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

Abstract

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. 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. 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. 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.