Refuting TMD Guideline Misconceptions about NM Occlusion Part 2: RCDSO Draft Guidelines for Diagnosis and Management of TMD

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Psychosomatic versus Somatopsychic TMD — two opposite directions of causation in temporomandibular disorder diagnosis and treatment 8. Mini-navigation block (Read both parts of this series) Just below the Featured Image and just above the existing RCDSO 2018 quote, add this small navigation block: Read both parts of this series: Refuting TMD Guideline Misconceptions about NM Occlusion — Part 1 (this page) Refuting TMD Guideline Misconceptions about NM Occlusion — Part 2 → 9. Body content updates — H2 architecture Per your locked standard, prose stays verbatim. The page needs proper H2/H3 hierarchy added. Adjustment A — Add an opening H2 above the RCDSO 2018 quote: The RCDSO 2018 Draft TMD Guidelines on Neuromuscular Occlusion (Place this H2 just above the existing RCDSO 2018 quote that begins "RCDSO 2018 Draft TMD Guidelines (Page 6): The concept of 'neuromuscular occlusion' is based on...") Adjustment B — Add an H2 above the Myotronics response: The existing bold "Myotronics Response to the above statement:" should be converted to a proper H2: Myotronics Response to the Above Statement (Replace the existing bold paragraph header with this H2.) Adjustment C — Add an H2 above the four studies: After the Myotronics response paragraph that ends with "(1-4)", and before the first study citation, add this H2: The Peer-Reviewed Studies the RCDSO Did Not Cite Adjustment D — Convert each numbered citation to an H3 with descriptive title: The existing "1. Cooper B: ..." citations are functioning as numbered list items. Convert each to an H3 with a brief descriptive title that surfaces what the study found, followed by the citation, abstract label, and abstract text. Citation 1 — Convert to: Cooper 1997: Bioelectric Instrumentation in TMD Documentation and Management Cooper B: The role of bioelectric instrumentation in the documentation of management of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83(1): 91-100. Abstract (existing abstract text stays verbatim) Citation 2 — Convert to: Cooper and Kleinberg 2008: Neuromuscular Orthosis Treatment in 313 TMD Patients Cooper B, Kleinberg I: Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients. J Craniomandib Pract 2008; 26(2): 104-117. Abstract (existing abstract text stays verbatim) Citation 3 — Convert to: Weggen, Schindler, and Hugger 2011: Myocentric vs. Manual Methods of Jaw Position Recording Weggen H, Schindler H, Hugger A: Effects of myocentric vs. manual methods of jaw position recording in occlusal splint therapy — a pilot study. Journal of Craniomandibular Function 3 (2011), No. 3: 177-203. Abstract (existing abstract text stays verbatim) Citation 4 — Convert to: Weggen, Schindler, Kordass, and Hugger 2013: Clinical and EMG Follow-Up of Myofascial Pain Patients Weggen T, Schindler HJ, Kordass B, Hugger A: Clinical and electromyographic follow-up of myofascial pain patients treated with two types of oral splint: a randomized controlled pilot study. Int J Comput Dent. 2013, No. 16(3): 209-24. Abstract (existing abstract text stays verbatim) 10. In-body cross-reference paragraph (link to new flagship essay) After the fourth Weggen abstract concludes, and before the existing horizontal rule and Last Updated stamp, add this new H2 + paragraph: The Same Pattern Across Borders The RCDSO 2018 Draft Guidelines were not an isolated regulatory event. The same dismissal of EMG-based diagnostics and TENS-guided splint therapy appears in the AAOP's 2019 application to the American Dental Association — including the explicit attack on surface EMG and jaw tracking on pages 22 and 91 of that application — and in the ADA's subsequent recognition of Orofacial Pain as a dental specialty on March 31, 2020. The Canadian guideline language and the American specialty application are not coincidental; they are two regional expressions of the same institutional pattern. The structural and historical analysis is examined in Dentistry Without Occlusion: A Profession Redefining Itself Out of Its Foundation →. 