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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 2  |  Page : 70-73

Efficacy of low-level laser therapy on orofacial pain: A literature review


1 Department of Oral and Maxillofacial Medicine, Dentistry Research Center, Golestan University of Medical Sciences, Gorgan, Iran
2 Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran

Date of Web Publication8-May-2018

Correspondence Address:
Haleh Zokaee
Department of Maxillofacial Medicine, Golestan University of Medical Sciences, Naharkhoran Blvd, In Front of Edalat 97 Gorgan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_2_18

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  Abstract 

Low-level laser therapy (LLLT) is a therapeutic approach to treat orofacial pain using a 600–1000 nm laser with a <500 mW power. The efficacy of LLLT is due to the chemical reactions causing an anti-inflammatory and analgesic effect on the affected regions. The aim of this study is to review the effects of low-level laser application on orofacial pain in the English articles released since 2017. Our search keywords were 'low-level laser therapy, temporomandibular disease (TMD), mucositis and orofacial pain'. The most relevant papers were clinical trial, review and meta-analysis articles. 26 out of 243 searched articles were selected from PubMed, Google Scholar and Science Direct and reviewed. Most of the studies reported the positive role of LLLT on orofacial pain relief regardless of their variable procedures; however, the exact mechanism of action still remains unclear. Some studies indicated that LLLT has significantly reduced pain, reduceamount of clicking and both masseter and temporal muscles activityin TMD. As an overall result, it is concluded that LLLT can be served as a therapeutic method for myofascial pain, mucositis and temporomandibular joint disorders and this is due to its analgesic features.

Keywords: Headache, low-level laser therapy, mucositis, temporomandibular disease


How to cite this article:
Zokaee H, Akbari Zahmati AH, Mojrian N, Boostani A, Vaghari M. Efficacy of low-level laser therapy on orofacial pain: A literature review. Adv Hum Biol 2018;8:70-3

How to cite this URL:
Zokaee H, Akbari Zahmati AH, Mojrian N, Boostani A, Vaghari M. Efficacy of low-level laser therapy on orofacial pain: A literature review. Adv Hum Biol [serial online] 2018 [cited 2019 Nov 15];8:70-3. Available from: http://www.aihbonline.com/text.asp?2018/8/2/70/232017


  Introduction Top


Low-level laser therapy (LLLT) as a novel prophylactic and therapeutic method is the application of emitted light in the 600–1000 nm spectrum range (red to near infrared), with irradiance of 5 mW/cm 2 to 5 W/cm 2 and as little power as 1 mW up to 10 W, with pulsed or continuous beams, and the treatment time of 30–60 s per point.[1] Anti-inflammatory activity, analgesic effect, anti-microbial activity, contributing to wound healing acceleration and bone deposition are the basic effects of low-level laser applications.[2] Although the mechanism of low-level laser action is not elucidated, there are some information showing the effects of low-level lasers on inflammatory responses, which relieves its analgesic and wound healing effects; it is believed that the anti-inflammatory effect of low-level lasers is derived from the proven ability of lasers to limit the release of inflammatory mediators such as bradykinin, histamine and especially, prostaglandin during inflammatory responses.[3] The analgesic effect of low-level lasers is related to the inhibition of Aδ and C fibers, which slows conduction velocity, reduces amplitude of compound action potentials and suppresses neurogenic inflammation.[1],[4] Furthermore, by stimulating collagen metabolism and fibroblast proliferation,[5] LLLT acts as a therapeutic agent in wound healing. Despite many studies on low-level laser application in musculoskeletal disorders, oral and maxillofacial regions for LLLT are not well documented and are limited till now. The purpose of this narrow review is to find an overview on the effects of low-level lasers on orofacial complications by discussing its positive or negative efficacies studied in available articles since 2017.


  Effect of Low-Level Laser Therapy on Temporomandibular Joint Disorders Top


Temporomandibular joint (TMJ) disorder can be defined as the pain in the TMJ and its peripheral area which can lead to mandibular functional limitations or clicking while moving.[6] Temporomandibular disorders (TMD) is a common disorder and has two main causes including: myofascial and articular fossa.[7] However, its absolute aetiology of onset still remains undisclosed; it is a multifactorial problem. These are some of the most important major predisposing factors: Muscle pain or spasm and capsule inflammation or damage that caused by unbalanced occlusion, parafunctional habits such as trauma, bruxism or teeth clenching, stress and anxiety or intra-articular disk abnormalities are the major predisposing factors.[8],[9] Several treatments are proposed for TMD: noninvasive treatments include physical therapy, medication therapy (analgesics and muscle relaxants) and invasive treatments such as surgical procedures.[7],[10] According to recent studies, LLLT can also be an effective approach to treat this problem.[11],[12],[13],[14],[15],[16] Our study on the effect of LLLT on TMDs consists of eight articles performed since 2017. All of the studies did not report the exact quantity of LLLT effect on pain reduction, sign and symptom elimination and maximal mouth opening (MMO) improvement in hTMJ and masticatory muscles.

