Effects of photobiomodulation combined with orofacial myofunctional therapy on the quality of life of individuals with temporomandibular disorder

Dias, Wellyda Cinthya Félix Gomes da Silva; Cavalcanti, Renata Veiga Andersen; Magalhães Júnior, Hipólito Virgílio; Pernambuco, Leandro de Araújo; Alves, Giorvan Ânderson dos Santos

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Original Article • CoDAS 34 (5) • 2022 • https://doi.org/10.1590/2317-1782/20212020313 copy

Effects of photobiomodulation combined with orofacial myofunctional therapy on the quality of life of individuals with temporomandibular disorder

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To analyze the impact of photobiomodulation combined with orofacial myofunctional therapy (OMT) on the oral health quality of life (OHQOL) of individuals with temporomandibular disorder, before and after the treatment.

Methods

Blind, controlled, randomized clinical trial with 34 volunteers randomly distributed into two groups: G1, who received OMT combined with photobiomodulation, and G2, treated with OMT combined with inactive laser. The subjects were first assessed with a visual analog scale (VAS) to classify them according to the degree of orofacial pain and with the Oral Health Impact Profile – Short Form (OHIP-14) regarding the impact on the OHQOL. The resulting data were statistically analyzed. The significance level was set at 0.05 (95%).

Results

“Physical pain”, “psychological discomfort”, “physical disability”, and “psychological disability” were the aspects with the greatest impact on the OHQOL. The G1 subjects responded positively to their treatment, as well as G2 to theirs. There was a strong positive correlation between VAS and total OHIP-14 score in both groups after the treatment. However, the functional recovery in the control group individuals (G2) was the most perceived positive change in the OHQOL in comparison with the experimental group (G1).

Conclusion

The people who received photobiomodulation combined with OMT perceived an improvement in the OHQOL, as well as those treated with placebo laser. There was a strong positive correlation in both groups in the improvement of the degree of pain and self-perception of the OHQOL.

Keywords
Temporomandibular Joint Disorders; Quality of Life; Laser Therapy; Myofunctional Therapy; Speech, Language and Hearing Sciences

