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Laser Therapy Research for TMJ TMD

ML830 Laser Therapy for the Treatment of TMJ & TMD

Dr. Donald G. Kimble Neuro Muscular TMJ Specialist

There are a variety of treatment modalities, which can be divided into Phase I and Phase II. The purpose of Phase I is to eliminate muscle spasms, TMJ swelling, bruxism (grinding of the teeth) and any dislocation, and generally reduce any type of pain. This treatment usually includes the use of the TMJ appliance (mouth splint), exercises, medication, different therapy, and natural muscles relaxants, and Micro-light Cold Laser Treatments (ML830) to relieve TMJ pain. The ML830 ia a non-invasive, non-thermal laser, capable of penetrating deep into tissue. It is one of the most fascinatingnew healing advances, and is FDA CLEARED to treat and manage TMJD pain, muscle and joint pain relief.
The purpose of Phase I therapy is to definitively correct any discrepancies, if necessary, between the upper and lower jaws. Phase 1 therapy may include adjustments of the TMJ joint, orthodontics, surgery or a combination of treatments. It is important to note that Phase II therapy should not be attempted without successful Phase 1 treatment.
Phase I Therapy is usually composed of three types of treatment, all aimed at reducing or eliminating muscle and joint pain.
Therapy No.1
The use of an intra-oral splint (The TMJ Appliance). The TMJ appliance is a computer designed intra oral device that fits most adult mouths without adjusting. It is specifically designed to assist in the treatments of TMJ disorders. The TMJ appliance has been designed by Australian Dentist Dr. Chris Farrell, in response to the need for a low cost intra-oral splint that could be implemented by health care providers, as well as dentists, for the many patients who present with symptoms of TMJ disorders. It is specifically designed to assist in treatments of TMJ disorder. No molding, adjusting or custom fitting is required.
Therapy No. 2
The use of different modes of treatment to reduce muscle and nerve pain. This is a special natural pain relief supplement called (SERENITOL). Proven effective in reducing the reversing the effect if Sleep Apnea, Bruxism, nightly TMJ dysfunction, insomnia, Anxiety Neurosis, Chronic Fatigue and other sleep related disorders. Use of Serenitol, used properly and conservatively is very benefical.
Therapy No.3
The use of MicroLight ML830 Cold Laser Therapy. The ML830 Laser is a non-thermal laser capable of penetrating deep into tissue. FDA CLEARED to treat and manage TMJD pain, muscle and joint pain relief, the ML830 Laser is also used to treat carpal tunnel syndrome at our office.
One of the most fascinating and used healing advances is the ML830 low level laser. We are pleased to announce that the ML830 laser has received clearance for the treatment of TMJD and Carpal Tunnel Syndrome.
Laser therapy has been successfully used around the world for over 25 years, with no reported long-term or irreversible side effect. TMJD sufferers are now free to seek relief from TMJ jaw pain through a new non-invasive form of therapy before resorting to surgery. We have had excellent results using the non-thermal laser to relieve pain and promote healing of the painful tissue.
Phase I therapy is considered reversible. In other words, if treatment of phase 1 therapy is discontinued, no detrimental changes will have occurred. If the patient sees no improvement, then they are no worse off than before they began treatment.

Dr. Donald G. Kimble Neuro Muscular TMJ Specialist

Click Here to Read the Full Article on ML830 Laser for TMJ

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The Influence of Low Intensity Laser Therapy on Temporomandibular Disorder Pain. TMD

S. Sattayut, DDS (KKU); PhD (Lond) and P. Bradley MD; FRCS; FDSRCS; FDSRCS (Edin)

Lasers in Dentistry Research Group, Faculty of Dentistry, Khon Kaen University, Khon Kaen Thailand
Oral Diagnostic Sciences, College of Dental Medicine, Nova Southeastern University, Ft. Lauderdale Florida USA