Marini et al. conducted a random, double-blind study on patients with TMD (disc displacement without reduction and osteoarthritis) evaluating the efficacy of super pulsed LLLT (SLLLT) in adjunction to nonsteroidal anti-inflammatory drugs therapy. Individuals were divided into three groups. First group was exposed to SLLLT using a diode lasers [gallium-aluminum-arsenide laser (910 nm, 400 mW, 2 weeks, totally 10 sessions)]. Second group received ibuprofen 800 mg for 10 days twice a day and third group (Placebo) received sham laser. Baseline and post-treatment evaluation consisting of Visual Analogue Scale (VAS) (to assess pain intensity), maximal mandibular opening (MMO) (to assess mandibular function) and magnetic resonance imaging was performed to all of the groups. Regarding to mean VAS, the SLLLT group showed a significant lower pain score in comparison to the drug group after 5th day of study. Results also confirm the superiority of SLLLT on MMO improvement. They concluded that SLLLT can be an efficient treatment to reduce the clinical signs and symptoms of osteoarthritis and TMJ disc displacement without reduction.[11]

De Santillana et al. evaluated the effectiveness of active and passive low laser therapy for pain management in arthrogenic TMD in a random, placebo-controlled study. Thirty arthrogenic TMD patients suffering from bilateral TMJ arthralgia were assigned into two groups: active LLLT group (which/who) received diode laser (gallium-aluminum-arsenide, 905 nm, 125 mw) and passive group. Each patient's TMJ pain values were compared using VAS at baseline, 3, 6, 9 and 12 days after four sessions of treatment and the ANOVA test was used to compare intergroup differences between right and left TMJ in active group. Results showed a more considerable pain reduction in passive group at the end of the study in comparison with the active group and results also indicated a high level of pain relief in left TMJ active group.[12]

Salmos-Brito et al. designed a study with the aim of assessing the LLLT effectiveness on pain intensity reduction and MMO in patients with acute and chronic TMD (32 acute and 26 chronic) and all of them received LLLT using thera laser (gallium-aluminum-arsenide, 830 nm, 40 mW) in five points around the painful TMJ and condyle region, and after twelve sessions of laser application, they suggested that LLLT can be applied as a supplementary treatment for pain intensity reduction and MMO improvement in both acute and chronic group. However, patients in acute group experienced better results.[17]

Ahrari et al. assessed the efficacy of LLLT on myogenous TMD in a random, double-blind placebo-controlled study. The study was done using a diode laser (50 mW, 810 nm, 1500 Hz) for 4 weeks, totally twelve sessions. After four phases of assessment, it was indicated that there was a significant improvement in MMO and a decrease in pain symptoms in laser group in comparison to the placebo group in all the phases of evaluation. They concluded that LLLT can be an effective treatment for pain reduction and MMO improvement in patients suffering myogenic TMD.[13]

Seifi and Vahid-Dastjerdi designed a case report study to determine the effect of LLLT on severe TMJ clicking relief in a 14-year-old orthodontic girl complaining dental malalignment and improper jaw relation. After fixed appliance removal, in a recall session at 6th month of retention phase, she received LLLT using a diode laser (808 nm, 70 mw, 60 s). Clicking disappeared immediately after laser application and there were no signs of recurrence 4 months later. They concluded that LLLT can be served as an adjunctive protocol with orthodontic treatment to eliminate clicking.[14]

Shinozaki et al. evaluated the efficacy of LLLT on masticatory muscle pain in woman suffering from temporomandibular dysfunction (TMD). An infrared diode laser (gallium-aluminum-arsenide laser 790 nm, 40 mw) was applied to TMJ and temporal muscle. Masseter and temporal muscle activity was assessed using electromyographic (EMG) and baseline and post-treatment assessments were done. Results suggested immediate relaxation of both muscles. Assessments showed a significantly higher reduction of electrical activity of masseter muscle immediately after the treatment. They demonstrated that LLLT can immediately reduce both masseter and temporal muscles activity. However, temporal muscles expressed a higher activity.[18]

Da Silva et al. designed a random, double-blind study to assess the severity of signs and symptoms in patients treated with adjunctive low-level laser. The treatment was done on patients suffering intra-articular TMD for more than 6 months using an infrared laser with these settings (Group-I: 52/5 J/cm 2, 780 nm, 70 mw, 30s per point, Group-II: 105 J/cm 2, 780 nm, 70 mw, 40 s per paint, Group-III (Placebo): J/cm 2, 780 nm, 70 mw, 30 s per point) for 5 weeks, totally ten sessions on nine points. The laser shots were on 9 sites. These sites consist of five condylar and four muscular. Baseline and post-therapy assessments using VAS and palpation indicated a statistically significant reduction of painful symptoms and increase of the mean MMO for Group-I and Group-II group. However, Group-II group responded better to the treatment.[15]