11. FAQ block — add at end of body, before the Continue Learning footer Frequently Asked Questions What did the RCDSO 2018 Draft TMD Guidelines say about neuromuscular occlusion? The Royal College of Dental Surgeons of Ontario's 2018 Draft TMD Guidelines stated that the concept of neuromuscular occlusion is based on the diagnostic value of electromyography for TMD and that controlled studies suggested a wide range of results and inconsistent findings using EMG, minimizing its usefulness as a diagnostic test. The guidelines further stated that there was insufficient evidence from well-controlled studies to rule out a placebo effect for treatment based on electrical stimulation, and that until properly controlled studies were available, there was insufficient evidence to support the clinical use of these techniques. What evidence refutes the RCDSO 2018 position? Four peer-reviewed studies establish the clinical efficacy of neuromuscular occlusion and EMG-guided splint therapy: Cooper 1997, Cooper and Kleinberg 2008, Weggen Schindler and Hugger 2011, and Weggen Schindler Kordass and Hugger 2013. The Cooper-Kleinberg 2008 study examined 313 TMD patients and documented overwhelming symptom relief with neuromuscular orthosis treatment. The Weggen 2011 randomized controlled trial found that myocentric jaw position recording produced significantly greater pain reduction than bimanual manipulation. These studies were available at the time the RCDSO drafted its 2018 guidelines. Is the RCDSO claim about EMG inconsistency accurate? The RCDSO claim that EMG produces inconsistent findings reflects a partial reading of the literature. A significant body of peer-reviewed scientific literature published over the past 60 years has consistently documented that TMD patients exhibit elevated resting EMG muscle activity and weak or asymmetrical functional EMG muscle activity compared to healthy controls. The Weggen 2013 study confirms this finding and notes that the mean/median power frequency of EMG can distinguish between healthy subjects and patients. The inconsistency the RCDSO cited reflects measurement protocol differences across studies, not a fundamental failure of EMG as a diagnostic tool. How does the RCDSO position relate to the broader institutional pattern? The RCDSO 2018 Draft Guidelines reflect the same institutional pattern that produced the AAOP's 2019 specialty application to the American Dental Association — discounting objective neuromuscular instrumentation, framing TMD as a chronic pain condition primarily addressed through medication and behavioral management, and treating clinicians who measure mandibular position as outliers. The framework is not American or Canadian — it is a posture organized dentistry has assumed wherever the institutional pipeline of research framing, certification, and standard-of-care language has been allowed to assemble. The structural analysis is examined in Dentistry Without Occlusion: A Profession Redefining Itself Out of Its Foundation →. What does Part 2 of this series cover? Part 2 of Refuting TMD Guideline Misconceptions about NM Occlusion extends the rebuttal with additional peer-reviewed evidence on the elevated EMG activity in TMD patients, the