Photobiomodulation with simultaneous use of red and infrared light emitting diodes in the treatment of temporomandibular disorder: study protocol for a randomized, controlled and double-blind clinical trial

Abstract

Introduction: Temporomandibular disorder (TMD) is considered the main cause of orofacial pain of non-dental origin, and a public health problem. The symptomatology is muscular and/or articular pain, restriction of the mandibular range of motion, and changes in the mandibular movement pattern. Due to its complexity there are already treatments using various forms of therapy. Photobiomodulation using light sources, such as low-level laser or light emitting diodes (LED), with different wavelengths, in a single or combined form, allows one more therapeutic resource to be explored. The objective of this study is to evaluate the effects of photobiomodulation with the simultaneous use of red and infrared LEDs, on pain, range of mandibular movements, and on the electrical activity of masticatory muscles in individuals with TMD. Methods: A randomized, controlled, double-blind clinical trial is proposed, which will involve 33 individuals (n = 11 per group) of both sexes, ages 18 to 45 years in 3 groups: LED group; placebo group; and control group, submitted to 6 non-consecutive sessions of photobiomodulation totaling 2 weeks of treatment. The Research Diagnostic Criteria for Temporomandibular Disorders—RDC/TMD will be used to assess and determine the participants’ TMD. The pain will be assessed using the Visual Analog Scale – VAS, the mandibular range of motion will be determined with the aid of a digital caliper, and the electrical activity of the masticatory muscles will be verified by electromyography. A mixed plate of 18 red LEDs—660 nm and 18 infrared LEDs—850 nm with power of 3.5 mW per LED, 4.45 mW/cm 2 , radiant exposure of 5.35 J/cm 2 , will be used for photobiomodulation. The irradiated area will be 14.13 cm 2 , and energy of 75.6 J, in the TMJ region and in the bilateral masseter and temporal muscles. Participants from all groups will be reassessed after the first therapeutic intervention, and at the end of treatment. Discussion: We expect the use of photobiomodulation with LEDs, infra and red, to reduce pain, improve temporomandibular joint function in patients with TMD, and thus improve the general conditions of the patient.

Role of Photobiomodulation Therapy in Modulating Oxidative Stress in Temporomandibular Disorders. A Systematic Review and Meta-Analysis of Human Randomised Controlled Trials

“…Thus, 51 articles were assessed based on eligibility criteria. Seven studies were excluded due to the following reasons: two studies presented with a study protocol only [50,51], and one study each was excluded for the following reasons: subjects with mean age below 18 year old [52]; laser acupuncture [53]; TMJ magnetic resonance imaging (MRI) for diagnosis of TMD [54]; TMJ osteoarthritis with fossa ad condyle changes [55]; and utilisation of combined physiotherapeutic, pharmacotherapy and homeopathic measures [56] (inter-reviewer agreement, κ = 1). Consequently, 44 out of 51 full text articles were included and analysed in the present systematic review .…”

Different Therapeutic Effects of CO2 and Diode Laser Irradiation on Tooth Movement-Related Pain

“…Despite these differences, both types of lasers have a photodynamic effect (e.g., photons activate mitochondria) (16,17), which has been thought to be the basis of the therapeutic effect of laser irradiation. LLLT has been applied to treat temporomandibular disorder (18) and endodontic and periodontal diseases (17) in dentistry, and an analgesic effect of LLLT on orthodontic force-induced pain has been reported, although not consistently (11,12,19,20). To evaluate the analgesic effect quantitatively and to elucidate the appropriate CO 2 or diode laser irradiation strategy for orthodontic force-induced pain, the changes in jaw-opening reflex excitability caused by laser irradiation were measured in the experimental tooth movement (ETM) animal model.…”

Effectiveness of the Therapeutic Laser in the Syndrome of Dysfunction of the Temporomandibular Joint of Arthrogenic Origin

“…The main signs and symptoms are muscle and joint pain, noises in the joints (cracking and/or clicking), restriction of jaw range of motion, and changes in jaw movement pattern. It can present with tinnitus, vertigo, lack of muscular coordination and biomechanical imbalance of the cervical region (2). In addition, a variety of other symptoms can occur, such as abnormal swallowing and tenderness of the hyoid bone; these symptoms can compromise quality of life and even sleep.…”

“…The effects of LLLT that have been highlighted are analgesics and anti-inflammatories (11). According to various studies, LLLT has shown beneficial results with respect to pain derived from DTM (2)(3)(4)(11)(12)(13)(14)(15)(16); it resulted in the immediate reduction of painful symptoms and a greater range of movements mandibular in the treated group (12). However, for others the LLLT has not shown be more effective than other therapies to simultaneously resolve both pain and impairment of orofacial functions in DTM (13).…”