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      Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review

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          Abstract

          Temporomandibular disorders (TMD) are characterized by the presence of temporomandibular joint (TMJ) and/or masticatory muscle pain and dysfunction. Low-level laser is presented as an adjuvant therapeutic modality for the treatment of TMD, especially when the presence of inflammatory pain is suspected.

          Objective

          To systematically review studies that investigated the effect of low level laser therapy (LLLT) on the pain levels in individuals with TMD.

          Material and Methods

          The databases Scopus, embase, ebsco and PubMed were reviewed from January/2003 to October/2010 with the following keywords: laser therapy, low-level laser therapy, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, temporomandibular joint, temporomandibular, facial pain and arthralgia, with the inclusion criteria for intervention studies in humans. exclusion criteria adopted were intervention studies in animals, studies that were not written in english, Spanish or Portuguese, theses, monographs, and abstracts presented in scientific events.

          Results

          After a careful review, 14 studies fit the criteria for inclusion, of which, 12 used a placebo group. As for the protocol for laser application, the energy density used ranged from 0.9 to 105 J/cm 2, while the power density ranged from 9.8 to 500 mW. The number of sessions varied from 1 to 20 and the frequency of applications ranged from daily for 10 days to 1 time per week for 4 weeks. A reduction in pain levels was reported in 13 studies, with 9 of these occurring only in the experimental group, and 4 studies reporting pain relief for both the experimental group and for the placebo.

          Conclusion

          Most papers showed that LLLT seemed to be effective in reducing pain from TMD. However, the heterogeneity of the standardization regarding the parameters of laser calls for caution in interpretation of these results. Thus, it is necessary to conduct further research in order to obtain a consensus regarding the best application protocol for pain relief in patients with TMD.

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          Most cited references119

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          Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis.

          As part of the Multisite Research Diagnostic Criteria For Temporomandibular Disorders (RDC/TMD) Validation Project, comprehensive temporomandibular joint diagnostic criteria were developed for image analysis using panoramic radiography, magnetic resonance imaging (MRI), and computerized tomography (CT). Interexaminer reliability was estimated using the kappa (kappa) statistic, and agreement between rater pairs was characterized by overall, positive, and negative percent agreement. Computerized tomography was the reference standard for assessing validity of other imaging modalities for detecting osteoarthritis (OA). For the radiologic diagnosis of OA, reliability of the 3 examiners was poor for panoramic radiography (kappa = 0.16), fair for MRI (kappa = 0.46), and close to the threshold for excellent for CT (kappa = 0.71). Using MRI, reliability was excellent for diagnosing disc displacements (DD) with reduction (kappa = 0.78) and for DD without reduction (kappa = 0.94) and good for effusion (kappa = 0.64). Overall percent agreement for pairwise ratings was >or=82% for all conditions. Positive percent agreement for diagnosing OA was 19% for panoramic radiography, 59% for MRI, and 84% for CT. Using MRI, positive percent agreement for diagnoses of any DD was 95% and of effusion was 81%. Negative percent agreement was >or=88% for all conditions. Compared with CT, panoramic radiography and MRI had poor and marginal sensitivity, respectively, but excellent specificity in detecting OA. Comprehensive image analysis criteria for the RDC/TMD Validation Project were developed, which can reliably be used for assessing OA using CT and for disc position and effusion using MRI.
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            Management of TMD: evidence from systematic reviews and meta-analyses.

            This systematic review (SR) synthesises recent evidence and assesses the methodological quality of published SRs in the management of temporomandibular disorders (TMD). A systematic literature search was conducted in the PubMed, Cochrane Library, and Bandolier databases for 1987 to September 2009. Two investigators evaluated the methodological quality of each identified SR using two measurement tools: the assessment of multiple systematic reviews (AMSTAR) and level of research design scoring. Thirty-eight SRs met inclusion criteria and 30 were analysed: 23 qualitative SRs and seven meta-analyses. Ten SRs were related to occlusal appliances, occlusal adjustment or bruxism; eight to physical therapy; seven to pharmacologic treatment; four to TMJ and maxillofacial surgery; and six to behavioural therapy and multimodal treatment. The median AMSTAR score was 6 (range 2-11). Eighteen of the SRs were based on randomised clinical trials (RCTs), three were based on case-control studies, and nine were a mix of RCTs and case series. Most SRs had pain and clinical measures as primary outcome variables, while few SRs reported psychological status, daily activities, or quality of life. There is some evidence that the following can be effective in alleviating TMD pain: occlusal appliances, acupuncture, behavioural therapy, jaw exercises, postural training, and some pharmacological treatments. Evidence for the effect of electrophysical modalities and surgery is insufficient, and occlusal adjustment seems to have no effect. One limitation of most of the reviewed SRs was that the considerable variation in methodology between the primary studies made definitive conclusions impossible.
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              A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders

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                Author and article information

                Journal
                J Appl Oral Sci
                J Appl Oral Sci
                J. Appl. Oral. Sci.
                Journal of Applied Oral Science
                Faculdade de Odontologia de Bauru da Universidade de São Paulo
                1678-7757
                1678-7765
                Nov-Dec 2012
                : 20
                : 6
                : 594-602
                Affiliations
                [1 ]Specialist in Orthodontics. Master's student in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brazil.
                [2 ]PhD, Professor, Department of Physiology, Federal University of Sergipe, Aracaju, SE, Brazil.
                [3 ]Doctorate student in Health Sciences, Federal University of Sergipe, Aracaju, SE, Brazil.
                [4 ]PhD, Professor, Department of Dentistry, Federal University of Sergipe, Aracaju, SE, Brazil.
                [5 ]Doctorate student, Araraquara School of Dentistry, UNESP - Univ Estadual Paulista, Araraquara, SP, Brazil.
                [6 ]PhD, Professor, Department of Prosthodontics. Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
                Author notes
                Corresponding address: Mila Leite de Moraes Maia - Rua Terêncio Sampaio, 309 - Bairro Grageru - 49025-700 - Aracaju - Sergipe - Brazil - Phone: +55 79 9959-2567 - e-mail: milademoraes@ 123456hotmail.com
                Article
                10.1590/S1678-77572012000600002
                3881861
                23329239
                ba5b5791-8dae-4afb-a5c7-6884cfbb55fe

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 06 September 2011
                : 08 October 2011
                : 06 November 2011
                Funding
                Funded by: CAPES
                Categories
                Systematic Review

                laser therapy,temporomandibular joint disorders,review

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