response of masticatory muscles to TENS, and the broader scientific basis for objective neuromuscular instrumentation in TMD diagnosis. Continue to Part 2 → 12. Continue Learning footer — add at end of body, after the FAQ block 🔹 Standard of Care and Evidence Refuting TMD Guideline Misconceptions about NM Occlusion — Part 2 → What is the "Standard of Care"? — Part 1 → What is the Standard of Care? – Part 2 → The Controversy: How Effective is the Neuromuscular Occlusal Approach in the Diagnosis and Treating TMD → 🔹 The Framework Distinction What is TMJ? → Prevalent Philosophies of Treating TMJ → Psychosocial vs. Physiologic: Clarifying the Diagnostic Divide in Orofacial Pain → Psychosocial Anti-Instrumentation Perspective – What is Their Treatment? → Dentistry Without Occlusion: A Profession Redefining Itself Out of Its Foundation → 🔹 The Original Science Behind GNM Why OC is Different — The Original Science Behind GNM Dentistry → SCIENTIFIC TRUTHS: Bio-Physiology & Objective Measurements → The Science Behind GNM — Evidence, Research & Objective Measurement → Gneuromuscular vs. Neuromuscular Dentistry → What Does the K7 Technology Measure? → 🔹 The Instrumentation Science of Electromyography (sEMG) → Computerized Mandibular Scanning (CMS) → Functional Electrosonography (ESG) → Science of J5 Dental TENS → 🔹 Finding a GNM Trained Dentist Near You Choosing a Dentist that Practices GNM Dentistry → Finding a Gneuromuscular (GNM) Dentist Near You → 🔹 Ready to Train OC Masterclass Training — Course Schedule and Registration → 13. Last Updated stamp Already in place — keep as is: Last Updated: May 7, 2026 14. Author byline Already in place — keep as is. Order of placement on the page (top to bottom): Existing nav and page title (no change) NEW: Featured Image — Psychosomatic vs. Somatopsychic TMD with full alt text NEW: "Read both parts of this series" mini-navigation block NEW H2: The RCDSO 2018 Draft TMD Guidelines on Neuromuscular Occlusion Existing RCDSO 2018 quote (verbatim) NEW H2: Myotronics Response to the Above Statement (replacing existing bold) Existing Myotronics response paragraph + reference cluster (1-4) NEW H2: The Peer-Reviewed Studies the RCDSO Did Not Cite NEW H3: Cooper 1997: Bioelectric Instrumentation in TMD Documentation and Management + existing citation + Abstract label + existing abstract NEW H3: Cooper and Kleinberg 2008: Neuromuscular Orthosis Treatment in 313 TMD Patients + existing citation + Abstract label + existing abstract NEW H3: Weggen, Schindler, and Hugger 2011: Myocentric vs. Manual Methods of Jaw Position Recording + existing citation + Abstract label + existing abstract NEW H3: Weggen, Schindler, Kordass, and Hugger 2013: Clinical and EMG Follow-Up of Myofascial Pain Patients + existing citation + Abstract label + existing abstract NEW H2: The Same Pattern Across Borders + new bridging paragraph (with link to flagship essay) Existing horizontal rule (keep) NEW: Frequently Asked Questions block (5 Q&A in H3 format) NEW: Continue Learning footer with six 🔹 buckets Existing Last Updated stamp (keep — already in place) Existing author byline (keep — already in place) That's everything in one pass. The page transforms from a linear citation list into a structured rebuttal with proper hierarchy, FAQ depth, and full integration into the framework cluster. Tell me when each step is deployed or when the whole page is done. Refuting TMD Guideline Misconceptions about NM Occlusion Part 1: RCDSO Draft Guidelines for Diagnosis and Management of TMD Home | About OC | OC Masterclass Training | Course Schedule | Registration | Accommodations | About Dr. Chan | Doctor Education | Patient Education | Finding a GNM Dentist | pasted

