The efficacy of combining low-level laser therapy with oral motor exercises in patients with temporomandibular disorders (pilot study)


  • Ali M. Alqahtani Department of Diagnostic Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
  • Mai S. Almohaya Department of Histopathology, Iman General Hospital, Riyadh, Saudi Arabia
  • Nezar S. Al Torairi Department of Physiotherapy, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
  • Lubna M. Al Otaibi Department of Oral Medicine and Special Care Dentistry, Dental Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia



Temporomandibular disorders, Low-level laser therapy, Muscle exercise, Temporomandibular joint


Background: The term temporomandibular disorders (TMDs) is used for clinical signs and symptoms affecting the masticatory muscles, temporomandibular joints (TMJs) and associated structures or both. TMDs may present clinically with facial pain in the region of the TMJs and/or muscles of mastication, limitation in mouth opening, and TMJ clicking during mastication. Treatment of TMDs includes occlusal splints, drug therapy, physiotherapy, auriculotherapy and low-level laser therapy (LLLT).

Methods: Ten patients with TMD were recruited from the Oral Medicine clinics at Prince Sultan Military Medical City. The participants were randomly allocated into two equal groups. All participants attended a total of eight laser treatment sessions using a 940 nm diode laser. The deep-tissue laser hand-piece was applied perpendicular to the Temporalis muscle, Masseter muscle and TMJ region bilaterally. Patients in the second group attended physiotherapy sessions in addition to the laser sessions. Participants were evaluated for range of mandibular movement, pain, and tenderness to palpation before treatment, one-week post-treatment, and thirty days after treatment completion.

Results: This study, being a pilot study, was conducted in a comparatively small number of patients. It allowed for the assessment of research feasibility, methodology, limitations, and preliminary outcomes. Moreover, variations in the response to treatment were observed between the two groups, with results of this study supporting previous findings that LLLT is an effective treatment for TMD symptoms, tenderness to palpation, as well as improving jaw functional behavior.

Conclusions: Therefore, LLLT therapy may be a promising tool for the management of TMD, especially when combined with physiotherapy.


Greene C. Managing the Care of Patients with Temporomandibular Disorders. J Am Dent Assoc. 2010;41(9):1086-8.

Drobek W, Schoenaers J, De Laat A. Hormone-dependent fluctuations of pressure pain threshold and tactile threshold of the temporalis and masseter muscle. J Oral Rehab. 2002;29(11):1042-51.

Mujakperuo H, Watson M, Morrison R, Macfarlane T. Pharmacological interventions for pain in patients with temporomandibular disorders. Cochrane Database Syst Rev. 2010;(10).

Michelotti A, Iodice G, Vollaro S, Steenks M, Farella M. Evaluation of the short-term effectiveness of education versus an occlusal splint for the treatment of myofascial pain of the jaw muscles. J Am Dent Assoc. 2012;143(1):47-53.

Hoffmann R, Kotchen J, Kotchen T, Cowley T, Dasgupta M, Cowley A. Temporomandibular Disorders and Associated Clinical Comorbidities. Clin J Pain. 2011;27(3):268-74.

Venezian G, Antônio Moreira Rodrigues da Silva M, Mazzetto R, Oliveira Mazzetto M. Low Level Laser Effects on Pain to Palpation and Electromyographic Activity in TMD Patients: A Double-Blind, Randomized, Placebo-Controlled Study. Cranio. 2010;28(2):84-91.

Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992;6:301-55.

Fricton J, Schiffman E. Reliability of a Craniomandibular Index. Journal of Dental Research. 1986;65(11):1359-64.

Magri L, Carvalho V, Rodrigues F, Bataglion C, Leite-Panissi C. Non-specific effects and clusters of women with painful TMD responders and non-responders to LLLT: double-blind randomized clinical trial. Lasers Med Sci. 2017;33(2):385-92.

Gomes C, Politti F, Andrade D, de Sousa D, Herpich C, Dibai-Filho A, et al. Effects of massage therapy and occlusal splint therapy on electromyographic activity and the intensity of signs and symptoms in individuals with temporomandibular disorder and sleep bruxism: a randomized clinical trial. Chiropr Man Therap. 2014;22:43.

Gökçen-Röhlig B, Kipirdi S, Baca E, Keskin H, Sato S. Evaluation of orofacial function in temporomandibular disorder patients after low-level laser therapy. Acta Odontologica Scandinavica. 2012;71(5):1112-7.

