temporomandibular disorder dental disease/infection
Management of TMD Symptoms with Photobiomodulation Therapy Ammaar H. Abidi, D.D.S., Ph.D.; Alan O. Blanton, D.D.S., M.S.; Christopher J. Walinski, D.D.S.
ABSTRACT Photobiomodulation therapy (PBMT) was performed on a patient complaining of migraines, nocturnal bruxism, jaw clicking and pain upon chewing. The patient was treated on five consecutive days with two different laser devices. PBMT was performed at the temporalis, masseteric, sternocleidomastoid and shoulder regions bilaterally, using one of the lasers on each side. The patient’s constant headaches and pain were reduced from a 5.5 to 2 on a 10-point visual analog pain scale. This preliminary study provides evidence that PBMT may be an option in the management of temporomandibular disorders (TMD) and myofascial pain; however, more studies are required to validate this finding. Temporomandibular disorder (TMD) reflects a subgroup of orofacial disorders that results in pain of the temporomandibular joint (TMJ), masticatory muscles and surrounding tissues.[1] The etiology of TMD is multifactorial and has been linked to emotional stress, psychological factors, traumatic injury, proinflammatory
immune responses, neoplastic growth, occlusal interferences, loss or malpositioning of the teeth, dysfunction of masticatory muscles and adjacent structures, etc.[2,3] Current methods used to treat and manage TMD include dental/occlusal appliances or splint therapy, medication (NSAIDs or tricyclic antidepressants), head and neck posture improving exercises, and stress management.[4] However, certain dental therapies, such as orthognathic surgery, prosthodontic rehabilitation and fractured mandibles, are all associated with alterations in the TMJ, leading to worsening of TMD.[5] Conservative approaches, such as soft diets, anti-inflammatory drugs and photobiomodulation therapy (PBMT) or low-level laser therapy (LLLT), have been used to manage TMD. Lasers have proven to be successful in clinical settings and treatments of soft tissues, musculoskeletal pain, bone regeneration and dentinal hypersensitivity, and provide reduction in symptoms and improved function.[6-11] The mechanism of action in PBMT is via absorption of light, with deeply penetrating wavelengths ranging from 630 nm to 1300 nm, to stimulate tissues with direct irradiation to achieve analgesic and anti-inflammatory effects.[12] The output energy in PBMT does not affect skin temperature and is classified as a soft laser, which increases lymphatic flow, reduces edema and prostaglandin E2 (PGE2) and cyclooxygenase (COX) levels.[13] A case report by Ayyildiz et al. indicated that LLLT performed with a 685 nm red probe diode laser was an appropriate treatment for TMD-
The New York State Dental Journal NOVEMBER 2020 23 ●