Read both parts of this series:

The RCDSO 2018 Draft TMD Guidelines on Diagnostic Aids

RCDSO 2018 Draft TMD Guidelines (Page 6): “The clinical value of a number of diagnostic aids currently in use has not been demonstrated in well-controlled and scientifically based studies; these include jaw tracking devices, EMG recording and sonography (Doppler).”

Myotronics Response to the above statement:

Proper diagnosis of any medical/ dental condition is made by the treating doctor and begins with obtaining the patient’s medical history and performing a comprehensive clinical examination of the affected area.  The temporomandibular disorders (TMD) diagnostic process and treatment plan are greatly enhanced using technologies that can scrutinize the anatomic and functional components of the masticatory system, providing reliable and precise objective measurement data.  Surface Electromyography (EMG) is a well-accepted modality that is safe and effective for the evaluation of masticatory muscle function of TMD patients, for providing objective milestones in planning treatment and for documenting patients’ response to treatment.

A significant body of the scientific literature published in peer-reviewed journals over the past 60 years has concluded that the TMD patient population has an elevated resting EMG muscle activity and weak or asymmetrical functional EMG muscle activity.1-59

Reference Cluster 1: Elevated Resting EMG and Asymmetrical Functional EMG in TMD Patients (1957–2009)

  1. Perry HT: Muscular changes associated with temporomandibular joint dysfunction. Journal of Am Dent Res 1957; 54:644-653.
  2. Lous L, Sheikholeslam A, Moller E: Postural activity in subjects with functional disorders of the chewing apparatus. Scand J Dent Res 1970; 78:404-410.
  3. Moller E, Sheikholeslam A, Lous L: Deliberate relaxation of the temporal and masseter muscles in subjects with functional disorders of the chewing apparatus. Scand J Dent Res 1971; 79:478-482.
  4. Munro RR: Electromyography of the masseter and anterior temporalis muscles in patients with atypical facial pain. Australian Dent J 1972:131-139.
  5. Moss JP, Chalmers CF: An electromyographic investigation of patients with a normal jaw relationship and a class III jaw relationship. Am J Orthod 1974; 665:538-556.
  6. Yemm R: Neurophysiologic studies of temporomandibular joint dysfunction. Oral Science Rev 1976; 7:31-53.
  7. Kotani H, Kawazoe Y, Hamada T, Yamata S: Quantitative electromyographic diagnosis of myofascial pain dysfunction syndrome. J Prosthet Dent 1980; 43:450-456.
  8. Sheikholeslam A, Moller E, Lous L: Pain, tenderness and strength of human mandibular elevators. Scand J Dent Res 1980; 88:60-66.
  9. Sheikholeslam A, Moller E, Lous L: Postural and maximal activity in elevators of mandible before and after treatment of functional disorders. Scand J Dent Res 1982; 90:37-46.
  10. Riise C, Sheikholeslam A: The influence of experimental interfering occlusal contacts on the postural activity of the anterior temporal and masseter muscles in young adults. J Oral Rehabil 1982; 9:419-425.
  11. Sheikholeslam A, Riise C: Influence of experimental interfering occlusal contacts on the activity of the anterior temporal and masseter muscles during submaximal and maximal bite in the intercuspal position. J Oral Rehabil 1983; 10:207-214.
  12. Riise C, Sheikholeslam A: The influence of experimental interfering occlusal contacts on the activity of the anterior temporal and masseter muscles during mastication. J Oral Rehabil 1984; 11:325-333.
  13. Moller E, Sheikholeslam A, Lous L: Response of elevator activity during mastication to treatment of functional disorders. Scand J Dent Res 1984; 90:37-46.
  14. Keefe FJ, Dolan EA: Correlation of pain behavior and muscle activity in patients with myofascial pain-dysfunction syndrome. J Craniomandib Disord Facial Oral Pain1984; 2:181-184.
  15. Sherman RA: Relationships between jaw pain and jaw muscle contraction level: Underlying factors and treatment effectiveness. J Prosthet Dent 1985; 54(1):114-118.