Abstract: A double-blind clinical trial was conducted on 30 femal Temporomandibular Disorders (TMD) patients who had pain as a chief complaint. The patients were randomly allocated into three groups based on Low Intensity Laser (LILT) regimes namely 820nm Gallium Aluminium Arsenide (GaAIAs) laser at energy densities of 21.4 J/cm2, 107 J/cm2 and placebo laser. Each patient had three LILT treatments in a week. The pressure pain threshold (PPT) of trigger points in masticatory muscles, unassested maximum mouth opening without pain (MOSP) and symptom severity index (SSI) were recorded as baseline data and monitored after every treatmnet. Jaw kinesiology, electromyography (EMG) and pain ratingn index from McGill pain questionnaire were also recorded as baseline and final results. The analysis of vocariance and further analysis showed that the higher energy density laser group had significant inclreases in PPT and EMG amplitude recorded from voluntary clenching (cEMG) compared with the placebo group at P values 0.0001 and 0.022 respectively. A significantly greater number of patients recovered from myofascial pain and TMJ arthralgia as assessed clinically in the higher energy group campared with the placebo (P value = 0.0. and 0.006 respectively). There was no statistically significant difference in the other parameters of assessment among the groups at a P value 0.05. At a period of 2 to 4 weeks review after LILT, there was an average 52% reduction of pain as assessed by SSI.

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Treatment of Temporomandibular Joint (TMJ) Pain with Diode Laser Therapy

Mikiko Kobayashi and Junichiro Kubota

Department of Plastic and Reconstructive Surgery,
Kyorin University School of Medicine, Mitaka City Tokyo Japan

Abstract: Temporomandibular joint (TMJ) pain can be very debilitating for the affected patient, particulary when it is a chronic disorder associated with temporomandibular disorder (TMD). Low reactive laser therapy (LLLT) has been proved effective in a variety of pain etiologies, and low incident levels of diode laser irradiation and are very effective in relieving TMJ joint painn associated with TMD, as the first stage in a two-staged strategy in the successful treatment of TMD. The present study reports on four representative cases of TMJ pain treated with a GaAIAs diode laser, 830nm continuous wave, 150mW for 5 to 10 sec/point, once per week. Incident energy densities were from approximately 20 J/cm2 to 40 J/cm2. One of the possible pain relief mechanisms involves the LLLT-mediated improved microcirculation in the temporal and masseter muscles, thereby relaxing and softening the affected muscles and relieving the pain. This also helps with cases of trismus. LLLT is side-effect free, is easy to apply and is well-tolerated by all ages and conditions of patient. When used in combination with conventional orthodontic maneuvers to remedy the functional defecs behind the TMD, LLLT offers the practitioner a safe and effective method for pain relief in troublesome TMJ pain paitients.

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Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders.

Salmos-Brito JA, de Menezes RF, Teixeira CE, Gonzaga RK, Rodrigues BH, Braz R, Bessa-Nogueira RV, de Martínez Gerbi ME.

Dental School, University of Pernambuco, Pernambuco, Brazil,

Lasers Med Sci. 2012 Feb 25. [Epub ahead of print] [PMID: 22367394]

Abstract: The purpose of this study was to address the following question: among patients with acute or chronic temporomandibular disorders (TMD), does low-level laser therapy (LLLT) reduce pain intensity and improve maximal mouth opening? The sample comprised myogenic TMD patients (according Research Diagnostic Criteria for TMD). Inclusion criteria were: male/female, no age limit, orofacial pain, tender points, limited jaw movements and chewing difficulties. Patients with other TMD subtypes or associated musculoskeletal/rheumatologic disease, missing incisors teeth, LLLT contra-indication, and previous TMD treatment were excluded. According to disease duration, patients were allocated into two groups, acute (<6 months) and chronic TMD (≥6 months). For each patient, 12 LLLT sessions were performed (gallium-aluminum-arsenide; λ = 830 nm, P = 40 mW, CW, ED = 8 J/cm(2)). Pain intensity was recorded using a 10-cm visual analog scale and maximal mouth opening using a digital ruler (both recorded before/after LLLT). The investigators were previously calibrated and blinded to the groups (double-blind study) and level of significance was 5% (p < 0.05). Fifty-eight patients met all criteria, 32 (acute TMD), and 26 (chronic TMD). Both groups had a significant pain intensity reduction and maximal mouth opening improvement after LLLT (Wilcoxon test, p < 0.001). Between the groups, acute TMD patient had a more significant pain intensity reduction (Mann-Whitney test, p = 0.002) and a more significant maximal mouth opening improvement (Mann-Whitney test, p = 0.011). Low-level laser therapy can be considered as an alternative physical modality or supplementary approach for management of acute and chronic myogenic temporomandibular disorder; however, patients with acute disease are likely to have a better outcome.

