Comparative Evaluation of the Effectiveness of Ultrasound Heat Therapy, Low-level Laser Therapy and Transcutaneous Electrical Nerve Stimulation in Symptomatic Temporomandibular Disorders: An In vivo Study

Aim Temporomandibular disorders (TMDs), one of the most common causes of chronic orofacial pain is caused by the dysfunction of the various components of the temporomandibular joint and often require the use of non-invasive physical therapeutic modalities for its management. The present study was undertaken to compare the efficacy of plain therapeutic ultrasound (Th US), transcutaneous electric nerve stimulation (TENS therapy) and low-level laser therapy (LLLT) in the management of TMD. Materials and methods In this randomized clinical trial, 45 subjects aged between 18 to 40 years and diagnosed with TMD were randomly divided into three groups. The subjects of group A, group B and group C were treated with Th US, TENS therapy and LLLT, respectively, twice a week for a period of two weeks. The efficacy of each modality was evaluated in terms of pain intensity and functional improvement of the subjects both prior to and after each session using Visual Analogue Scale (VAS), Helkimo dysfunctional clinical index (HI) and Maximum Mouth Opening (MMO). Inter-group and multi-group comparisons of all the parameters, along with age-based differences, were analyzed using SPSS software (version 26) and a p-value of 0.05 was considered to be statistically significant. Results The mean age of the included study subjects were 30.3 ± 9.1, 27.5 ± 6.7 and 27.4 ± 6 years in the Th US, TENS therapy and LLLT respectively, with a female predominance (53.3%). A significant reduction of pain intensity (VAS) and dysfunction (HI), along with improvement of mouth opening (MMO), was seen among the subjects of all three groups by the end of the last interventional session (p < 0.05). However, a maximum difference was noted among the subjects of group C (LLLT) in terms of inter-group and multi-group comparisons of VAS, HI and MMO, followed by group A (Th US) and group B (TENS), respectively. Though the recurrence rate was high among the subjects of group Β (26.6%), there was no statistical significance. Conclusion Although significant improvements were observed among all three study groups, LLLT established a superiority over Th US and TENS therapy in terms of pain relief, mouth opening as well as functional outcome of the joint. Based on our results, we suggest the application of LLLT as an effective interventional option for TMD patients to achieve better and long-lasting functional results.

Introduction: Temporomandibular joint disorders (TMDs) are the most common source of pain on the face. There are multiple etiologies, and several types of treatment have been reported. The use of non-invasive and reversible therapies in the treatment of such problems is recommended. The present study evaluated the effect of low-level laser (LLL) therapy and transcutaneous electric nerve stimulation (TENS) on TMDs. Methods: In this single-blind study, 40 patients with temporomandibular disorders were randomly divided into four groups: TENS (TENSTem dental), LLL (diode 810 nm CW), shamTENS, and sham-LLL. All subjects were examined and data on pain and tenderness in the temporomandibular joint (TMJ) and masticatory muscles (using the visual analogue scale) and mouth-opening (distance between incisal edges before feeling pain; mm) were collected before baseline (T1), after each session (T2-T5) and one month after the end of the sessions (T6)), and analyzed using repeated measure analysis of variance (ANOVA) and Bonferroni statistical tests. A P value < 0.05 was considered significant. Results: The decrease in pain (P=0.000), tenderness (P=0.000) and increase in mouth-opening ability (P=0.002) was greater in the TENS and LLL groups than in the placebo groups. At the one-month follow-up, significant decrease in pain and tenderness was recorded in the TENS and LLL groups (P=0.000). There was no significant differences between TENS and LLL and the placebo groups for maximum mouth-opening at the end of the study (P=0.692). Conclusion: Using TENS or LLL therapy can improve TMD symptoms at least for the short term. Although the effects of the placebo played a role in improving symptoms, their effects were less important.

Myofascial pain is one of the most common facial region pains, presenting itself with various signs and symptoms like tenderness of masticatory muscles and difficulty in mouth opening. Considering its multifactorial aetiology various treatment modalities are present. The aim of this study is to compare the effectiveness of transcutaneous electrical nerve stimulation (TENS)and low-level laser therapy (LLLT) for the patients of temporomandibular disorders (TMDS). The study was conducted with 20 patients diagnosed with TMDS. Group A received LLLT at 660 nm, 6 J/point, two sessions/week for 4 weeks and group B received TENS at 2-250 Hz, two sessions/week for 4 weeks. Pain Score decreased and mouth opening increased in both groups with time, however, the difference between the two groups was not statistically significant. Right and left lateral excursions showed improvement at different intervals in both groups. However, the LLLT group showed significant improvement. Clinical trial showed improvement in visual analogue scale (VAS), maximum mouth opening (MMO) and lateral excursion in the different time intervals in both the groups with LLLT showed more improvement with lateral excursions movements.

