Effectiveness of acupuncture, ozonio therapy and low-intensity laser in the treatment of temporomandibular dysfunction of muscle origin: a randomized controlled trial

TORTELLI, Síglia Adriana Campos; SARAIVA, Leonardo; MIYAGAKI, Daniela Cristina

doi:10.1590/1807-2577.10719

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Revista de Odontologia da UNESP

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Original Article • Rev. Odontol. UNESP 48 • 2019 • https://doi.org/10.1590/1807-2577.10719 copy

Effectiveness of acupuncture, ozonio therapy and low-intensity laser in the treatment of temporomandibular dysfunction of muscle origin: a randomized controlled trial

Efetividade da acupuntura, ozonioterapia e do laser de baixa intensidade no tratamento da disfunção temporomandibular de origem muscular: um ensaio clínico randomizado

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

One of the most common causes of orofacial pain is temporomandibular disorder (TMD).

Objective

The aim of this study was to compare the effectiveness of acupuncture, ozone therapy and laser therapy in the treatment of muscle TMD patients through a randomized controlled trial.

Material and method

Twelve professors and postgraduate students from the University of Passo Fundo, diagnosed with TMD, aged between 23 and 50 years old, of both sexes, were evaluated. Individuals were randomly divided into 3 groups: G1: laser therapy, G2: acupuncture, and G3: ozone therapy. TMD diagnostic questionnaires (RDC / TMD), Quality of Life Questionnaire (OHIP-14), Pain Scale (VAS) and maximum mouth opening were applied. Descriptive statistics and percentage were used for sample characterization, which were presented using absolute and relative frequency distributions. Qualitative variables were analyzed with Wilcoxon tests p≤0.05.

Result

There was no statistically significant difference between treatments. Regarding pain and maximum mouth opening, the groups showed no statistical difference when individually analyzed, but when compared in general, they did (p=0.002 and p=0.003).

Conclusion

It can be considered that all treatments were able to decrease pain and improve maximal opening capacity related to muscle TMD. It can also be concluded that the TMD-related quality of life, in relation to the pain variable, was generally effective when compared before and after the interventions.

Descriptors:
Temporomandibular joint; temporomandibular joint disorders; laser therapy; acupuncture therapy; ozone

Variables	N	%
Age (mean and standard deviation)	32.83 ± 8.60
Sex
Male	2	16.7
Female	10	83.3
Source
European (leucoderms)	7	58.3
South-American (meloderm)	3	25.0
Other	2	16.7
Origin ancestors
African	2	16.7
European	9	75.0
Others	1	8.3
School grade
Higher Education	5	41.7
Masters / Doctorate	7	58.3
Marital status
Married in the same room	4	33.3
Divorced	1	8.3
Never married	7	58.3
Income
0 to minimum wage	1	8.3
Twice the minimum wage	5	41.7
Three times the minimum wage	1	8.3
Four times the minimum wage	1	8.3
Eight times the minimum wage	2	16.7
Nine times the minimum wage	2	16.7
	N	%
Facial pain in the last month	12	100%
Onset of facial pain (years)	6.25 ± 3.27
Type of pain in the face
Persistent	2	16.7
Recurring	10	83.3
Number of days prevented from performing activities due to pain (mean and standard deviation)	2.41 ± 7.15
Facial pain intensity that interfered with your daily activities (mean and standard deviation)	2.41 ± 3.02
Prevention of opening the mouth because of pain	5	41.7
TMJ Symptoms
Click	10	83.3
Crackle	12	100.0
Grinding teeth sleeping	10	83.3
Grinding Your Teeth Awake	8	66.7
TMJ pain or stiffness in the morning	11	91.7
Noise or ringing in the ears	5	41.7
Uncomfortable bite	7	58.3
Headache last months	11	91.7
What activities did the TMJ problem prevent you from doing?
Chew	5	41.7
Drinking	1	8.3
Exercising	2	16.7
Eating hard foods	8	66.7
Eating soft food	2	16.7
Smile / Laugh	4	33.3
Sexual activity	2	16.7
Brushing your teeth or face	2	16.7
Yawning	9	75.0