Venezian et al. performed a random, double-bind placebo-controlled study to evaluate the effects of LLLT on pain reduction and EMG activity in TMD patients suffering myofascial pain. A diode laser (gallium-aluminum-arsenide 780 nm, 50–60 mw, 25–60 J/cm 2) was applied to the masticatory muscles of the control group. VAS technique and EMG activity assessments were evaluated and compared between the groups. The symptoms reduced significantly in both groups regarding to the pain at palpation although the pain returned after 30 days in 60 J/cm 2 subjects in comparison with 25 J/cm 2 dosage. There were no significant changes in EMG activity between two groups after the treatment. Finally, they confirmed the positive effect of LLLT on pain reduction.[16]


  Effect of Low-Level Laser on Oral Mucositis Top


Mucositis is the inflammation of mucosal membranes, which mostly occurs as a side effect of chemotherapy and radiotherapy. Oral mucositis is a major problem for head and neck cancer (HNC) and hematopoietic stem cell transplantation (HSCT) patients receiving chemotherapy and radiotherapy, resulting in pain, dysphagia, weight loss, depression, higher risk of infection, decreased quality of life and increased healthcare costs.[19],[20] According to the recent studies, all HSCT or bone marrow-transplanted patients, treated with high-dose chemotherapy, develop varying severity of oral mucositis, and it is also considerable that up to 80% of patients receiving radiotherapy for HNC and also 90% of paediatric patients treated for cancer develop oral mucositis.[21]

Despite application of many agents as therapeutic or prophylactic, there is no common consent on oral mucositis prevention and treatment. In recent decade, however, LLLT was considered as a new preventive and therapeutic agent for oral mucositis induced by chemotherapy and radiotherapy. In this review of articles, from 18 analysed articles on the use of LLLT in orofacial complications, twelve were human studies,[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33] one was animal study,[34] one literature review and meta-analysis [35] on the usage of LLLT in oral mucositis. The wavelengths used as therapeutic agent include 830 nm (GaAlAs),[24],[29] 660 nm (InGaAl),[28],[33],[34] 670 nm (GaAlAs),[27] 632.8 nm (He-Ne)[26] and an AsGa diode laser.[31] According to these studies, the application of LLLT in therapeutic field was reported effective. Furthermore, the wavelengths used as prophylactic agents include 660 nm (InGaAl),[22],[30] 630 nm (diode laser)[25] and a GaAlAs.[24] In two studies,[22],[30] LLLT reported to be effective in the prevention of oral mucositis induced by chemotherapy and radiotherapy, According to these articles, LLLT can be effective agent in prevention and treatment of oral mucositis induced by chemotherapy and radiotherapy. LLLT can be suggested tool for reducing oral mucositis severity and even in some cases, prevention of oral mucositis in patients receiving chemoradiotherapy.


  Effect of Low-Level Laser on Orofacial Pain Top


Orofacial pain as a general term includes any pain in the mouth, jaws and face derived from many reasons. This category of pain is defined as a pain localised to the region above the neck, in front of ears and below the orbitomeatal line, as well as 'pain within the oral cavity; including pain of dental origin and TMD'.[36],[37] It is estimated that 22% of general population in the US and 7% in UK suffer from some forms of facial pain at some points.[38] The most basic etiologic classification of oral pain is as following:[39]

  1. Primarily somatic, arising from musculoskeletal or visceral structures
  2. Primarily neuropathic, which occurs as a result of abnormal or damaged pain pathways
  3. Primarily psychological, which is rare.


Therefore, other aetiologies such as dentoalveolar, mucosal diseases, bone pathology, sinusitis, salivary glands, vascular pains, referred pains from eyes, ears, intracranial or heart and other reasons such as chronic idiopathic facial pain, atypical odontalgia, central post-stroke pain and cancer are the extensive subsets of the classification mentioned before. Considering the extensive range of aetiologies, there are different therapeutic options for orofacial pains. Among these options, LLLT is a new one. From the analysed articles about the usage of LLLT in orofacial complications, four studies on the use of LLLT as a treatment for orofacial pain were included. From these four, three of them manoeuvred on the somatic pains [12],[40],[41] and one, on persistent idiopathic facial pain and neuropathic pain.[42] The therapeutic wavelengths are 905 nm,[40] 780 nm (GaAlAs),[41] 830 nm (GaAlAs)[42] and a GaAlAs laser.[12] According to two of these studies,[12],[41] LLLT was an effective treatment in somatic pains. In other two studies,[40],[42] however, no significant differences in pain relief was reported.


  Conclusion Top


According to what has been mentioned before, it can be concluded that LLLT especially diode ones can be useful in pain reduction, maximum opening improve and sounds elimination in TMDs. Furthermore, mucositis can be prevented or treated by prophylactic applications or empiric usage. LLLT would hopefully have analgesic pain effect especially in those with inflammatory aetiology in background. Of course, more research needs to be done on the LLLT effects on oral and maxillofacial structures due to extend laser application because of its multipotential capabilities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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