Comparison of the Effects of Transcutaneous Electrical Nerve Stimulation and Low-Level Laser Therapy on Drug-Resistant Temporomandibular Disorders

Temporomandibular disorders (TMD) occur in a small number of patients who undergo orthognathic surgery. Transcutaneous electrical nerve stimulation (TENS) is a treatment modality used to manage TMD. This study aimed to assess the effects of TENS on reducing symptoms following orthognathic surgery. This was a pre-protocol randomized clinical trial. Patients with retrognathia and myogenic temporomandibular joint disorders following mandibular advancement were studied. The subjects were randomly divided into two groups: the treatment group, which received TENS, and the control group. This study was conducted at Shahid Beheshti University of Medical Science. Patients in the treatment group underwent 10 sessions of TENS two months after surgery, which were repeated 1month later. The main outcomes of the study were pain severity measured using a visual analog scale and maximum mouth opening (MMO). Pain and MMO were assessed 1, 3, 6months after the intervention. A total of 29 patients were included in group I (TENS) and 31 in group II (control). Pain was significantly different between the treatment and control groups 3 and 6months after the intervention (p = 0.001, p < 0.001 retrospectively). MMO was significantly different between the treatment and control groups at 1, 3, and 6months after the intervention (p = 0.032, p = 0.007, p = 0.013 retrospectively). TENS appears that TENS is effective for pain relief and improvement in maximum mouth opening (MMO) in patients with temporomandibular disorder (TMD) following orthognathic surgery.

Objective: The aim of the present study was to compare low-level laser therapy (LLLT) and transcutaneous electric nerve stimulation (TENS) in the management of patients with temporomandibular disorders (TMDs). Background: TMDs are a collective term embracing a number of clinical problems that affect the masticatory muscles, the temporomandibular joint and associated structures, or both. Materials and Methods: A total of 20 patients with TMD of muscular origin were randomly selected and divided into two groups: Group 1 comprising 10 patients who were to receive LLLT and Group 2 constituting 10 patients who were to obtain TENS therapy. Treatment included nine sessions of the respective therapy rendered over the period of 30-day to patients of either group. The visual analog scale (VAS), improvement in mouth opening and evaluation by palpation of temporalis and masseter muscle were used for follow-up analysis. A paired t-test was employed to study the significance of the results. Results: The results showed a reduction in VAS values and tenderness to muscle palpation for both groups. A significant improvement in mouth opening was also noted in the course of therapy in both groups. Conclusion: Both LLLT and TENS were effective with regard to pain control, improvement in mouth opening and reduction in temporalis and masseter muscle tenderness. LLLT appeared slightly better than TENS therapy when evaluating variables of VAS and mouth opening.

To assess the efficacy of low-level laser therapy (LLLT) with different wavelengths and transcutaneous electric nerve stimulation (TENS) and explore the optimal wavelength range of laser application in the treatment of pain caused by temporomandibular disorders (TMD). An electronic search on PubMed, Cochrane Library, Embase, Scopus and Web of Science was undertaken to identify the randomised clinical trials (RCTs) published from database inception to 16 April 2021, aiming to compare the effects of LLLT with different wavelengths (632.8-672nm, 780-904nm, and 910-1100nm) or TENS or placebo group on TMD patients pain reduction. In addition, manual search of the studies was performed. The reviewers assessed the risk of bias of individual studies with the Cochrane risk of bias tool and excluded the RCTs with a high risk of bias in any field. Meanwhile, the reviewers, after performing the network meta-analysis, assessed the quality of evidence, which contributed to network estimate via the GRADE framework. Twenty-seven RCTs with 969 patients with TMD were included. In the meta-analysis, all treatment groups showed an overall improvement in pain scores, when compared with the placebo group. LLLT with wavelength ranging from 910nm to 1100nm produced more pain relief in the visual analogue scale (VAS) immediately after treatment [mean difference (MD)=4.68, 95% confidence interval (CI):(3.08,6.28)]. After one-month follow-up, LLLT with wavelength ranging from 910nm to 1100nm also showed superior pain-relieving effects [MD=3.61, 95% CI: (-1.77, 8.99)]. However, no significant difference was observed. Based on the SUCRA ranking, L3 ranked first immediately after treatment and 1month later. The results of the meta-analysis showed the LLLT had better short-term efficacy than TENS in the treatment of pain caused by TMD. Better results can be achieved with higher wavelengths. Therefore, we recommended to treat TMD using LLLT with wavelength ranging from 910nm to 1100nm.

