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The following articles are just a sampling of literature supportive of low frequency TENS efficacy in the treatment of TMD/MSD. Controlled studies of Pantaleo and Prayer-Gallletti are of particular interest.
Pantaleo, T., M.D., PrayerGalletti, F., M.D., Pini-Prato, G., M.D., and Prayer-Galletti, S., M.D., “Electromyographic study in patients with myofacial pain-dysfunction syndrome.” Bull, Group. int, Rech, sc. Stomat. et Odont. Vol26, pp. 167-179, 1983.
An electrical myographic (EMG) study of ipsilateral masseter and temporalis mucles was undertaken in healhty volunteers and in patients with MPD syndrome, with the aim of getting further insight into the pathophysiology of this disease. Unlike controls, patients had abnormal MKG features and displayed involuntary sustained EMG activity at rest, chiefly in the temporalis muscles.
Transcutaneous eletrical nerve stimulation (TENS) performed withteh Myo-monitor induced relaxation and relief of pain; these effects were however reversed by voluntary mouth closures.
The correction of occlusal position by acrylic splints was able to induce a persistent reduction or a suppression of the abnormal EMG activity at rest and a good relief of pain; more over, after the correction, higher levels of EMG activity were found during maximal biting in the intercuspal position.
Mechanisms underlying these effects were discussed and in particular it was suggested that abnormal afferent activity from perdiotontium and jaw muscles may contribute to the establishment of sustained contraction leading to muscular pain, which in turn may cause reflex muscle activity in vicious circle.
Westerberg George A., Dinham, Richard, DMD. “The Myo-monitor and the myofacial pain dysfunction syndrome.” Journa f the hawaii Dental Association. Vol. 10 No 2, Aug. 1977.
Thirty patients presented symptoms associated with the Myo-facial Pain Dysfunction Syndrome. All of these patients recieved Myo-monitor oriented therapy and nearly all of them professed some initial relief or total remission of their symptoms during the short time span of this study.
The data presented is based largely on clinical observations and patient response to comparison of their symptoms before and after treatment. Symptoms evaluated were generally related to muscle tenderness and mandibular mobility.
It is concluded that:
- The centric occlusion position is seldom coincident with the myo-centric position of occlusion in patients who exhibit symptoms associated with Myo-facial Pain Dysfunction Syndrome.
- A Myo-monitor generated occlusal position affords some relief if not complete remission of symptoms in 90% of cases treated.
- Long-term follow-up studies are necessary to evaluate the success of treatment.
Wessberg, George A., DDS, Carroll, Wesley L., DDS, et al., “Transcutaneous electricla stimulation as an adjunct in the management of myofascial pain dysfunction syndrome.” The Journal of Prosthetic Dentistry. Vol. 45, No. 3, March 1981.
This study evaluates the immediate and long-term results of a muscularly oriented treatment regimen for symptoms of the MPD syndrome. Data obtained from post-treatment evaluation of 21 patients treated with TENS demonstrated a success rate of 95% immediately and 86% after 1 year. Our data demonstrated a very high incidence of lateral pterygoid muscle dysfunction (85.7%). This suggests that discrepancies in the transverse and anteriooposterior position of the mandible relative to centric occlusion are not well tolerated. Elimination of these discrepancies in maxillomandibular relations via TENS and occlusal adjustment or occlusal splint placement appears to promote the long-term relief of muscle symptomology. Attempts should be made to eliminate the splint after the patient becomes asymptomatic for 30 days, as many individuals may function satisfactorily in their existing habitual occlusion once the myospasm subside. Comparison of these results with other reports in the literature is quite favorable. However, few authors present data of long-term follow up for other treatment modalities.
Pshiero, R., Fraccari, f., and Pagnacco, O. “Analysis of the results of the use of the Myo-monitor in patients with reduced mouth opening.” Min Stom. vol, 35, pp 857-864, Sept 1986.
Fifteen young patients with markedly reduced mouth opening (less than 26 mm) with no severe articular alterations revealed by radiography were subjected to treatment with a Myo-monitor. The mouth opening was measured during stimulation and the data analyses mathematically. The treatment was effective in all cases. The mean curve of increase over time showed altering phases of rapid advance and plateaux. The first stage, lasting about 45 minutes constantly produced almost no increase.
Konchak, P., Thomas, N., Lanigan, D., Devon, R. “Freeway space measurement using mandibular kinesiograph and EMG before and after TENS.” The Angle Orthodontist. October 1988, pp 343-350.
Four categories of relaxation of the masticatory musculature were determined in patients before and after TENS. 58% more patients achieved masticatory muscle relaxation after TENS(50%) before, 79% after).
The average freeway space measurement increased after TENS. Differences for individual patients in their pre-and post-stimulation freeway space values, however, could be either positive or negative, as some experienced an increase in masticatory muscle activity following TENS stimulation.
Clinical and true freeway space values were inversely correlated with the S-N/MP angle, but the correlation values are low.
Angle classifications were not correlated with freeway space.
S-N/MP angle and percentage nasal height were inversely correlated.
