Establishment of a Temporomandibular Physiological State with Neuromuscular Orthosis Treatment Affects Reduction of TMD Symptoms in 313 Patients

Abstract

The objective of this investigation was to test the hypothesis that alteration of the occlusions of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly, rather than anatomically based, would result in reduction or resolution of symptoms that characterize the TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD symptoms were examined for neuromuscular dysfunction, using several electronic instruments before and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement of the activities of the masticatory muscles during rest and in function, tracking and assessment of various movements of the mandible, and listening for noises made by the TMJ during movement of the mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate location of a physiological rest position for the mandible. TENS also made it possible to select positions of the mandible that were most relaxed above and anterior to the rest position when the mandible was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position was recorded in the form of a bite registration, which was subsequently used to fabricate a removable mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated retention and stabilization of the mandible in its new-found physiological position, which was confirmed by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions achieved remained intact and were associated with improved resting and functioning activities of the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this study and that taking patients from a less to a more physiological state is an effective means for reducing or eliminating TMD symptoms, especially those related to pain, most notably, headaches.

Thirty-year follow-up of a TMD case treated based on the neuromuscular concept

“…10,11 The Myo-centric position (MCP) was recorded as a reference jaw position. 12,13 The intensity of electric stimuli by TENS was increased slightly to move the mandible approximately 1.5 mm above the rest position on a neuromuscular trajectory. This position was considered MCP.…”

Effects of transcutaneous electrical nervous stimulation on electromyographic and kinesiographic activity of patients with temporomandibular disorders: A placebo-controlled study

“…The kinesiographic array was mounted on the subject's head, and the optimal position of the magnet for kinematic movement recording was monitored with the software. The two electrodes for TENS were placed bilaterally over the cutaneous projection of the notch of the V pair of cranial nerves, that is located between the coronoid and condylar process and was retrieved by manual palpation of the zone anterior to the tragus, while a third grounding electrode was placed in the center of the back of the neck (Cooper and Kleinberg, 2008); however, since in the area of application of TENS, fibers of VII pair of cranial nerves are present, the result of TENS application is the motor stimulation of masticatory and facial muscles.…”

“…In addition, the effect of TENS application on sEMG activity of masticatory muscles has been poorly investigated: indeed, only two study (Rodrigues et al, 2004;Cooper and Kleinberg, 2008) investigated the effect of TENS on sEMG activity of masticatory muscles, reporting a reduced sEMG activity of hyperactive muscles and an increased activity of masseter muscles during maximum voluntary clenching (Rodrigues et al, 2004); however, these studies used a long TENS application time (from 45 to 60 min) in symptomatic patients; furthermore, none of the studies analyzed kinesiographic changes after TENS application.…”

Positive outcome of occlusal freeway space reestablishment in patients with medication overuse due to chronic migraine

“…Altered muscular activity, such as contracture sustained over time, and muscle spasm, associated with shortening of the muscle fibers, may help explain the phenomena that underlie the onset of trigger points. These points are presented with painful compression and can evoke characteristically referred pain even in relatively remote locations and sometimes impressive autonomic phenomena [10].…”