 105(4):452-6. doi: 10.1016/j.tripleo.2007.09.012.
Azizi A, Sahebjamee M, Lawaf S, Jamalee F, Maroofi N. Effects of Low-level Laser in the Treatment of Myofascial Pain Dysfunction Syndrome. J Dent Res Dent Clin Dent Prospects. 2007; 1(2):53-8. doi: 10.5681/joddd.2007.009.
Glick M. Burket's Oral Medicine. 12th ed. People’s Medical Publishing House: Shelton Connecticut; 2015. Chapter 11, Temporomandibular disorders; P. 278.
Beckerman H, de Bie RA, Bouter LM, De Cuyper HJ, Oostendorp RA. The efficacy of laser therapy for musculoskeletal and skin disorders: a criteria-based meta-analysis of randomized clinical trials. Phys Ther. 1992; 72(7):483-91. doi: 10.1093/ptj/72.7.483
Klausner JJ. Epidemiologic studies reveal trends in temporomandibular pain and dysfunction. J Mass Dent Soc. 1995 Winter;44(1):21-5.
Melchior Mde O, Venezian GC, Machado BC, Borges RF, Mazzetto MO. Does low intensity laser therapy reduce pain and change orofacial myofunctional conditions? Cranio. 2013;31(2):133-9. doi: 10.1179/crn.2013.021
LeResche L. Epidemiology of temporomandibular disorders: implications for the investigation of etiologic factors. Crit Rev Oral Biol Med. 1997;8(3): 291-305. doi: 10.1177/10454411970080030401
Michelotti A, Steenks MH, Farella M, Parisini F, Cimino R, Martina R. The additional value of a home physical therapy regimen versus patient education only for the treatment of myofascial pain of the jaw muscles: short-term results of a randomized clinical trial. J Orofac Pain. 2004 ;18(2):114-25.
Kato MT, Kogawa EM, Santos CN, Conti PC. TENS and low-level laser therapy in the management of temporomandibular disorders. J Appl Oral Sci. 2006 Apr;14(2):130-5. doi: 10.1590/s1678-77572006000200012
Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. Management of myofascial pain: low-level laser therapy versus occlusal splints. J Craniofac Surg. 2010; 21(6):1722-8. doi: 10.1097/SCS.0b013e3181f3c76c.
Fouda A. Comparison between four treatment modalities for active myofascial triggers points, Plast Aesth Res.2014;1:21-28. doi: 10.4103/2347-9264.135545
Mortazavi H, Javadzadeh A, Delavarian Z, Zare mahmoodabadi R. Myofascial pain dysfunction syndrome(MPDS). Iran J Otorhinol. 2010;22(61):131-6. doi: 10.22038/IJORL.2010.368
Darbandi A, Jajouei A. Etiology of TMJ disorders in patients referred to Shahed dental School Tehran. J Dent sch. 2003;21(1)36-43.
Maia ML, Bonjardim LR, Quintans Jde S, Ribeiro MA, Maia LG, Conti PC. Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review. J Appl Oral Sci. 2012;20(6):594-602. doi: 10.1590/s1678-77572012000600002
Zuim PR, Garcia AR, Turcio KH, Hamata MM. Evaluation of microcurrent electrical nerve stimulation (MENS) effectiveness on muscle pain in temporomandibular disorders patients. J Appl Oral Sci. 2006;14(1):61-6. doi: 10.1590/s1678-77572006000100012
Salmos-Brito JA, de Menezes RF, Teixeira CE, Gonzaga RK, Rodrigues BH, Braz R. Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders. Lasers Med Sci. 2013;28(1):57-64. doi: 10.1007/s10103-012-1065-8.
Mazzetto MO, Hotta TH, Pizzo RC. Measurements of jaw movements and TMJ pain intensity in patients treated with GaAlAs laser. Braz Dent J. 2010;21(4):356-60. doi: 10.1590/s0103-64402010000400012
Shirani AM, Gutknecht N, Taghizadeh M, Mir M. Low-level laser therapy and myofacial pain dysfunction syndrome: a randomized controlled clinical trial. Lasers Med Sci. 2009 ;24(5):715-20. doi: 10.1007/s10103-008-0624-5.
Khalighi HR, Mortazavi H, Mojahedi SM, Azari-Marhabi S, Moradi Abbasabadi F. Low Level Laser Therapy Versus Pharmacotherapy in Improving Myofascial Pain Disorder Syndrome. J Lasers Med Sci. 2016;7(1):45-50. doi: 10.15171/jlms.2016.10.
da Cunha LA, Firoozmand LM, da Silva AP, Camargo SE, Oliveira W. Efficacy of low-level laser therapy in the treatment of temporomandibular disorder. Int Dent J. 2008;58(4):213-7. doi: 10.1111/j.1875-595x.2008.tb00351.x
Katsoulis J, Ausfeld-Hafter B, Windecker-Gétaz I, Katsoulis K, Blagojevic N, Mericske-Stern R. Laser acupuncture for myofascial pain of the masticatory muscles. A controlled pilot study. Schweiz Monatsschr Zahnmed. 2010;120(3):213-25.
Altan L, Bingöl U, Aykaç M, Yurtkuran M. Investigation of the effect of GaAs laser therapy on cervical myofascial pain syndrome. Rheumatol Int. 2005;25(1):23-7. doi: 10.1007/s00296-003-0396-y
Zhang C, Wu JY, Deng DL, He BY, Tao Y, Niu YM. Efficacy of splint therapy for the management of temporomandibular disorders: a meta-analysis. Oncotarget. 2016;20;7(51):84043-84053. doi: 10.18632/oncotarget.13059.
Amin A, Meshramkar R, Lekha K. Comparative evaluation of clinical performance of different kind of occlusal splint in management of myofascial pain. Indian Prosthodont Soc. 2016;16(2):176-81. doi: 10.4103/0972-4052.176521.
Demirkol N, Sari F, Bulbul M, Demirkol M, Simsek I, Usumez A. Effectiveness of occlusal splints and low-level laser therapy on myofascial pain. Lasers Med Sci. 2015;30(3):1007-12. doi: 10.1007/s10103-014-1522-7
Williams GW, Kivitz AJ, Brown MT, Verburg KM. A comparison of valdecoxib and naproxen in the treatment of rheumatoid arthritis symptoms. Clin Ther. 2006;28(2):204-21. doi: 10.1016/j.clinthera.2006.01.016
Guimaraes AS, Carlsson GE, Marie SK. Bite force and handgrip force in patients with molecular diagnosis of myotonic dystrophy. J Oral Rehabil. 2007;34(3):195-200. doi: 10.1111/j.1365-2842.2006. 01665.x
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