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Effectiveness of physiotherapy and GaAlAs laser in the management of temporomandibular joint disorders.

Dostalová T, Hlinakova P, Kasparova M, Rehacek A, Vavrickova L, Navrátil L.

Department of Paediatric Stomatology, 2nd Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2012 May;30(5):275-80. [PMID: 22551049]

OBJECTIVE: Low-level laser therapy (LLLT) is a treatment method commonly used in physiotherapy for musculoskeletal disorders. The aim of this study was to monitor the function of temporomandibular joint (TMJ) and surrounding tissues and compare the objective measurements of the effect of LLLT.

BACKGROUND DATA: LLLT has been considered effective in reducing pain and muscular tension; thus improving the quality of patients' lives.

MATERIALS AND METHODS: TMJ function was evaluated by cephalometric tracing analysis, orthopantomogram, TMJ tomogram, and computer face-bow record. Interalveolar space between central incisors before and after therapy was measured. Patients evaluated pain on the Visual Analog Scale. LLLT was performed in five treatment sessions (energy density of 15.4 J/cm(2)) by semiconductive GaAlAs laser with an output of 280 mW, emitting radiation wavelength of 830 mm. The laser supplied a spot of ~0.2 cm(2).

RESULTS: Baseline comparisons between the healthy patients and patients with low-level laser application show that TMJ pain during function is based on anatomical and function changes in TMJ areas. Significant differences were seen in the posterior and anterior face height. The results comparing healthy and impaired TMJ sagittal condyle paths showed that patients with TMJ pain during function had significantly flatter nonanatomical movement during function. After therapy, the unpleasant feeling was reduced from 27.5 to 4.16 on the pain Visual Analog Scale. The pain had reduced the ability to open the mouth from 34 to 42 mm.

CONCLUSIONS: The laser therapy was effective in the improvement of the range of temporomandibular disorders (TMD) and promoted a significant reduction of pain symptoms.

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Rheumatoid arthritis-affected temporomandibular joint pain analgesia by linear polarized near infrared irradiation.

Yokoyama K, Oku T.
Department of Anesthesia, School of Dentistry, Kagoshima University Dental Hospital, Sakuragaoka, Japan.

Can J Anaesth. 1999 Jul;46(7):683-7. [PMID: 10442966]

PURPOSE: To describe a new short-term treatment for pain in rheumatoid arthritis (RA)-affected temporomandibular joint (TMJ).

CLINICAL FEATURES: We investigated four female patients (age 42.8+/-26.0 yr) with chronic rheumatoid arthritis affecting a single TMJ. Patients had received antirheumatic drugs such as sodium aurothiomalate, and as a result showed no symptoms in other body joints. Linear polarized near infrared radiation using Super Lizer was applied weekly with and/or without jaw movement to the unilateral skin areas overlying the mandibular fossa, anterior articular tubercle, masseter muscle and posterior margin of the ramus of the mandible. The duration of irradiation to each point was two seconds on and ten seconds off per cycle and the intensity at each point was approximately 138 J x cm(-2) at a wavelength of 830 nm. Interincisal distance was measured with maximal mouth opening in the absence and presence of pain before and after each treatment. Additionally, subjective TMJ pain scores assessed using a visual analog scale were performed for painful maximal mouth opening before and after each irradiation. TMJ pain disappeared after only four treatments. Moreover, painless maximal mouth opening without pain after irradiation in three patients was on average improved to 5.3+/-2.1 mm. However, one case was observed where the opening length prior to irradiation did not improve, despite the fact that the RA-affected TMJ pain had disappeared.

Conclusion: Application of linear polarized near infrared irradiation to patients with RA-affected TMJ pain is an effective and non-invasive short-term treatment.

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Measurements of Jaw Movements and TMJ Pain Intensity in Patients Treated with GaAlAs Laser

Marcelo Oliveira MAZZETTO 1; Takami Hirono HOTTA 1,2; Renata Campi de Andrade PIZZO 1
1) Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil; 2) Dental School, University of Franca, Franca, SP, Brazil

Braz Dent J (2010) 21(4): 356-360 [PMID: 20976388]

