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Pain relief and reestablishment of normal jaw function are the main goals of conservative management of Temporomandibular Disorders (TMD). Transcutaneous electrical nerve stimulation (TENS) and laser therapy are part of these modalities, although little is known about their real efficacy in controlled studies. This research compared these two treatments in a sample of 18 patients with chronic TMD of muscular origin, divided into two groups (LASER and TENS). Treatment consisted of ten sessions, in a period of 30 days. Active range of motion (AROM), visual analogue scale (VAS) of pain and muscle (masseter and anterior temporalis) palpation were used for follow-up analysis. Data were analyzed by Friedman test and ANOVA for repeated measurements. Results showed decrease in pain and increase in AROM for both groups (p<0.05), and improvement in muscle tenderness for the LASER group. Authors concluded that both therapies are effective as part of TMD management and a cumulative effect may be responsible for the improvement. Caution is suggested when analyzing these results because of the self-limiting feature of musculoskeletal conditions like TMD.

Temporomandibular disorders (TMD) are characterized by the presence of temporomandibular joint (TMJ) and/or masticatory muscle pain and dysfunction. Low-level laser is presented as an adjuvant therapeutic modality for the treatment of TMD, especially when the presence of inflammatory pain is suspected.ObjectiveTo systematically review studies that investigated the effect of low level laser therapy (LLLT) on the pain levels in individuals with TMD. Material and MethodsThe databases Scopus, embase, ebsco and PubMed were reviewed from January/2003 to October/2010 with the following keywords: laser therapy, low-level laser therapy, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, temporomandibular joint, temporomandibular, facial pain and arthralgia, with the inclusion criteria for intervention studies in humans. exclusion criteria adopted were intervention studies in animals, studies that were not written in english, Spanish or Portuguese, theses, monographs, and abstracts presented in scientific events. ResultsAfter a careful review, 14 studies fit the criteria for inclusion, of which, 12 used a placebo group. As for the protocol for laser application, the energy density used ranged from 0.9 to 105 J/cm2, while the power density ranged from 9.8 to 500 mW. The number of sessions varied from 1 to 20 and the frequency of applications ranged from daily for 10 days to 1 time per week for 4 weeks. A reduction in pain levels was reported in 13 studies, with 9 of these occurring only in the experimental group, and 4 studies reporting pain relief for both the experimental group and for the placebo. ConclusionMost papers showed that LLLT seemed to be effective in reducing pain from TMD. However, the heterogeneity of the standardization regarding the parameters of laser calls for caution in interpretation of these results. Thus, it is necessary to conduct further research in order to obtain a consensus regarding the best application protocol for pain relief in patients with TMD.

The aim of this study was to evaluate the maximum bite force in temporomandibular disorders (TMD) patients. Two hundred women were equally divided into four groups: myogenic TMD, articular TMD, mixed TMD and control. The maximum bite force was measured in the first molar area, on both sides, in two sessions, using an IDDK (Kratos) Model digital dynamometer, adapted to oral conditions. Three-way anova, Tukey and Pearson correlation tests were used for the statistical analysis. The level of statistical significance was given when P < or = 0.05. The maximal bite force values were significantly higher in the control group than in the experimental ones (P = 0.00), with no significant differences between sides. Higher values were obtained in the second session (P = 0.001). Indeed, moderate negative correlation was found between age and bite force, when articular, mixed groups and all groups together were evaluated. A moderate negative correlation was also detected between TMD severity and the maximal bite force values for myogenic, mixed and all groups together. Authors concluded that the presence of masticatory muscle pain and/or TMJ inflammation can play a role in maximum bite force. The mechanisms involved in this process, however, are not well understood and deserve further investigation.