Evaluation of The Efficacy of Therapeutic Ultrasound, Transcutaneous Electrical Nerve Stimulation and Low-Level Laser Therapy in the Management of Temporomandibular Disorders: A Comparative Study

Abstract

Aim Temporomandibular disorders (TMDs), one of the most common causes of chronic orofacial pain is caused by the dysfunction of the various components of the temporomandibular joint and often require the use of non-invasive physical therapeutic modalities for its management. The present study was undertaken to compare the efficacy of plain therapeutic ultrasound (Th US), transcutaneous electric nerve stimulation (TENS therapy) and low-level laser therapy (LLLT) in the management of TMD. Materials and methods In this randomized clinical trial, 45 subjects aged between 18 to 40 years and diagnosed with TMD were randomly divided into three groups. The subjects of group A, group B and group C were treated with Th US, TENS therapy and LLLT, respectively, twice a week for a period of two weeks. The efficacy of each modality was evaluated in terms of pain intensity and functional improvement of the subjects both prior to and after each session using Visual Analogue Scale (VAS), Helkimo dysfunctional clinical index (HI) and Maximum Mouth Opening (MMO). Inter-group and multi-group comparisons of all the parameters, along with age-based differences, were analyzed using SPSS software (version 26) and a p-value of 0.05 was considered to be statistically significant. Results The mean age of the included study subjects were 30.3 ± 9.1, 27.5 ± 6.7 and 27.4 ± 6 years in the Th US, TENS therapy and LLLT respectively, with a female predominance (53.3%). A significant reduction of pain intensity (VAS) and dysfunction (HI), along with improvement of mouth opening (MMO), was seen among the subjects of all three groups by the end of the last interventional session (p < 0.05). However, a maximum difference was noted among the subjects of group C (LLLT) in terms of inter-group and multi-group comparisons of VAS, HI and MMO, followed by group A (Th US) and group B (TENS), respectively. Though the recurrence rate was high among the subjects of group Β (26.6%), there was no statistical significance. Conclusion Although significant improvements were observed among all three study groups, LLLT established a superiority over Th US and TENS therapy in terms of pain relief, mouth opening as well as functional outcome of the joint. Based on our results, we suggest the application of LLLT as an effective interventional option for TMD patients to achieve better and long-lasting functional results.