Tratamento de pacientes com dor miofascial e limitação de abertura bucal através da laserterapia: estudo clínico randomizado duplo-cego

Abstract

This randomized double-blind parallel clinical trial evaluated the effect of a rapid treatment protocol of low-level laser therapy in patients with temporomandibular disorder, myofascial pain and mouth opening limitation. A total of 384 adult patients were evaluated by Research Diagnostic Criteria for Temporomandibular Disorders, and 20 of them were included in the study. The participants were randomized and divided into laser group (n= 10) and placebo group (n= 10). The laser group received two sessions of laser therapy, with an interval of 48 hours, in painful muscular and articular sites of the face, sensitive to manual palpation, pre-established. The infrared laser tip was used in touch with the skin, perpendicular to, without moving it, 100 mW power, fluency of 80 J/cm2, for 22 seconds per site. In the placebo group, the protocol was the same, but the tip regulated not to deliver energy to the tissue. The patients were evaluated for spontaneous pain sensitivity and during mandibular movements, before the treatment (T1), after the first laser therapy session (T2), 48 hours after, before (T3) and after (T4) the second session, 7 (T5) and 30 days (T6) after T1. Subjects were also assessed using the Oral Health Impact Profile for Temporomandibular Disorders questionnaire at T1 and T6. Patients, assessors, and statistician were blinded. To evaluate the inter-group differences, the Student's t-test and Chi-Square test were used, and intra-group changes were evaluated through the Paired t-test. During the study, two patients from the placebo group were excluded (n= 8). Both the laser and placebo groups presented similar inter-group results during the treatment and followup period for all variables analyzed in the study. Comparing T1 to T6, was a significant increase in the maximum mouth opening and improvement in the oral health related of quality of life scores only in the laser group. Trial registration: RBR-4w2gd8. Funding: Extension Incentive Fund of Federal University of Santa Maria (FIEX 2017).