Comparative effectiveness of low‐level laser therapy with different wavelengths and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular disorders: A systematic review and network meta‐analysis

Abstract

Objective: 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).Methods: 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 (632.8-672 nm, 780-904 nm, and 910-1100 nm) 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 metaanalysis, assessed the quality of evidence, which contributed to network estimate via the GRADE framework.Results: 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 910 nm to 1100 nm 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 910 nm to 1100 nm 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 1 month later. Conclusion: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 910 nm to 1100 nm.

Diagnosis and Treatment of Myogenous Temporomandibular Disorders: A Clinical Update

“…One special feature of LLLT is that it does not make contact with skin and can be used even with wounds. In a systematic review and network meta-analysis conducted in 2022, Ren et al explored the optimal wavelength range of laser application, affirming that laser therapy with a wavelength of 910–1100 nm was the most effective [ 87 ].…”

“…While TENS, LLLT and therapeutic US are useful in pain reduction, systematic reviews and meta-analyses carried out in 2022 have shown that LLLT was the most effective in reducing pain among the three treatment modalities [ 87 , 89 , 90 ]; LLLT was found to be superior to TENS and was also proven to be better in reducing pain than therapeutic US [ 89 ]. Better results could be achieved with higher wavelengths, and wavelengths ranging from 910 nm to 1100 nm were recommended to treat TMD using LLLT [ 87 ].…”

Therapy outcome measures in temporomandibular disorder: a scoping review

“…Open access exercise (such as masticatory muscle opening, range of motion training and manual TMJ disc manipulation), drug (including analgesics, central muscle relaxants, anxiolytics) and appliance (stabilisation appliance, anterior positioning appliance therapy) therapies. [6][7][8][9][10][11] Conservative treatment, including counselling, exercises, occlusal splint therapy, massage and manual therapies, should be considered the first choice for TMD pain because of their low risk of side effects. Pharmacotherapy and minimally invasive procedures should be considered in the case of severe acute or chronic pain resulting from serious disorders, inflammation and degeneration.…”

“…The main TMD therapeutic goals are pain relief, jaw function recovery and quality of life (QOL) improvement 5. Reversible conservative treatments in the initial TMD treatment include physical (such as masticatory muscle massage, hot compress and electrical stimulation therapy), exercise (such as masticatory muscle opening, range of motion training and manual TMJ disc manipulation), drug (including analgesics, central muscle relaxants, anxiolytics) and appliance (stabilisation appliance, anterior positioning appliance therapy) therapies 6–11. Conservative treatment, including counselling, exercises, occlusal splint therapy, massage and manual therapies, should be considered the first choice for TMD pain because of their low risk of side effects.…”

Mid- and Long-Term Effect of Kinesio Taping on Temporomandibular Joint Dysfunction: A Randomised- Controlled Trial

“…The aetiology of TMD is considered multifactorial. Biomechanical, neuromuscular, biopsychosocial and neurobiological factors also affected the development of TMD (3). Studies have shown that TMD is more common in women aged 20-40 years (4,5).…”