ASSESSMENT OF LOW-LEVEL LASER THERAPY IN TEMPOROMANDIBULAR DISORDER PATIENTS: A CASE REPORT

Abstract

A 20-year-old patient presented to our department with chief complaint of pain and limited mouth opening on both sides of tmj region from last 1 year( Fig 1). Medical and dental histories were recorded along with examination. The medical history was unremarkable except that patient was mild anemic. On dental examination there wasn’t any tooth loss but on right side molars was in cross bite  (Fig 2). OPG and MRI was recommended.  MRI showed anterior disc dislocation without reduction. Upon questionnaire there wasn’t any history of trauma, any joint disorder, allergy or sleep deprivation but she was preparing for an exam and had clenching, nocturnal and diurnal tooth grinding. She had visited another dentist with the same complaint and dentist advised him to remove all 3^rd molar impactions along with medications and splint. Despite of removing all impactions using muscle relaxants, analgesics and splint therapy for 5 months there wasn’t much difference in pain and mouth opening. On clinical examination patient experienced severe pain on mouth opening and lateral excursion. Pain was 10 on VAS, mouth opening measured was 13mm and tmj along with all muscles of mastication was tender to palpation. On auscultation there wansn’t any tmj noises. Patient was instructed about LLLT and informed consent were obtained from a patient. LLLT was performed on both sides of tmj along with muscles of mastication( Fig 3).  Total 8 sessions were done, 2 sessions per week. Application time was 60 seconds. Wavelength used was 980nm, frequency was 100 HZ, energy and power was 15 j/cm² and 2.0 W/cm² . Application sites was temporalis, masseter, medial pterygoid and later pterygoid along with temporo mandibular joint extra orally and intraorally. Treatment protocol was decided according to author Abdalwhab Zwiri et.al. ⁽³⁾ Pain on VAS along with mouth opening was recorded on every week after session. At the end of a treatment occlusal splint was fabricated as a night guard and  explained the patient about its use. Follow up was done after 1 week ,1 month and 3 months from the end of the last session to investigate the effectiveness and cumulative effect. First week after session pain on VAS was 7 and mouth opening was 15mm. 2^nd week after the session pain on VAS was 4 and mouth opening was 18mm. 3^rd week after the session pain on VAS was 3 and mouth opening was 20mm after 4^th and final session pain was 2 and mouth opening was increased to 26mm.( Fig 4)