Comparative effectiveness of photobiomodulation and manual therapy alone or combined in TMD patients: a randomized clinical trial.

Fernanda Thomé Brochado,Vinicius Coelho Carrard,Angelo Luiz Freddo,Karen Dantur Chaves,Luciano Henrique De Jesus,Manoela Domingues Martins

doi:10.1590/1807-3107bor-2018.vol32.0050

Fernanda Thomé Brochado, Vinicius Coelho Carrard + Show 4 more

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https://doi.org/10.1590/1807-3107bor-2018.vol32.0050

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Abstract

The effectiveness of photobiomodulation (PBM) and manual therapy (MT), alone or combined (CT), were evaluated in pain intensity, mandibular movements, psychosocial aspects, and anxiety symptoms of temporomandibular disorder (TMD) patients. Fifty-one TMD patients were randomly assigned to three groups: the PBM group (n = 18), which received PBM with 808 nm, 100 mW, 13.3 J/cm2, and 4 J per point; the MT group (n=16) for 21 minutes each session on masticatory muscles and temporomandibular joint TMJ; and the CT group (n = 17), applied during twelve sessions. Seven evaluations were performed in different moments using visual analogue scale (VAS), Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and II, and Beck anxiety inventory (BAI). All groups demonstrated reductions in pain and improvement in jaw movements during treatment and at follow-up (< 0.001). The assessment of psychosocial aspects of TMD, comparing baseline and follow-up in all treatment groups, revealed that treatment did not promote modification in the intensity of chronic pain (p > 0.05). However, depression symptoms showed a reduction in PBM and CT groups (p≤0.05). All treatments promoted reduction in physical symptoms with and without pain and enhancement of jaw disabilities (p ≤ 0.05). MT promotes improvement in 5 functions, PBM in 2, and CT in 1 (p < 0.001). BAI analysis revealed that all treatments lead to a reduction in anxiety symptoms (p≤0.05). All protocols tested were able to promote pain relief, improve mandibular function, and reduce the negative psychosocial aspects and levels of anxiety in TMD patients. However, the combination of PBM and MT did not promote an increase in the effectiveness of both therapies alone.

Highlights

Submitted: September 08, 2017 Accepted for publication: April 10, 2018 Last revision: April 25, 2018Temporomandibular disorders (TMDs), considered the major cause of non-dental facial pain, involve a wide range of symptoms in masticatory muscles and temporomandibular joints.[1,2] Diagnosis is usually delayed due to the multifactorial etiology, and the lack of assessment devices and parametersBraz
TMD was more prevalent in females (95.1%) with a mean age of 44 years (±17.1), ranging from 21 to 77 years old
Assessment of pain The visual analogue scale (VAS) data obtained in all periods of evaluation are demonstrated in Figure 3 (A and B)

Summary

Introduction

Submitted: September 08, 2017 Accepted for publication: April 10, 2018 Last revision: April 25, 2018Temporomandibular disorders (TMDs), considered the major cause of non-dental facial pain, involve a wide range of symptoms in masticatory muscles and temporomandibular joints.[1,2] Diagnosis is usually delayed due to the multifactorial etiology, and the lack of assessment devices and parametersBraz. Comparative effectiveness of photobiomodulation and manual therapy alone or combined in TMD patients: a randomized clinical for studies.[2] Most studies that evaluate TMD treatment modalities use only Visual Analogue Scale (VAS) and mouth opening analysis, neglecting important aspects such as chronic pain, depression, anxiety, and other symptoms. To increase the consistency between studies, the Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD) was developed and has been used worldwide as a gold standard for TMD evaluation.[2] The measure is a dual-axis system, where Axis I involves the clinical examination resulting in TMD classification into three groups: 1) muscle disorders, including myofascial pain, with and without mouth opening limitation; 2) disk displacement, with or without mouth opening reduction or limitation; and 3) arthralgia, arthritis, and/or arthrosis. Axis II assesses functional jaw disability, psychological status, and psychosocial functioning.[3,4] Axis II is very important, since around 75% of patients suffer from chronic symptoms, with negative biopsychosocial consequences.[4]

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