Abstract: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) on the improvement of the mandibular movements and painful symptoms in individuals with temporomandibular disorders (TMD). Forty patients were randomly divided into two groups (n=20): Group 1 received the effective dose (GaAlAs laser λ 830 nm, 40 mW, 5J/cm²) and Group 2 received the placebo application (0 J/cm²), in continuous mode on the affected condyle lateral pole: superior, anterior, posterior, and posterior-inferior, twice a week during 4 weeks. Four evaluations were performed: E1 (before laser application), E2 (right after the last application), E3 (one week after the last application) and E4 (30 days after the last application). The Kruskal-Wallis test showed significant more improvements (p<0.01) in painful symptoms in the treated group than in the placebo group. A significant improvement in the range of mandibular movements was observed when the results were compared between the groups at E4. Laser application can be a supportive therapy in the treatment of TMD, since it resulted in the immediate decrease of painful symptoms and increased range of mandibular movements in the treated group. The same results were not observed in the placebo group.

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Effectiveness of low-level laser therapy in temporomandibular joint disorders: a placebo-controlled study

Fikácková H, Dostálová T, Navrátil L, Klaschka J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2007 Aug;25(4):297-303. [PMID: 17803388]

OBJECTIVE: Low-level laser therapy (LLLT) treatment for pain caused by temporomandibular joint disorders (TMD) was investigated in a controlled study comparing applied energy density, subgroups of TMD, and duration of disorders.

BACKGROUND DATA: Although LLLT is a physical therapy used in the treatment of musculoskeletal disorders, there is little evidence for its effectiveness in the treatment of TMD.

METHODS: The study group of 61 patients was treated with 10 J/cm(2) or 15 J/cm(2), and the control group of 19 patients was treated with 0.1 J/cm(2). LLLT was performed by a GaAlAs diode laser with output of 400 mW emitting radiation wavelength of 830 nm in 10 sessions. The probe with aperture 0.2 cm(2) was placed over the painful muscle spots in the patients with myofascial pain. In patients with TMD arthralgia the probe was placed behind, in front of, and above the mandibular condyle, and into the meatus acusticus externus. Changes in pain were evaluated by self-administered questionnaire.

RESULTS: Application of 10 J/cm(2) or 15 J/cm(2) was significantly more effective in reducing pain compared to placebo, but there were no significant differences between the energy densities used in the study group and between patients with myofascial pain and temporomandibular joint arthralgia. Results were marked in those with chronic pain.

CONCLUSION: The results suggest that LLLT (application of 10 J/cm(2) and 15 J/cm(2)) can be considered as a useful method for the treatment of TMD-related pain, especially long lasting pain.

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Arthralgia of the temporomandibular joint and low-level laser therapy

Fikácková H, Dostálová T, Vosická R, Peterová V, Navrátil L, Lesák J.
Institute of Biophysics and Informatics, 1st Medical Faculty, Charles University, Prague, Czech Republic.

Photomed Laser Surg. 2006 Aug;24(4):522-7. [PMID: 16942435]

OBJECTIVE: This case report describes the treatment of a patient with arthralgia of the temporomandibular joint (TMJ) caused by disc displacement.

BACKGROUND DATA: The goal of the treatment of TMJ arthralgia is to decrease pain by promotion of the musculoskeletal system’s natural healing ability.

METHODS: This report describes the complex treatment of TMJ arthralgia. Low-level laser therapy (LLLT) was chosen for its antiinflammatory and analgesic effects. Laser therapy was carried out using the GaAlAs diode laser with an output power of 400 mW, emitting radiation with a wavelength of 830 nm, and having energy density of 15 J/cm2; the laser radiation was applied by contact mode on four targeted spots in 10 sessions. Physiotherapy was recommended to this patient to prevent the injury of intraarticular tissue caused by incorrect movement during opening of the mouth. Splint stabilization and prosthetic treatment were used to reduce overloading of the TMJ, resulting from unstable occlusion and to help repositioning of the dislocated disc.

RESULTS: Five applications of LLLT led to decrease of pain in the area of the TMJ on the Visual Analog Scale, from 20 to 5 mm. The anti-inflammatory effect of the laser was confirmed by thermographic examination. Before treatment, the temperature differences between the areas of the normal TMJ and TMJ with arthralgia was higher than 0.5 degrees C. However, at the conclusion of LLLT, temperatures in the areas surrounding the TMJ were equalized.

CONCLUSION: This study showed the effectiveness of complex non-invasive treatment in patients with arthralgia of the TMJ. The analgesic and anti-inflammatory effects of LLLT were confirmed by infrared thermography.

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