Internal Photobiomodulation For Management Of Temporomandibular Joint Internal Derangement

Primary outcomes

1. Pain level assessment using Visual Analogue Scale

   Time frame: after one month from the last laser session

   All patients will be evaluated subjectively through Visual Analogue Scale (VAS) to clinically assess the pain intensity with ratings between 0 for pain-free and 10 for maximum pain

2. Oral health-related quality of life using OHIP-TMD

   Time frame: after one month from the last laser session

   Oral health-related quality of life will be assessed using OHIP-TMD, a 22-item temporomandibular disorder-specific version of the Oral Health Impact Profile (OHIP).

   Each item in the OHIP-TMDs is scored on a Likert scale, often ranging from: 0 (Never) to 4 (Very often). For each respondent, the scores for all 22 items are summed to create a total score. The total score ranges from 0 to 88, where higher scores indicate a greater negative impact on oral health-related quality of life.

3. Maximum mouth opening evaluation using the Miller index

   Time frame: after one month from the last laser session

   The Miller Index is calculated as a ratio of the observed maximum interincisal distance (distance between the edges of the upper and lower incisors when the mouth is fully open) to the patient's height. This provides a normalized measure of mouth opening relative to body stature.

   Miller Index= Maximum Interincisal Distance (mm)/Height (cm)

   Normal Range: A typical Miller Index is around 1.6 to 1.7 mm/cm in healthy individuals. This means that for every centimeter of height, the expected mouth opening is about 1.6 to 1.7 mm.

   Deviations:

   • Lower than Normal: May indicate restricted mouth opening (e.g., trismus, TMDs, fibrosis, ankylosis).
   • Higher than Normal: May occur in conditions involving hypermobility.