  16. Naeije M, Hansson TL: Electromyographic screening of myogenous and arthrogenous TMJ dysfunction patients. J Oral Rehabil 1986; 13(5):433-441.
  17. Balciunas BA, Staling LM, Parente FL: Quantitative electromyographic response to therapy for myo-oral facial pain: a pilot study. J Prosth Dent 1987; 58(3):366-369.
  18. Burdette BH, Gale EN: The effects of treatment on masticatory muscle activity and mandibular posture in myofascial pain-dysfunction patients. J Dent Res 1988; 67(8):1126-1130.
  19. Cram JR, Klemons TM: EMG: Comparisons in craniofacial muscles following therapy for head and neck pain. Med Electr 1988:106- 110.
  20. Gervais RO, Fitzsimmons GW, Thomas NR: Masseter and temporalis electromyographic activity in asymptomatic, subclinical and temporomandibular joint dysfunction patients. J Craniomandib Pract 1989; 7:52-57.
  21. Chong-Shan S, Hui-Yun W: Postural and maximum activity in elevators during mandible pre- and post-occlusal split treatment of temporomandibular joint disturbance syndrome. J Oral Rehabil 1989; 16:155-161.
  22. Chong-Shan S, Hui-Yun W: Value of EMG analysis of mandibular elevators in openclose- clench cycle to diagnosing TMJ disturbance syndrome. J Oral Rehabil 1989; 16:101-107.
  23. Shi CS. Proportionality of mean voltage of masseter muscle to maximum bite force applied for diagnosing temporomandibular joint disturbance syndrome. J Prosthet Dent 1989; 62(6):682-684.
  24. Harness DM, Donlon WC, Eversole LR: Comparison of clinical characteristics in myogenic, TMJ internal derangement and atypical facial pain patients. Clin J Pain 1990; 6(1):4-17.
  25. Choi J: A study on the effects of maximal voluntary clenching on the tooth contact points and masticatory muscle activities in patients with temporomandibular disorders. J Craniomandib Disord Facial Oral Pain 1992; 6:41-46.
  26. Kroon GW, Naeije M: Electromyographic evidence of local muscle fatigue in a subgroup of patients with myogenous craniomandibuthe postural activity of the anterior temporal and masseter muscles in young adults. J Oral Rehabil 1982; 9:419-425.
  27. Visser A, McCarroll RS, Oosting J, Naeije M: Masticatory electromyographic activity in healthy young adults and myogenous craniomandibular disorder patients. J Oral Rehabil 1994; 21(1):67-76.
  28. Abekura H, Kotani H, Tokuyama H, Hamada T: Asymmetry of masticatory muscle activity during intercuspal maximal clenching in healthy subjects and subjects with stomatognathic dysfunction syndrome. J Oral Rehabil 1995; 22(9):699-704.
  29. Erlandson PM, Poppen R: Electromyographic biofeedback and rest position training of masticatory muscles in myofascial pain-dysfunction patients. J Prosthet Dent 1998; 62:335-338.
  30. Liu ZJ, Yamagata K, Kasahara Y, Ito G: Electromyographic examination of jaw muscles in relation to symptoms and occlusion of patients with temporomandibular joint disorders. J Oral Rehabil 1999; 26(1):33-47.
  31. Pinho JC, Caldas FM, Mora MJ, Santana-Penín U: Electromyographic activity in patients with temporomandibular disorders. J Oral Rehabil 2000; 27(11):985-990.
  32. Alajbeg IZ, Valentic-Peruzovic M, Alajbeg I, Illes D: Influence of occlusal stabilization splint on the asymmetric activity of masticatory muscles in patients with temporomandibular dysfunction. Coll Antropol 2003; 27(1):361-371.
  33. Glaros AG, Burton E: Parafunctional clenching, pain, and effort in temporomandibular disorders. J Behav Med 2004; 27(1):91-100.
  34. Pallegama RW, Ranasinghe AW, Weerasinghe VS, Sitheeque MA: Influence of masticatory muscle pain on electromyographic activities of cervical muscles in patients with myogenous temporomandibular disorders. J Oral Rehabil 2004; 31(5):423-429.
  35. Bodéré C, Téa SH, Giroux-Metges MA, Woda A: Activity of masticatory muscles in subjects with different orofacial pain conditions. Pain 2005; 116(1-2):33-41.
