Low level laser therapy in the management of temporomandibular disorders
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This double blind randomized controlled trial (RCT) evaluated the dose effect of Low Level Laser Therapy (LLLT) as an adjunctive intervention in the treatment of myofascial pain of the masseter muscles. This study also investigated optimal dose/time parameters to achieve reduction of symptoms in this set of patients. Subjects were volunteers from the Temporomandibular Disorders (TMD) and Orofacial Pain clinic, University at Buffalo, School of Dental Medicine. Eligible subjects had a confirmed diagnosis of myofascial pain following the specifications of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and had a Characteristic Pain Intensity of at least 5/10. LLLT was implemented using light obtained from an 810 nm laser diode cluster with a total output of 1 W, and a 660 nm LED cluster with a total output of 100 mW. Patients received LLLT using a dose (energy density) of 2, 4 or 6 J/cm 2 delivered at an irradiance rate of 110 mW/cm 2 twice weekly for 4 weeks. A control group receiving a placebo treatment was used for comparison. All 4 groups also received a custom soft occlusal appliance for use at night. Follow-up evaluation was done a week after the last treatment session. At baseline and follow-up all subjects were evaluated using the RDC/TMD guidelines. For the evaluation of pain an 11 point (0–10) numeric rating scale (NRS) of pain intensity (0 no pain to 10 worst pain possible) was used at base line and follow-up. Subjects also filled out a daily pain diary and were asked to note any use of pain medications. Results show a significant overall improvement in all groups. No significant difference was found between treatment groups. Conclusion. More studies are required to define the parameters of the effective use of LLLT for TMD patients with myofascial pain as the dose parameters used in this study did not provide additional benefit.