			BEFORE THE TREATMENT		AFTER THE TREATMENT
			G1	G2	G1	G2
OHIP-14 DOMAINS	QUESTIONS	ANSWERS	n (%)	n (%)	n (%)	n (%)
Functional limitation	1. Have you had trouble pronouncing any words because of problems with your teeth, mouth, or dentures?	Never	10 (52.6)	10 (66.7)	12 (63.2)	15 (100.0)
		Rarely	1 (5.3)	1 (6.7)	1 (5.3)	0 (0.00)
		Sometimes	4 (21.1)	3 (20.0)	6 (31.6)	0 (0.0)
		Recurrently	2 (10.5)	1 (6.7)	0 (0.0)	0 (0.0)
		Always	2 (10.5)	0 (0.0)	0 (0.0)	0 (0.0)
	2. Have you felt that your sense of taste has worsened because of problems with your teeth, mouth, or dentures?	Never	14 (73.7)	9 (60.0)	15 (78.9)	15 (100.0)
		Rarely	1 (5.3)	2 (13.3)	3 (15.8)	0 (0.0)
		Sometimes	2 (10.5)	3 (20.0)	1 (5.3)	0 (0.0)
		Recurrently	0 (0.0)	1 (6.7)	0 (0.0)	0 (0.0)
		Always	2 (10.5)	0 (0.0)	0 (0.0)	0 (0.0)
Physical pain	3. Have you had painful aching in your mouth?	Never	2 (10.5)	0 (0.0)	7 (36.8)	7 (46.7)
	3.	Rarely	0 (0.0)	3 (20.0)	4 (21.1)	2 (13.3)
	3.	Sometimes	6 (31.6)	3 (20.0)	4 (21.1)	3 (20.0)
	3.	Recurrently	5 (26.3)	5 (33.3)	4 (21.1)	2 (13.3)
	3.	Always	6 (31.6)	4 (26.7)	0 (0.0)	1 (5.9)
	4. Have you found it uncomfortable to eat any foods because of problems with your teeth, mouth, or dentures?	Never	0 (0.0)	3 (20.0)	7 (36.8)	6 (40.0)
	3.	Rarely	3 (15.8)	1 (6.7)	3 (15.8)	3 (20.0)
	3.	Sometimes	1 (5.3)	1 (6.7)	5 (26.3)	3 (20.0)
	3.	Recurrently	6 (31.6)	3 (20.0)	3 (15.8)	1 (6.7)
	3.	Always	9 (47.4)	7 (46.7)	1 (5.3)	2 (13.3)
Psychological discomfort	5. Have you been self-conscious because of your teeth, mouth, or dentures?	Never	1 (5.3)	0 (0.00)	6 (31.6)	6 (40.0)
		Rarely	1 (5.3)	2 (13.3)	6 (31.6)	1 (6.7)
		Sometimes	5 (26.3)	4 (26.7)	3 (15.8)	6 (40.0)
		Recurrently	3 (15.8)	3 (20.0)	2 (10.5)	2 (13.3)
		Always	9 (47.4)	6 (40.0)	2 (10.5)	0 (0.0)
	6. Have you felt tense because of problems with your teeth, mouth, or dentures?	Never	0 (0.0)	3 (20.0)	5 (26.3)	5 (33.3)
		Rarely	0 (0.0)	1 (6.7)	4 (21.1)	3 (20.0)
		Sometimes	6 (31.6)	2 (13.3)	4 (21.1)	3 (20.0)
		Recurrently	4 (21.1)	5 (33.3)	3 (15.8)	2 (13.3)
		Always	9 (47.4)	4 (26.7)	3 (15.8)	2 (13.3)
Physical disability	7. Has your diet been unsatisfactory because of problems with your teeth, mouth, or dentures?	Never	2 (10.5)	2 (13.3)	11 (57.9)	8 (53.3)
		Rarely	0 (0.0)	0 (0.0)	2 (10.5)	0 (0.0)
		Sometimes	5 (26.3)	6 (40.0)	4 (21.1)	7 (46.7)
		Recurrently	5 (26.3)	4 (26.7)	2 (10.5)	0 (0.0)
		Always	7 (36.8)	3 (20.0)	0 (0.0)	0 (0.0)
	8. Have you had to interrupt meals because of problems with your teeth, mouth, or dentures?	Never	3 (15.8)	5 (33.3)	10 (52.6)	10 (66.7)
		Rarely	3 (15.8)	4 (26.7)	7 (36.8)	2 (13.3)
		Sometimes	6 (31.6)	2 (13.3)	2 (10.5)	3 (20.00)
		Recurrently	4 (21.1)	3 (20.0)	0 (0.0)	0 (0.0)
		Always	3 (15.8)	1 (6.7)	0 (0.0)	0 (0.0)
Psychological disability	9. Have you found it difficult to relax because of problems with your teeth, mouth, or dentures?	Never	1 (5.3)	2 (13.3)	5 (26.3)	5 (33.3)
	1.	Rarely	1 (5.3)	3 (20.0)	5 (26.3)	2 (13.3)
	1.	Sometimes	4 (21.1)	6 (40.0)	5 (26.3)	4 (26.7)
	1.	Recurrently	6 (31.6)	1 (6.7)	4 (21.1)	1 (6.7)
	1.	Always	7 (36.8)	3 (20.0)	0 (0.0)	3 (20.0)
	10. Have you been a bit embarrassed because of problems with your teeth, mouth, or dentures?	Never	10 (52.6)	8 (53.3)	12 (63.2)	13 (86.7)
		Rarely	1 (5.3)	1 (6.7)	6 (23.6)	0 (0.0)
		Sometimes	5 (26.3)	3 (20.0)	1 (5.3)	2 (13.3)
		Recurrently	0 (0.0)	2 (13.3)	0 (0.0)	0 (0.0)
		Always	3 (15.8)	1 (6.7)	0 (0.0)	0 (0.0)
Social disability	11. Have you been a bit irritable with other people because of problems with your teeth, mouth, or dentures?	Never	9 (47.4)	7 (46.7)	8 (42.1)	10 (66.7)
		Rarely	2 (10.5)	2 (13.3)	3 (15.8)	1 (6.7)
		Sometimes	2 (10.5)	0 (0.0)	4 (21.1)	1 (6.7)
		Recurrently	1 (5.3)	4 (26.7)	4 (21.1)	3 (20.0)
		Always	5 (26.3)	2 (13.3)	0 (0.0)	0 (0.0)
	12. Have you had difficulty doing your usual jobs because of problems with your teeth, mouth, or dentures?	Never	4 (21.1)	8 (53.3)	8 (42.1)	12 (80.0)
		Rarely	3 (15.8)	1 (6.7)	3 (15.8)	0 (0.0)
		Sometimes	6 (31.6)	1 (6.7)	6 (31.6)	3 (20.0)
		Recurrently	3 (15.8)	5 (33.3)	2 (10.5)	0 (0.0)
		Always	3 (15.8)	0 (0.0)	0 (0.0)	0 (0.0)
Handicap	13. Have you felt that life, in general, was less satisfying because of problems with your teeth, mouth, or dentures?	Never	8 (42.1)	7 (46.7)	15 (78.9)	14 (93.3)
		Rarely	2 (10.5)	2 (13.3)	2 (10.5)	0 (0.0)
		Sometimes	5 (26.3)	3 (20.0)	1 (5.3)	0 (0.0)
		Recurrently	2 (10.5)	2 (13.3)	1 (5.3)	1 (6.7)
		Always	2 (10.5)	1 (6.7)	0 (0.0)	0 (0.0)
	14. Have you been totally unable to function because of problems with your teeth, mouth, or dentures?	Never	5 (26.3)	8 (53.3)	10 (52.6)	13 (86.7)
		Rarely	5 (26.3)	1 (6.7)	4 (21.1)	0 (0.0)
		Sometimes	5 (26.3)	4 (26.7)	5 (26.3)	2 (13.3)
		Recurrently	2 (10.5)	2 (13.3)	0 (0.0)	0 (0.0)
		Always	2 (10.5)	0 (0.0)	0 (0.0)	0 (0.0)

