Analgetički efekti terapije laserom male snage kod pacijenata sa temporomandibularnim disfunkcijama

Pain localized to masticatory muscle area and/or temporomandibular joint area, followed with an irregular lower jaw movement, is the most prominent symptom of temporomandibular disorders (TMD). Literature data indicate that symptoms and signs of TMD significantly influence the function of the orofacial system, the socio-psychological status and the quality of life of patients. Multidisciplinary approach to treatment arises from the complex and multifactorial etiology of TMD and the significant role of psychosocial factors. Low level laser therapy (LLLT) has been recommended as therapeutic modality aimed at treating TMD because of its analgesic, anti-inflammatory and biostimulative effects. Nevertheless, research results remain contradictory at present and no consensus has been reached regarding the optimal parameters and protocols of laser therapy. The goal of this research was to examine the effects of low level laser therapy on reducing pain intensity in patients with TMD. With the use of the standard protocol for diagnostifying TMD, established by Dworkin and LeResche (RDC/TMD), 63 participants had been selected and randomly constituted into two experimental groups. The first group included 35 participants which have been subjected to low level laser therapy (LLLT) three times a week, in the duration of five weeks (Wavelength: 780 nm; Probe aperture: 1 cm2; Time: 60 sec per point; Number of treated points: 4; Power density: 70 mW/cm2; Radiant energy: 4.2 J; Daily energy delivered: 16,8 J; Energy density (dose): 4,2 J/cm2; Total treatment dose: 16,8 J/cm2; Cumulative dose: 252 J/cm2). The second group included 28 participants subjected to nonsteroidal anti-inflammatory drug therapy - NSAID (ibuprofen) in the duration of two weeks (first three days 3x400mg, remaining time 2x400mg per day). In order to measure the therapy effects, pain intensity evaluation has been conducted via the visual analog scale (VAS), as well as the evaluation of maximal mouth opening range without experiencing pain. Evaluations have been conducted within the LLLT group prior to conducting therapy, after the fifth and the tenth therapy sessions consecutively, as well as immediately following therapy, then two weeks after therapy conclusion and finally three months after therapy conclusion. Using the Oral Health Impact Profile questionnaire (OHIP-14), evaluation has been conducted prior to therapy and three months after therapy, with the goal of assessing the influence of pain intensity on the participants' quality of life. The activity analyses concerning salivary alpha-amylase and cortical concentration have been conducted on TMD participants prior and post therapy, as well as on 22 control group participants without TMD symptoms. Research results indicate that there has been a significant reduction in pain intensity within both therapy groups an increase in painless mouth opening range. Pain intensity and painless mouth opening range analyses conducted within the three months after the conclusion of therapy indicate that the accomplished therapy results are sustainable. Comparing OHIP-14 questionnaire scale scores shows a significant increase in quality of life in TMD participants, after applying therapeutic modalities. The results of salivary biomarker analyses show a significant increase in salivary alpha-amylase activity concerning TMD participants when comparing them with control group participants, while no significant differences in cortical concentration have been noticed...Bol lokalizovan u mastikatornim mišićima i/ili temporomandibularnim zglobovima praćen neregularnim kretnjama donje vilice, najizraţeniji je simptom temporomandibularnih disfunkcija (TMD). Literaturni podaci ukazuju da simptomi i znaci TMD znaĉajno utiĉu na funkciju orofacijalnog sistema, socio-psihološki status i kvalitet ţivota pacijenata. Multidisciplinarni pristup leĉenju proizilazi iz kompleksne i multifaktorijalne etiologije TMD i znaĉajne uloge psihosocijalnih faktora. Terapija laserom male snage (low level laser therapy - LLLT) predloţena je kao terapijski modalitet u leĉenju TMD zbog svojih analgetiĉkih, antiiflamatornih i biostimulativnih efekata. MeĊutim, rezultati istraţivanja su još uvek kontradiktorni i nije uspostavljen konsenzus oko optimalnih parametara laserskog zraĉenja i optimalnog terapijskog protokola. Cilj istraţivanja bio je da se ispita da li terapija laserom male snage utiĉe na smanjenje intenziteta bola kod osoba sa temporomandibularnim disfunkcijama. Upotrebom standardnog protokola za dijagnostiku temporomandibularnih disfunkcija predloţenog od strane Dworkin i LeResche (RDC/TMD) izdvojeno je 63 ispitanika. Nasumiĉnim izborom formirane su dve eksperimentalne grupe ispitanika. Prvu grupu ĉinilo je 35 ispitanika koji su bili podvrgnuti terapijom laserom male snage (LLLT) tri puta nedeljno tokom pet nedelja (talasna duţina lasera: 780 nm; otvor laserske sonde: 1 cm; trajanje aplikacije: 60 sekundi po jednoj taĉki; broj tretiranih taĉaka: 4; gustina snage (intenzitet): 70 mW/cm2; predata energija po taĉki: 4.2 J; ukupna predata energija u jednoj poseti: 16,8 J; gustina energije (doza): 4,2 J/cm2; doza po tretmanu: 16,8 J/cm2; kumulativna doza: 252 J/cm2). Drugu grupu ĉinilo je 28 ispitanika kod kojih je sprovedena terapija nesteroidnim antiinflamatornim lekovima - NSAID (ibuprofen) tokom dve nedelje (u prva tri dana 3x400mg, preostalo vreme 2x400mg dnevno). U cilju procene efekata terapije, vršeno je merenje intenziteta bola pomoću vizuelno analogne skale (VAS) i merenje opsega maksimalnog bezbolnog otvaranja usta. Merenja su vršena pre poĉetka terapije, posle 5. i 10. posete za grupu pacjenata tretiranih LLLT, neposredno po završetku terapije, dve nedelje po završetku terapije i tri meseca po završetku terapije. Pomoću upitnika za procenu uticaja oralnog zdravlja na kvalitet ţivota (Oral Health Impact Profile - OHIP-14), vršeno je merenje pre poĉetka terapije i tri meseca po završetku terapije, radi procene uticaja intenziteta bola na kvalitet ţivota ispitanika. Analiza aktivnosti salivarne alfa-amilaze i koncentracije kortizola u pljuvaĉci vršena je u ispitanika sa TMD pre i posle terapije, kao i kod ispitanika kontrolne grupe koju je ĉinilo 22 odrasle osobe bez znakova i simptoma TMD. Rezultati istraţivanja ukazuju da je u obe terapijske grupe postignuta znaĉajna redukcija intenziteta bola i poboljšanje opsega bezbolnog otvaranja usta. Analizom intenziteta bola i opsega bezbolnog otvaranja usta tokom perioda praćenja od tri meseca utvrĊeno je da su se postignuti terapijski rezultati odrţali. PoreĊenje skorova na skali OHIP-14 upitnika ukazuje na znaĉajno poboljšanje kvaliteta ţivota ispitanika sa TMD nakon primenjenih terapijskih modaliteta..