  36. da Silva MA, Issa JP, Vitti M, da Silva AM, Semprini M, Regalo SC: Electromyographical analysis of the masseter muscle in dentulous and partially toothless patients with temporomandibular joint disorders. Electromyogr Clin Neurophysiol 2006; 46(5):263-268.
  37. Tosato Jde P, Caria PH: Electromyographic activity assessment of individuals with and without temporomandibular disorder symptoms. J Appl Oral Sci 2007; 15(2):152-155.
  38. Ries LG, Alves MC, Bérzin F: Asymmetric activation of temporalis, masseter, and sternocleidomastoid muscles in temporomandibular disorder patients. J Craniomandib Pract 2008; 26(1):59-64.
  39. Tartaglia GM, Moreira Rodrigues da Silva MA, Bottini S, Sforza C, Ferrario VF: Masticatory muscle activity during maximum voluntary clench in different research diagnostic criteria for temporomandibular disorders (RDC/TMD) groups. Man Ther 2008; 13(5):434-440.
  40. Bodéré C, Woda A: Effect of a jig on EMG activity in different orofacial pain conditions. Int J Prosthodont 2008; 21(3):253-258.
  41. Tecco S, Tetè S, D’Attilio M, Perillo L, Festa F: Surface electromyographic patterns of masticatory, neck, and trunk muscles in temporomandibular joint dysfunction patients undergoing anterior repositioning splint therapy. Eur J Orthod 2008; 30(6):592-597.
  42. Santana-Mora, U, Cudeiro J, Mora-Bermudez MJ, Rilo-Pousa B, Ferreira-Pinho JC, Otero- Cepeda JL, Santana-Penin U: Changes in EMG activity during clenching in chronic pain patients with unilateral temporomandibular disorders. J Electromyography and Kinesiology 2009; 19(6):e543-549.
  43. Ardizone I, Celemin A, Aneiros F, del Rio J, Sanchez T, Moreno I: Electromyographic study of activity of the masseter and anterior temporalis muscles in patients with temporomandibular joint (TMJ) dysfunction: comparison with the clinical dysfunction index. Med Oral Patol Oral Cir Bucal 2010; 15(1):e14-19.
  44. Botelho AL, Silva BC, Gentil FH, Sforza C, da Silva MA: Immediate effect of the resilient splint evaluated using surface electromyography in patients with TMD. J Craniomandib Pract 2010; 28(4):266-273.
  45. Hermens HJ, Boon KL, and Zilvold G: The clinical use of surface EMG. Medica Physica 1986; 9:119-
  46. Goldensohn E: Electromyography. In: Disorders of the temporomandibular joint. Lazlo Schwartz, ed. Philadelphia/London: W.B. Saunders Co., 1966:163-176.
  47. Lloyd AJ: Surface electromyography during sustained isometric contractions. J Applied Physiology 1971; 30(5):713-719.
  48. Burdette BH, Gale EN: Intersession reliability of surface electromyography. Journal of Dental Research, [Abstract No. 1370], Vol 66, 1987.
  49. Christensen LV: Reliability of maximum static work efforts by the human masseter muscle. Am J Orthod Dentofacial Orthop 1989; 95(1):42-45.
  50. Burdette BH, Gale EN: Reliability of surface electromyography of the masseteric and anterior temporal areas. Arch Oral Biol 1990; 35(9):747-751.
  51. Ferrario VF, Sforza C: Coordinating electromyographic activity of the human masseter and temporalis anterior muscles during mastication. Eur J Oral Sci 1996; 104(5-6): 511-517.
  52. Buxbaum J, Mylinski N, Parente FR: Surface EMG reliability using spectral analysis. J Oral Rehabil 1996; 23(11):771-775.
  53. Castroflorio T, Icardi K, Torsello F, Deregibus A, Debernardi C, Bracco P: Reproducibility of surface EMG in the human masseter and anterior temporalis muscle areas. J Craniomandib Pract 2005; 23(2):130-137.
  54. Castroflorio T, Icardi K, Becchino B, Merlo E, Debernardi C, Bracco P,Farina D: Reproducibility of surface EMG variables in isometric sub-maximal contractions of jaw elevator muscles. J Electromyogr Kinesiol 2006;16(5):498-505. Epub 2005 Nov 15.
  55. Castroflorio T, Bracco P, Farina D: Surface electromyography in the assessment of jaw elevator muscles. J Oral Rehabil 2008; 35(8):638-645. Epub 2008 May 9.
  56. De Felicio CM, Sidequersky FV, Tartagalia GM, Sforza C: Electromyographic standardized indices in healthy Brazilian young adults and data reproducibility. J Oral Rehabil 2009; 36(8):577-583. Epub 2009 Jun22

