The Use of LASERS for TMJ Dysfunction

The American Academy of Craniomandibular Disorders has cited physical therapy as an important treatment modality in the management of TMDs. Physical therapy is intended to relieve musculoskeletal pain, reduce inflammation, and restore oral motor function. Numerous physical therapy interventions are potentially effective in managing TMD, including exercise and manual therapy techniques, thermal therapies by application of cold or heat, electrophysical modalities like transcutaneous electric neural stimulation, dry needling, and Laser Therapy, just to name a few.
Today I wanted to provide some insight as to how Laser Therapy has provided excellent results in reducing the pain intensity, reduction in inflammation, and the number of tender points, improvement in the range of jaw motion, and allowing more manual work to be done due to the reduction in pain. Hence it is an effective and efficient treatment method for TMDs. As we know, there is very little, if any education in the PT schools on Laser therapy, even in 2022 unfortunately. So, it necessitates us, as professionals, to expand our knowledge and awareness of additional tools or modalities that allow us to be more effective with our physical therapy skills.
Low-level laser therapy and Class IV Laser therapy have been investigated and used clinically in the treatment of a variety of acute and chronic musculoskeletal injuries, degenerative conditions, and wound healing for about 28 years. The basic effects of Laser therapy with units in the wavelength range of 600NM to 1000NM (biological window) are bio-stimulative, regenerative, analgesic, and anti-inflammatory.
Like any PT treatment or modality outcomes in Laser Therapy will depend on the knowledge of the practitioner on laser therapy, on patient body type and skin tone, treatment protocols, and procedure, and whether the unit you chose can be on the skin or off the skin, all these factors and more can promote or inhibit the effectiveness and the outcome of Laser Therapy in the treatment of TMDs.

Simple benefits regarding Class IV lasers are:

  • remove histamine and cytokines out of the cells, (all the toxins)
  • provides oxygen and nutrients into the cells
  • inhibits their pain signal to the brain
  • promotes endorphin and enkephalin release
  • increases ATP production
  • promotes cell growth
  • improves and promotes blood flow to an area
  • can reduce scar tissue and
  • helps the body’s healing process by up to 50% by stimulating the mitochondria to generate the body’s healing response.

A slightly more technical version, Class IV lasers creates the above number of physiological and biochemical changes in the tissues through the production of Nitric Oxide. The laser beam stimulates blood vessel endothelial cells to secrete a vasodilator termed endothelium-derived relaxing factor, which is nitric oxide (NO, specifically produced by NOS-3), causing the underlying smooth muscles cells to relax, dilating the blood vessels, increasing the number of nutrients and oxygen to the target area. This also allows greater drainage of lymphatic fluid decreasing swelling of the target tissue and surrounding tissues. NO also inhibits the aggregation of platelets and keeps inappropriate clotting from interfering with blood flow. The NO produced by NOS -3 also inhibits inflammation of the blood vessels by blocking exocytosis of mediators of inflammation from the endothelial cells. Among these are histamines and bradykinins, which themselves are irritants to surrounding nerve endings.

LASERS in PT Practice

At Freedom Physical Therapy Services, when we are utilizing our Class IV Berman Lasers, we apply therapeutic light through direct contact with the handheld laser probe on the skin. The probe is placed perpendicularly directly on the skin behind, in front of, and above the Temporomandibular joint area, and into the external acoustic meatus. It is also applied over the painful muscle spots (trigger points or tender points) like masseter, temporalis, sternocleidomastoid, and trapezius and the back of the neck and suboccipital. Intra-orally is also a possibility on to the masseter, anterior border of the ramus of the mandible—attachment of temporalis or coronoid process, posterior and superior to the molars in the buccal vestibule—lateral pterygoid muscle and on the lingual aspect of the posterior mandible—medial pterygoid muscle. The beauty of the Berman Lasers, their Wavelength options, and power options is to do this all covering a much broader area. To make sure you are covering the primary and secondary sources of pain contributing to the individual’s TMJ symptoms. The Berman Lasers High Power or Wattage options allow us as practitioners to do this very, very efficiently in a minimal amount of time or minutes!
Now, much of the above is super dependent on the quality of the Laser used, The particular wavelengths used, the Power or wattage available, and whether you can use your laser on the skin or off the skin, when you are off the skin you get scatter which significantly reduces the effects and penetration of the laser. So many factors to consider when making your purchase. I have been very pleased with my 4 Berman Class IV medical lasers and all the variability and power it offers, especially in our PT world when we are treating virtually every body part and condition, so the versatility and power the Berman lasers provide are sort of a one-stop-shop or unit to targe all areas effectively and at a price point affordable to most PT practices and Dental Practices. If interested in learning more contact Michael Berman at  Be sure to use Code MKLASERTMJ to get the best pricing available.

Michael Karegeannes
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