Relaxing the Muscles with TENS

by Clayton A. Chan, D.D.S.

When patient’s come to me for help regarding their TMJ problems I always use low frequency muscle stimulation (J5 Myomonitor, Myotronics, Inc, Kent, WA) to relax the muscles that are in spastic tension.  TENS stands for Transcutaneous Neural Stimulation.  The Myomonitor is the name brand for a particular type of TENS that the company Myotronics manufacturers.  The Myomonitor is a high quality low frequency TENS unit that does not monitor muscles  activity, but rather is designed to stimulate masticatory muscles to a relaxed state.

After a thorough evaluation and comprehensive work up, I will use this simple non-invasive modality to help me find and establish a more physiologic jaw/bite relationship in 6 Dimensions (AP, vertical, frontal/lateral, pitch, yaw and roll)  for lower orthotic laboratory fabrication.

Relaxing all the muscles of mastication first is the first fundamental principle that is missed among dental professionals when therapeutically treating TMD, orthodontic/orthopedic and restorativve kind problems. Without establishing the mandible to a more neutral state as it relates to the cranial base, the dentist will not effectively be able to calm the many head and neck pains that trigger the Central Nervous System and back to the jaw, teeth, head and neck region. This is a key principle that more and more clinicians are now recognizing.

This young 13 year old orthodontic female patient experienced headaches, pain at the side of her jaw, neck and shoulder pains, with no effective resolution from traditional chiropractics.  After stabilizing her jaw, expanding and correcting the Class II mal-alignment and overclosed bite I was able to finalize treatment with orthodontics.

The following video is a short clip showing the involuntary TENS pulse with the J5 Myomonitor (6 lead system) to access whether proper orthopedica verticalization and AP correction was accomplished.  An Optimized Bite was established and confirmed with computerized K7 jaw tracking and before and after muscle TENS relaxation.

Computerized Mandibular  Scanning (Jaw Tracking) of patient mandibular jaw position (sagittal and frontal view) showing before jaw tracking and after Orthodontic treatment jaw tracking.  Note the sagittal opening and closing paths are now coincident and there is no longer a pink triangle which is the measured area that indicates the amount of Antero-Posterior discrepancy in the bite.  Now it is one and the same with no occlusal skids, mandibular torques and the patient is no longer having TMD symptoms.

Myotronics TENS units have been cleared by the FDA.  INDICATIONS FOR USE:

  • Treat TMJ dysfunction and associated pain
  • Relieve symptoms associated with muscle spasm
  • Relax muscles and establish physiologic occlusion
  • Take an occlusal registration
  • Take denture impressions
  • Increase local blood flow
  • Increase mandibular range of motion.

This market indication was achieved (almost 20 years ago) by showing documented research on the efficacy of ULF (ultra-low frequency) bi-lateral simultaneous stimulation via the 5th (Trigeminal) and 7th (Facial) nerves. This regulated pulse allows the muscles (both superficial and of mastication) to relax at their most ‘efficient’ length against gravity without influence of where the teeth ‘mesh’ together and the brain’s ‘proprioception’ of where the bite ‘normally’ is (in many cases improperly-malocclusion).

Once this position is achieved, a properly trained dentist can ‘relocate’ the bite to this more efficient position through occlusal registration capture and orthotic (anatomically correct bite splint) therapy – thereby allowing the muscles to function optimally. While other TENS units can achieve therapeutic objectives, they can’t obtain a de-torqued physiologically balance position (think of your lower jaw as an airplane – it can pitch, roll, yaw, move forwards and backwards, and up and down).

To read more on the ADA and FDA approval

Myotronics J5 is the only 4 channel TENS device with FDA approved intended use for dental applications i.e. for occlusal registration and relaxation.    The J5′s 4 channel stimulation design facilitates the stimulation of masticatory and cervical muscles.

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