Boudreau S, Farina D, Falla D. The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Manual Therapy. 2010;15(5):410-4.

Fuentes C, Armijo-Olivo S, Magee D, Gross D. Effects of Exercise Therapy on Endogenous Pain-relieving Peptides in Musculoskeletal Pain. Clin J Pain. 2011;27(4):365-74.

Steele C, Bailey G, Polacco R, Hori S, Molfenter S, Oshalla M, et al. Outcomes of tongue-pressure strength and accuracy training for dysphagia following acquired brain injury. Int J Speech-Language Pathol. 2013;15(5):492-502.

Mangilli L, Sassi F, de Medeiros G, de Andrade C. Rehabilitative management of swallowing and oral-motor movements in patients with tetanus of a public service in Brazil. Acta Tropica. 2012;122(3):241-6.

Kim K, Ha I, Lee Y, Kim M, Shin B, Song M, et al. A clinical practice guideline for temporomandibular disorders in traditional Korean medicine: An evidence-based approach. Eur J Integrative Med. 2018;23:123-33.

Conti P. Low Level Laser Therapy in the Treatment of Temporomandibular Disorders (TMD): A Double-blind Pilot Study. Cranio. 1997;15(2):144-9.

Salmos-Brito J, de Menezes R, Teixeira C, Gonzaga R, Rodrigues B, Braz R, et al. Evaluation of low-level laser therapy in patients with acute and chronic temporomandibular disorders. Laser Med Sci. 2012;28(1):57-64.

Martens L. Laser physics and a review of laser applications in dentistry for children. Eur Arch Pediatric Dentistry. 2011;12(2):61-7.

Herpich C, Amaral A, Leal-Junior E, Tosato J, Gomes C, Arruda É, et al. Analysis of laser therapy and assessment methods in the rehabilitation of temporomandibular disorder: a systematic review of the literature. J Physical Therapy Sci. 2015;27(1):295-301.

Chen J, Huang Z, Ge M, Gao M. Efficacy of low-level laser therapy in the treatment of TMDs: a meta-analysis of 14 randomised controlled trials. J Oral Rehabil. 2015;42:291-9.

Xu GZ, Jia J, Jin L, Li JH, Wang ZY, Cao DY. Low-Level Laser Therapy for Temporomandibular Disorders: A Systematic Review with Meta-Analysis. Pain Res Manag. 2018;4230583.

Bjordal J. Low Level Laser Therapy (LLLT) and World Association for Laser Therapy (WALT) Dosage Recommendations. Photomed Laser Surg. 2012;30(2):61-2.

Machado B, Mazzetto M, Da Silva M, de Felício C. Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Lasers Med Sci. 2016;31(5):945-54.

Ahrari F, Madani AS, Ghafouri ZS, Tuner J. The efficacy of low level laser therapy for the treatment of myogenous temporomandibular joint disorder. Lasers Med Sci. 2014;29:551-7.

Yanik S, Polat ME. Effects of arthrocentesis and low-level laser therapy on patients with osteoarthritis of the temporomandibular joint. Br J Oral Maxillofac Surg. 2021;59(3):347-52.

Desai AP, Roy SK, Semi RS, Balasundaram T. Efficacy of Low-Level Laser Therapy in Management of Temporomandibular Joint Pain: A Double Blind and Placebo Controlled Trial. J Maxillofac Oral Surg. 2021;59(3):347-52.

Leal de Godoy CH, Motta LJ, Garcia EJ, Fernandes KPS, Mesquita-Ferrari RA, Sfalcin RA, et al. Electromyographic evaluation of a low-level laser protocol for the treatment of temporomandibular disorder: A randomized, controlled, blind trial. J Physical Therap Sci. 2017;29(12):2107-11.

Abbasgholizadeh ZS, Evren B, Ozkan Y. Evaluation of the efficacy of different treatment modalities for painful temporomandibular disorders. Int J Oral Maxillofac Surg. 2020;49(5):628-35.

De Bont LG, Dijkgraaf LC, Stegenga B. Epidemiology and natural progression of articular temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;83(1):72-6.

Sayed N, Murugavel C, Gnanam A. Management of temporomandibular disorders with low level laser therapy. J Maxillofac Oral Surg. 2014;13(4):444-50.






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