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The influence of educational measures and low-level laser phototherapy on temporomandibular disorders

DOI:10.1097/MD.0000000000019005 期刊:Medicine 出版年份:2020 更新时间:2025-09-19 17:13:59
摘要: Photobiomodulation therapy (PBMT) with low-power laser is used for pain relief in several clinical conditions, including temporomandibular disorders (TMD). As musculoskeletal pain often produces changes in motor behavior, it is common for patients with TMD to present limited mandibular movements. To the date, there is no consensus about the optimal dosimetric parameters of PMBT for TMD. This randomized, controlled, double-blind clinical trial aims to evaluate pain relief and mandibular mobility in patients with TMD following treatments with 2 laser wavelengths, red (660 nm) and infrared (808 nm) individually and in combination as compared to a placebo treatment. One-hundred participants presenting myalgia and arthralgia, with disk displacement or not, will be selected based on the Research Diagnostic Criteria for Temporomandibular Disorders. All participants will be instructed about the etiology, prognosis, and self-care techniques for pain control on TMD, and followed up for 2 weeks. After this period, those who still present pain score over 4 in a visual analog scale (VAS) will be included in the study. Participants will be randomly assigned to 4 treatment groups: G1 = placebo (SHAM); G2 = PBMT with red laser (660 nm, 0.034 cm2, 88 J/cm2, 100 mW, 3 J/point); G3 = PBMT with infrared laser (808 nm, 0.034 cm2, 88 J/cm2, 100 mW, 3 J/point); and G4 = PBMT with red and infrared laser alternated between sessions. The treatment consists of 8 sessions, 2 times a week. The effect of the proposed therapies will be measured by: pain reduction in VAS; pressure pain threshold on TMJ, masseter and temporal muscles; and the amplitude of mandibular movements (opening, protrusion, and right and left lateral movements). The data will be collected at the following times: initial (T1), after the 1st treatment session (T2), at the end of treatment (T3), and 30 days after the last PBMT session (T4). For statistical analysis will be used 2-way repeated measures analysis of variance test, complemented by a post hoc Tukey test (P < .05).
作者: Caroline Maria Gomes Dantas,Solange Mongelli de Fantini,Patrícia Moreira de Freitas Costa e Silva,Claudio Mendes Pannuti,Andrea Lusvarghi Witzel,Gladys Cristina Dominguez,Carolina Lapaz Vivan
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To evaluate the efficacy of different photobiomodulation protocols (red, infrared, and red associated with infrared laser) on pain of patients with TMD and to assess the immediate and longitudinal impact of proposed treatments on pain and mandibular mobility.

This investigation will contribute to enlighten a evidence-based practice of PBMT for TMD, by reporting the effects of specific wavelengths on pain and mandibular function of individuals with myalgia and arthralgia.

The care provider cannot be blinded to allocation due to the nature of the intervention.

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