Group	Variable	Pre-intervention
Acupuncture		Q1	Median	Q3	Q1	Median	Q3
	QOL Functional Limitation	0.00	0.00	0.00	0.00	0.50	1.75	0.180
	QOL Pain	4.00	4.50	6.50	1.50	4.00	5.75	0.102
	QOL Psychological Discomfort	2.50	5.00	7.50	2.00	3.00	6.25	0.655
	QL Physical Disability	0.00	2.00	4.75	0.00	0.00	.75	0.157
	QOL Psychological Disability	1.25	2.50	4.50	2.00	3.00	5.50	0.593
	QV Social Disability	1.25	2.00	2.75	1.00	2.50	4.00	0.564
	QL Disability	0.25	1.00	1.00	0.00	0.50	3.25	0.655
Laser Therapy
	QL Functional Limitation	.00	.50	2.50	.00	.00	.00	0.180
	QOL Pain	1.25	2.50	4.50	.25	1.50	2.00	0.257
	QOL Psychological Discomfort	.75	3.50	5.50	1.00	4.00	5.50	0.785
	QL Physical Disability	.00	1.00	5.00	.00	.00	1.50	0.414
	QOL Psychological Disability	1.25	2.50	3.00	2.00	2.50	3.00	0.564
	QV Social Inability	.00	2.00	4.0	.25	1.50	2.00	0.581
	QL Disability	.00	.50	2.50	.00	.00	2.25	0.785
Ozone Therapy
	QOL Functional Limitation	0.50	2.00	2.75	0.00	0.00	3.00	0.276
	QOL Pain	4.00	4.00	5.50	1.25	2.50	5.25	0.109
	QOL Psychological Discomfort	4.25	5.50	6.75	1.25	4.50	7.75	0.705
	QL Physical Disability	2.25	3.00	6.75	0.00	0.50	2.50	0.144
	QOL Psychological Disability	3.00	3.50	5.50	1.00	2.50	4.00	0.083
	QL Social Inability	2.50	4.00	6.25	0.50	3.00	4.75	0.083
	QL Disability	1.00	1.50	4.25	0.00	1.00	2.75	0.593
Total
	QOL Functional Limitation	.00	.00	2.00	.00	.00	.75	0.391
	QOL Pain	3.25	4.00	5.00	1.00	2.00	4.50	0.012
	QOL Psychological Discomfort	3.25	4.50	6.00	2.00	4.00	6.75	0.631
	QL Physical Disability	.00	2.50	4.75	.00	.00	1.00	0.028
	QOL Psychological Disability	2.00	3.00	3.75	2.00	2.50	4.00	0.472
	QL Social Inability	1.25	2.50	4.00	1.00	2.00	4.00	0.280
	QL Disability	.25	1.00	1.75	.00	.00	2.75	0.777

Group	Variable	Pre-intervention			Post-intervention			Value p^* * (Wilcoxon test). In bold (p<0.05).
		Q1	Median	Q3	Q1	Median	Q3
Acupuncture	Pain (VAS)	1.62	4.83	5.66	0.75	3.58	4.66	0.066
	Mouth Opening	3.91	4.58	4.91	4.18	4.59	5.09	0.109
Laser Therapy	Pain (VAS)	3.45	4.41	5.12	2.00	2.00	2.12	0.068
	Mouth Opening	3.52	4.20	4.86	3.91	4.48	5.15	0.068
Ozone Therapy	Pain (VAS)	2.75	3.75	5.62	0.50	1.16	1.33	0.068
	Mouth Opening	3.69	3.91	4.50	4.25	4.43	4.82	0.068
Total	Pain (VAS)	3.37	4.00	5.54	1.08	2.00	2.41	0.002
	Mouth Opening	3.72	4.23	4.77	4.16	4.46	4.88	0.003

Group	Variable	Pre-intervention			30 days after the intervention
Acupuncture		Q1	Median	Q3	Q1	Median	Q3	Value p
	Pain (VAS)	1.62	4.83	5.66	0.50	3.50	7.25	1.00
	Mouth Opening	3.91	4.58	4.91	4.05	4.60	5.07	0.715
		Immediate post-intervention			30 days after the intervention
		Q1	Median	Q3	Q1	Median	Q3	Value p
	Pain (VAS)	0.75	3.58	4.66	0.50	3.50	7.25	0.465
	Mouth Opening	4.18	4.59	5.09	4.05	4.60	5.07	0.715
Laser Therapy		Pre-intervention			30 days after the intervention
		Q1	Median	Q3	Q1	Median	Q3	Value p
	Pain (VAS)	3.45	4.41	5.12	0.00	1.50	4.50	0.109
	Mouth Opening	3.52	4.20	4.86	4.05	4.60	5.37	1.000
		Immediate post-intervention			30 days after the intervention
		Q1	Median	Q3	Q1	Median	Q3	Value p
	Pain (VAS)	2.00	2.00	2.12	0.00	1.50	4.50	0.068
	Mouth Opening	3.91	4.48	5.15	4.05	4.60	5.37	0.066
Ozone Therapy		Pre-intervention			30 days after the intervention
		Q1	Median	Q3	Q1	Median	Q3	Value p
	Pain (VAS)	2.75	3.75	5.62	0.00	0.50	5.50	0.141
	Mouth Opening	3.69	3.91	4.50	4.25	5.00	5.07	0.144
		Immediate post-intervention			30 days after the intervention
		Q1	Median	Q3	Q1	Median	Q3	Value p
	Pain (VAS)	.50	1.16	1.33	0.00	0.50	5.50	1.000
	Mouth Opening	4.25	4.43	4.82	4.25	5.00	5.07	0.273
Total		Pre-intervention			30 days after the intervention
		Q1	Median	Q3	Q1	Median	Q3	Value p
	Pain (VAS)	3.37	4.00	5.54	0.00	1.50	5.00	0.010
	Mouth Opening	3.72	4.23	4.77	4.05	5.00	5.07	0.533
		Immediate post-intervention			30 days after the intervention
		Q1	Median	Q3	Q1	Median	Q3	Value p
	Pain (VAS)	1.08	2.00	2.41	0.00	1.50	5.00	0.056
	Mouth Opening	4.16	4.46	4.88	4.05	5.00	5.07	0.169

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E-mail: adriana@foar.unesp.br

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[1] CONFLICTS OF INTERESTS The authors declare no conflicts of interest.