No correlation was found between percentage nasal height and FWS. Descriptive factors obtained from cephalometric measurments such as percentage nasal height and S-N/MP angle can be useful in diagnosis and treatment planning, but these values must be correlated with the clinical examination.
Previously accepted and unchallenged concepts of freeway space and vertical dimension such as those postulated by Guichet (1970) and Lindegard (1935) were not borne out by our application of kinesiogrpahic technology.
In applying FWS values as an aide to orthodontic diagnosis and treatment planning, individual patient values are of greater significance than are group averages. In ongoing studies, individual patient’s freeway space before and after treatment are being investigated to see whether this parameter is important influencing the ultimate stability of the occlusion.
A Few Other References:
- Dinham, G.A. Myocentic A Clinical Appraisal: A clinical assessment of The Angle Orthodontist, July neuromuscular occlusal positioning with the Myomonitor 1984: 211-217. (A clinical assessment of neuromuscular occlusal positioning with the Myo-monitor in 63 orthodontic patients).
- Vesanen, E, Vesanen, R.: The Jankelson Myo-monitor and Its Clinical Use Proc. Finn. Dent Soc, 1973, TENS, TMD 69: 244-247.
- Jankelson, B., Sparks, S., Neural Conduction of the Myo-monitor Stimulus: A J. Prosthetic Dent, Vol 34. No. Crane, P.F. and Radke, Quantitative Analysis. 3, pp. 245-253, September J.C. 1975.
- Weiss, M.H. Instruments/J3 Yes Case Report: Successful Treatment of Bell’s Palsy. Dental Survey. August 1976.
- Moss, C.R. Instruments/J3 Yes New Research and Techniques That Put an End to Quintessence of Dent. Occlusal RX That Makes Technicians Brux. Technology. No. 1 & 2, report 090. pp. 1-15, February 1978.
- Jankelson, B., Radke, J.C. Instruments/J3 Yes Myo-monitor: Its use and abuse (I + II) Quintessence Intl, Vol. 9, Report 1601. No. 2 & 3 Feb/Mar. 1978.
- Martinis, A.J., Jankelson, Instruments/J3 Effects of the Myo-monitor on Cardiac Pacemakers. J. Amer. Dent. Assn. Vol. 100, B., Radke, J., Adib, F. Feb. 1980.
- Thomas, N.R. Etiology/J4 Yes Pathophysiology of Head and Neck Musculoskeletal Frontiers of Oral Physiology. Disorders: The Effect of Fatigue and TENS on the EMG Vol. 7, pp. 162-170, 1990. Mean Power Frequency.
- Shipley, W. ortho, NM, TENS, Yes Neuromuscular Analysis in Orthodontics. NY State Dent. Journ. Vol. 56, CMS, No. 4, April 1990.
- Chaconas, S.J., Fragiskos, Myomonitor/EMG Yes Vertical dysplasias and myofascial pain dysfunction Compendium. 11(7):412-7. F.D. syndrome. July 1990.
- Langberg, G.J. Etiology/TENS Yes Ultra-Low-Frequency TENS: A Well-Kept Secret. Pain Management. Clinical Tips. Sept-Oct. 1990.
- Frucht, S., Jonas, I., Myomonitor, Yes Muscle relaxation by transcutaneous electric nerve Fortschr Kieferorthop. Vol. 56. Kappert, H.F. Efficacy, TENS stimulation (TENS) in bruxism. An electromyographic No. 5. Sept. 1995.
- Galletti SP, Bergamini M, TENS, Highlights in the subject of low frequency-high intensity Minerva Stomatol. 1995 Pantaleo T. Myomonitor, TENS (review). Sep;44(9):421-9. Review. muscle relaxation Italian.
- Bazzotti, L. TENS/Instruments Yes Electromyography tension and frequency spectrum Electromyogr Clin analysis at rest of some masticatory muscles, before and Neurophysiol. 1997 Sep;37(6):365-78.
- Dale, R. Myomonitor TMD: It’s Our Responsibility. Part Two. J. General Orthodontics. Vol. 10. No. 4. Winter 1999.
- Dale, R. Myomonitor TMD: It’s Our Responsibility. Part One. J. General Orthodontics. Vol. 10. No. 3. Fall 1999.
- Eble, O.S., Jonas, I.E., Myomonitor, Yes Transcutaneous electrical nerve stimulation (TENS): its J. Orofac Orthop. Vol. 61. No. Kappert, H.F. Efficacy, TENS short-term and long-term effects on the masticatory 2, 2000.
- Hülse, M., Losert- TENS, EMG Neuromuskulär ausgerichtete Bisslagebestimmung mit Manuelle Medizin. 2003. Bruggner, B., Schöttl, R., Hilfe niedrigfrequenter transkutaner elektrischer 41:120-128. Zawadzki, W. Nervenstimulation: Wechselwirkung der kraniozervikalen und kraniomandibulären Region. (Article in German) Determining the neuromuscular mandibular position by use of low frequency TENS. Interactions between the cranio-mandibular and the cranio-cervical regions.
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