Abstract The effectiveness of photobiomodulation (PBM) and manual therapy (MT), alone or combined (CT), were evaluated in pain intensity, mandibular movements, psychosocial aspects, and anxiety symptoms of temporomandibular disorder (TMD) patients. Fifty-one TMD patients were randomly assigned to three groups: the PBM group (n = 18), which received PBM with 808 nm, 100 mW, 13.3 J/cm2, and 4 J per point; the MT group (n=16) for 21 minutes each session on masticatory muscles and temporomandibular joint TMJ; and the CT group (n = 17), applied during twelve sessions. Seven evaluations were performed in different moments using visual analogue scale (VAS), Research Diagnosis Criteria for Temporomandibular Disorders (RDC/TMD) Axis I and II, and Beck anxiety inventory (BAI). All groups demonstrated reductions in pain and improvement in jaw movements during treatment and at follow-up (< 0.001). The assessment of psychosocial aspects of TMD, comparing baseline and follow-up in all treatment groups, revealed that treatment did not promote modification in the intensity of chronic pain (p > 0.05). However, depression symptoms showed a reduction in PBM and CT groups (p≤0.05). All treatments promoted reduction in physical symptoms with and without pain and enhancement of jaw disabilities (p ≤ 0.05). MT promotes improvement in 5 functions, PBM in 2, and CT in 1 (p < 0.001). BAI analysis revealed that all treatments lead to a reduction in anxiety symptoms (p≤0.05). All protocols tested were able to promote pain relief, improve mandibular function, and reduce the negative psychosocial aspects and levels of anxiety in TMD patients. However, the combination of PBM and MT did not promote an increase in the effectiveness of both therapies alone.

OBJETIVO: A ressonância magnética nuclear (RMN) é de grande utilidade para o diagnóstico das desordens temporomandibulares, inclusive o deslocamento de disco é muito comum. O objetivo deste estudo foi avaliar a relação entre ruído articular e deslocamento de disco com e sem redução por meio de avaliação clinica e ressonância magnética nuclear. METODOLOGIA: O estudo examinou 58 pacientes clinicamente, que foram submetidos à RMN quando apresentavam de sinais e sintomas de deslocamento de disco uni ou bilateral. O diagnóstico obtido pela RMN foi comparado com os achados clínicos relativos à presença ou não de ruído articular. RESULTADOS: Dos 58 indivíduos estudados, 39 (67%) apresentaram ruído articular do tipo click, os restantes 19 (33%) não apresentaram ruídos. Dos 39 com ruído, a ocorrência bilateral foi de 29 (74%) e unilateral em 10 (26%) casos, sendo 5 (13%) do lado direito e 5 (13%) do lado esquerdo. CONCLUSÃO: Os resultados demonstraram que os ruídos articulares não estão restritos a articulações com deslocamento de disco com redução. A presença ou ausência de ruído articular não devem ser os únicos aspectos considerados para o diagnóstico diferencial entre deslocamento de disco com e sem redução.

PURPOSE: Magnetic resonance imaging (MRI) is useful for interpreting temporomandibular joint (TMJ) disorders including disc displacement. This study aimed to evaluate the relationship between TMJ sounds and disc displacement with and without reduction by clinical examination and MRI. METHODS: A sample of 58 patients was clinically examined when after being referred to MRI due to signs and symptoms of unilateral or bilateral TMJ disc displacement. The diagnosis obtained using MRI was compared with the clinical findings for the presence or absence of articular sounds. RESULTS: Most patients (n=39; 67%) had joint sounds manifested as clicking; the other 19 patients (33%) did not present sounds. Among the 39 patients with sounds, bilateral clicking was observed in 29 (74%), and unilateral clicking in 10 (26%) patients. Unilateral clicking was equally observed on the right and left sides, each occurring in 5 five patients (13%). CONCLUSION: The results suggest that articular sounds do not occur exclusively in TMJ with disc displacement with reduction. The presence or absence of joint sounds will not suffice as the only aspect criterion to be considered in the differential diagnosis of disc displacement with and without reduction.