Introduction: Temporomandibular Joint Disorders (TMDs) are considered multifactorial, and several treatment approaches have been proposed for their effective management. The use of non invasive treatment modalities is recommended, which includes Transcutaneous Electric Nerve Stimulation (TENS), Low-Level Laser Therapy (LLLT), acupuncture, ultrasound, and manual therapies. Aim: To evaluate the effectiveness of TENS, LLLT, and ultrasound therapy in patients suffering from TMDs. Materials and Methods: This prospective, randomised clinical trial was conducted on thirty patients (11 males, 19 females) clinically diagnosed with TMD associated with Temporomandibular Joint (TMJ) pain, clicking joint sound, pain in the muscles of mastication, and limited mouth opening. Patients were sequentially randomised into three groups to be treated with TENS, laser beam, and ultrasound therapies, respectively. The Visual Analog Scale (VAS) Score and painfree mouth opening were recorded before, during, and after treatment. Data were analysed using Statistical Package for Social Sciences(SPSS) version 16.0 statistical software. Statistical tests such as the paired sample t-test, Analysis of Variance (ANOVA), and post-hoc Tukey test were performed. Results: There was a significant reduction in the VAS score in the TENS group (3.15), LLLT group (5.75), and ultrasound group (5.50) post-treatment (p&lt;0.001). In addition, improvements in Mean Mouth Opening (MMO) levels were observed with TENS (7.80 mm), LLLT (9.09 mm), and ultrasound therapy (7.15 mm). These differences were found to be statistically significant (p&lt;0.05). The laser and ultrasound groups fared better than the TENS group in the reduction of VAS scores (p&lt;0.05), and there was no significant difference in MMO among the three therapies. Conclusion: Reductions in VAS scores and improvements in mouth opening were noticed in all three groups post-treatment. The laser and ultrasound therapies were more effective in reducing pain compared to TENS therapy. Comparing pretreatment and mid-treatment values, laser beam therapy proved to be more effective in reducing pain scores compared to TENS and ultrasound therapy.

Transcutaneous electrical nerve stimulation (TENS) is a non-invasive treatment modality for acute and chronic pain. However, little information for muscle activity is available on the immediate effects of TENS in masticatory muscle pain related to temporomandibular disorders (TMDs). The present study aimed to evaluate the immediate effects of TENS treatment on TMD-related muscle pain. Thirty-six patients with TMD-related muscle pain and 39 healthy subjects served as TMD and control groups, respectively. For objective evaluations, maximum mouth opening, and maximum bite force were measured before and after TENS. The pain intensity was assessed according to a 100-mm visual analog scale (VAS). TENS was applied to painful muscles for 20 min with frequencies of 100–200 Hz. The treatment outcome was evaluated using Global Rating of Change (GRC) scales. In the TMD group, VAS values significantly decreased after TENS. Although there was significant increase in the maximum mouth opening after TENS for only TMD group, the maximum bite force of both groups was significantly greater after TENS. According to GRC scales, one patient with TMD-related muscle pain expressed negative feelings after TENS. Conclusively, TENS treatment might quickly relieve pain in masticatory muscles and improve masticatory functions in patients with TMD-related muscle pain.

Background: Erectile dysfunction (ED) is one of the manifestations of long COVID-19 and in most cases has an endothelial and neurogenic nature. Many experimental and clinical investigations have revealed the high efficacy of transcutaneous electrical nerve stimulation (TENS) of the pudendal nerve and low-level laser therapy (LLLT) in the treatment of ED. Purpose: To compare LLLT and TENS, and investigate the dynamics of their efficacy when combined in the treatment of patients with post-COVID-19 ED using the International Index of Erectile Function-15 (IIEF-15). Materials and Methods: This interventional, randomized controlled trial enrolled 82 patients with ED following COVID-19. All patients had their first ED diagnosis after COVID-19 within one month of the onset of respiratory symptoms. The duration of patients' ED was not less than six months, but less than one year. Patients were divided into four groups, one of which received sham LLLT and TENS (n = 20). The remaining patients underwent effective treatment using LLLT (n = 21), TENS (n = 21), and combined LLLT and TENS (n = 20). To study the effectiveness of the treatment, IIEF-15 and an assessment of tactile sensation in the genital area before and after the treatment, as well as 3 months after the end of the treatment, were used. Results: Both LLLT and TENS had a significant effect in improving erectile function, of 38% (p ≤ 0.01) and 27% (p ≤ 0.01), respectively. The improvement in erectile function after LLLT was higher than after TENS by 8.2% (p ≤ 0.05), but the combination of these methods exceeds the result of using LLLT alone by 20% (p ≤ 0.01). The reduction in hypoesthesia after LLLT did not exceed 17.4% (p ≤ 0.05). However, after TENS, the reduction in hypoesthesia reached 48.7% (p ≤ 0.01), and with a combination of the two methods, it reached 60.9% (p ≤ 0.01). Treatment outcomes in LLLT, TENS, and LLLT + TENS groups were stable for 3 months. Conclusions: According to IIEF-15 dynamics, LLLT and TENS are both very beneficial in treatment of post-COVID-19 ED, with LLLT showing a moderately better outcome than TENS. LLLT and TENS were found to have significant positive therapeutic effects on orgasm, sexual desire, and sexual satisfaction, among other aspects of sexual function. Nevertheless, the combination of LLLT and TENS proved to be much more successful in enhancing all IIEF domains, expanding the therapeutic effect spectrum, and improving the TENS effect following LLLT application. Only after TENS did genital hypoesthesia reliably regress, and the effect was amplified when TENS and LLLT were combined.