G1				G2
	BEFORE THE TREATMENT Median (Q₁-Q₃)	AFTER THE TREATMENT Median (Q₁-Q₃)	p-value*	BEFORE THE TREATMENT Median (Q₁-Q₃)	AFTER THE TREATMENT Median (Q₁-Q₃)	p-value ^* * Wilcoxon test
Visual analog scale	8 (7-10)	2 (0-5)	0.001	8 (5-9)	3 (0-5)	0.002
Functional limitation	1 (0-4)	0 (0-2)	0.180	0 (0-3)	0 (0-0)	0.018
Physical pain	6 (5-7)	2 (1-5)	0.001	6 (3-8)	1 (1-4)	0.009
Psychological discomfort	6 (4-8)	3 (1-5)	0.001	6 (2-8)	3 (0-4)	0.007
Physical disability	5 (4-7)	0 (0-3)	0.001	4 (2-6)	1 (0-3)	0.003
Psychological disability	3 (2-6)	1 (0-3)	0.001	2 (1-5)	2 (0-3)	0.070
Social disability	2 (2-5)	2 (0-5)	0.153	2 (0-3)	0 (0-6)	0.057
Handicap	2 (1-5)	0 (0-2)	0.006	1 (0-5)	0 (0-0)	0.007
OHIP-14 total	30 (23-35)	12 (3-22)	0.001	23 (14-31)	8 (2-15)	0.002

	G1 x G2	G1 x G2
	BEFORE THE TREATMENT	AFTER THE TREATMENT
	p-value*	p-value ^* * Mann-Whitney test
Visual analog scale	0.336	0.607
Functional limitation	0.607	0.036
Physical pain	0.758	0.864
Psychological discomfort	0.430	0.784
Physical disability	0.157	0.891
Psychological disability	0.215	0.973
Social disability	0.319	0.137
Handicap	0.372	0.128
OHIP-14 total	0.157	0.632

	G1		G2
	ρ	p-value^* * Spearman correlation test	ρ	p-value*
Age x	0.313	0.191	-0.090	0.749
VAS before the treatment	0.313	0.191	-0.090	0.749
Age x	-0.220	0.366	-0.114	0.686
VAS after the treatment	-0.220	0.366	-0.114	0.686
Age x	0.159	0.515	-0.230	0.409
Total OHIP-14 before the treatment	0.159	0.515	-0.230	0.409
Age x	-0.348	0.144	-0.063	0.823
Total OHIP-14 after the treatment	-0.348	0.144	-0.063	0.823
VAS before the treatment x	0.182	0.457	0.336	0.220
Total OHIP-14 before the treatment	0.182	0.457	0.336	0.220
VAS after the treatment x	0.767	0.000	0.704	0.003
Total OHIP-14 after the treatment	0.767	0.000	0.704	0.003

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[1] Conflict of interests: nothing to declare.