Zwiri, Abdalwhab M. A.
(2022)
A clinical study on the effects of treating temporomandibular disorder (TMD) by low level laser therapy (LLLT), conservative and combination treatments.
Masters thesis, Universiti Sains Malaysia.
Abstract
Temporomandibular disorders (TMD) are a common term for a group of
musculoskeletal diseases that are associated with pain and/or malfunction in the
chewing muscles. They are prevalent among Asians and Malaysians. Treatment
modalities involving conservative and LLLT have not been widely investigated,
although their potential exists. The aim of this study was to compare the effects of
treating TMD by low level laser therapy (LLLT), standard conservative treatment
(home based therapy) and the combination treatments. A total of 32 patients aged 18
years and above with TMD were enrolled in three different groups:10 (conservative),
11 (LLLT), and 11 (combined treatments). Purposive sampling method was applied.
A proforma for the patient’s history and examination and validated translated
questionnaires of Mal-RDC/TMD were used. Pain was measured by Visual Analogue
Score (VAS). Patients in LLLT only group and combined treatment group were treated
with 5 sessions of low-level laser every other day for a duration of 10 days. Patients in
conservative treatment group and combined treatment group received standard
conservative TMD treatment (diet and stress counseling, jaw exercises, physical
therapy). Blood samples were collected from all groups following universal
precautions for venipunctures in comparing hs-CRP, IL-6, IL-8. Descriptive analysis
and Repeated measures ANOVA were used for data analysis. Between the three
groups (LLLT, conservative, and combined treatment), there was a statistically
significant difference in the mean levels of IL-6 (p = 0.037) and IL-8 (p = 0.001). From
baseline to post-treatment, the level of anxiety amongst the patients dramatically
lowered, although the group did not differ significantly. From baseline to posttreatment,
the mean depression index score decreased because of the treatment. There
was no significant difference between all treatment groups in terms of jaw disabilites
following therapy (p =0.244). Chronic pain intensity score, NSPSE (p = 0.009) score
and NSPSI (p < 0.001) significantly decreased from baseline to post treatment, but not
significant between the groups. Mean lateral excursion, maximum assisted and
unassisted mouth opening all showed significant difference (p < 0.001) before and
after the treatment. The mean of VAS significantly (p < 0.001) decreased from baseline
to 12 weeks and between three groups (p < 0.010). A significant change was noticed
in IL-6 and IL-8. Among the groups with three different treatment modalities, LLLT
and combination (LLLT + conservative) treatment approaches were found to be better
than the conservative treatment alone.
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