The most prevalent conditions in the population are temporomandibular disorders (TMDs), which are linked to a number of morbidities. A number of treatment options have been proposed, and some of the most successful ones include low-level laser therapy (LLLT) and transcutaneous electrical nerve stimulation (TENS) therapy. The purpose of this study was to examine the effectiveness of two therapies-TENS treatment and LLLT-in the management of morbidities related to temporomandibular joint (TMJ) disorders. Based on inclusion and exclusion criteria, a total of 50 patients who had been sent to the oral medicine outpatient department and had been pre-diagnosed with TMJ disorders were randomly assigned to two groups, with 25 patients in each: Group I received TENS therapy, while Group II received LLLT. The acquired data was assessed statistically. Both groups showed a substantial decrease in discomfort, an increase in mouth opening, and a decrease in muscular tenderness when compared to within groups. LLT was more effective than TENS for TMD treatment. While TENS and LLLT both had good results, LLLT appeared to outperform TENS therapy in terms of muscle tenderness factors.

Introduction: Temporomandibular disorder (TMD) related pain can affect the individual's daily activities, psychosocial functioning, and quality of life. The aim of the study is to evaluate the effect of transcutaneous electrical nerve stimulation (TENS) on acute pain in patients with TMD. Materials and Methods: This is a double blind randomized clinical trial study. Patients were studied in two groups: In group1(Control group), patients received pharmacological agents with 7 sessions of passive TENS , patients in group 2 received the same protocol with 7 sessions of active TENS (Every session 15 min). Age and gender were variables and pain severity (based on visual analogue scale) and maximum mouth opening (MMO) 30 days after treatment were outcomes of the study. Results: Sixty patients were studied in two groups. Seven days after treatment, the mean of pain severity was 3.63±0.80 in group1 and 2.67±0.66 in group 2., The mean of MMO was 37.06±1.68 mm in group1 and 38.47±1.48 mm in group2.Analysis of the data showed a significant difference between the two groups for MMO. (P=0.001) Conclusion: It seems use of TENS may improve pain relief in conjunction with pharmacological agents in patients with TMD.

Comparison of the Efficiency of High-Intensity Laser Therapy and Transcutaneous Electrical Nerve Stimulation Therapy in Patients With Symptomatic Temporomandibular Joint Disc Displacement With Reduction

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.

Introduction: This study aimed to compare the short-term effects of Low-Level Laser Therapy (LLLT) and Transcutaneous Electrical Nerve Stimulation (TENS) on hand pain and function in patients with low or moderate levels of Carpal Tunnel Syndrome (CTS). Materials and Methods : Twenty-four patients with confirmed mild to moderate CTS were recruited for this study. The eligible patients were randomly divided into two groups: LLLT and TENS. Patients in the LLLT group were exposed to GaAlAs diode laser, 808 nm with 6.5 J/cm 2 for two points perpendicularly over the carpal area. Patients in the TENS group were treated daily by conventional TENS with 80 µs duration for a period of 30 minutes per day. All patients were treated daily, five days per week for a period of two weeks. The researchers performed clinical assessment using visual analogue scale and McGill Pain questionnaire for pain rating and Disabilities of the Arm, Shoulder and Hand questionnaire for functional scales. For statistical analysis, paired t-test was used in each group, and analysis of variance was used for comparison between groups. Results: All outcome measures in the LLLT group were substantially improved while the TENS group provided better pain sensation. Conclusion: This study documented that LLLT might be effective in reducing pain and improving function in patients with mild to moderate CTS. Electrical stimulation might have been effective (short term) in controlling pain in these patients. Keywords: Carpal Tunnel Syndrome; Function; Low-level Lasers; Pain; TENS