 Surface Electromyography of masticatory muscles together with electronic jaw tracking and joint vibration recording devices are clinically efficacious diagnostic aids for objective quantification of the physical components of Temporomandibular Disorders in patients screened for treatment. (1-17)

Reference Cluster 2: Surface EMG, Jaw Tracking, and Joint Vibration as Diagnostic Aids (1983–2006)

  1. Pantaleo, T., Prayer-Galletti, F., Pini-Prato, G., and Prayer-Galletti, S. An electromyographic study in patients with myofacial pain- dysfunction syndrome, Bulletin Group. Int. Rech. sc. Stomat. et Odont. 1983; 26:167- 179.
  2. Stohler, C., Yamada, Y., and Ash, M.M. Antagonistic muscle stiffness and associated behavior in the pain dysfunctional state. Helv Odont Acta 29:2,1985, in Schweiz. Mschr. Zahnmed. 95:719-13, 1985.
  3. Stohler, C., and Ash, M.M. Demonstration of chewing motor disorder by recording peripheral correlates of mastication. J Oral Rehab. Vol. 12 p 49- 57, 1985.
  4. Cooper, B.C., Alleva, M., Cooper, D., and Lucente, F.E. Myofacial pain dysfunction: Analysis of 476 patients. Laryngoscope 1986; 96:1099-1106.
  5. Nielsen I, Miller AJ. Response patterns of craniomandibular muscles with and without alterations in sensory feedback. J Prosthet Dent. 1988 Mar;59(3):352-62.
  6. Mongini, F., Tepia-Valenta, G., and Conserva, E. Habitual mastication in dysfunction: a computer-based analysis. J Prosthet. Dent. 1:484-494, 1989.
  7. Williamson, E.H., Hall, J.T., and Zwemer, J.D. Swallowing patterns in human subjects with and without temporomandibular dysfunction. Am J Orthod Dentofac Orthop. 98:507-511, 1990.
  8. Nielsen IL, McNeill C, Danzig W, Goldman S, Levy J, Miller AJ. Adaptation of craniofacial muscles in subjects with craniomandibular disorders. Am J Orthod Dentofacial Orthop. 1990 Jan;97(1):20-34.
  9. Kuwahara T, Miyauchi S, Maruyama T: Clinical classification of the patterns of mandibular movements during mastication in subjects with TMJ disorders. Int J Prosthodont 1992; 5(2):122-129.
  10. Tsolka P, Preiskel H. Kinesiographic and electromyographic assessment of the effects of occlusal adjustment therapy on craniomandibular disorders by a double-blind method. J Prosthet Dent 1993; 69:85-92.
  11. Kuwahara T, Bessette RW, Maruyama T: Chewing pattern analysis in TMD patients with unilateral and bilateral internal derangement. J Craniomandib Pract 1995; 13(3):167- 172.
  12. Tsolka P, Fenion M, McCullock A, Preiskel H. Controlled clinical, electromyographic and kinesiographic assessment of craniomandibular disorders in women. J Orofacial Pain 1994;8:80-9.
  13. Cooper B.  The role of bioelectric instrumentation in the documentation of management of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endo 1997; 83:1, 91-100
  14. Heffez L, Blaustein D: Advances in sonography of the temporomandibular joint. Oral Surg Oral Med Oral Pathol 1986; 62(5):486- 495.
  15. Gay T, Bertolami CN, Donoff RB, Keith DA, Kelly JP: The acoustical characteristics of the normal and abnormal temporomandibular joint. J Oral Maxillofac Surg 1987; 45(5): 397-407.
  16. Ishigaki S, Bessette RW, Maruyama T: A clinical study of temporomandibular joint (TMJ) vibrations in TMJ dysfunction patients. J Craniomandib Pract 1993; 11(1):7-13.
  17. Deng M, Long X, Dong H, Chen Y, Li X: Electrosonographic characteristics of sounds from   temporomandibular joint disc replacement. Int J Oral Maxillofac Surg 2006; 35(5):456-460.

Surface Electromyography, Jaw Tracking and Joint Vibration monitoring devices objectively document patient status, create objective milestones in planning treatment and document patient’s response to treatment. (1-20)

Reference Cluster 3: EMG, Jaw Tracking, and Joint Vibration for Objective Treatment Monitoring (1969–2017)

  1. Moller, E. Clinical electromyography in dentistry. Int. Dent. J 1969; 19:250-266.
  2. Kawazoe Y, Kotani H, Hamada T, Yamada S. Effect of occlusal splints on the electromyographic activities of masseter muscles during maximum clenching in patients with myofascial pain dysfunction syndrome. J Prosthet Dent l980; 43:578-80.
  3. Myslinski, N. R.., Buxbaum, J. D., and Parente, F. J. The use of electromyography to quantify muscle pain. Meth. and Find. Exptl. Clin. Pharmacol 1985; 7(10):551-556.
  4. Sheikholeslam, A., Holmgren, K., and Riise, C. A clinical and electromyographic study of the long-term effects of an occlusal splint on the temporal and masseter muscles in patients with functional disorders and nocturnal bruxism. Journal of Oral Rehabilitation 1986; 13:137-145.
  5. Jankelson, R.R. Analysis of maximal electromyographic activity of the masseter and anterior temporalis muscles in myocentric and habitual centric in temporomandibular joint and musculoskeletal dysfunction. Pathophysiology of Head and Neck Musculoskeletal Disorders. Bergimini M (ed), Front Oral Physiol. Basel, Karger, 7:83-98, 1990.
  6. Lynn, J.M. Craniofacial neuromuscular dysfunction vs. function: A comparison study of the condylar position and intro-articular space. Pathophysiology of Head and Neck Musculoskeletal Disorders. Bergamini M (ed) Front Oral Physiol. Basel, Karger Vol. 7, p 136-143, 1990.
  7. Coy RE, Flocken JE, Adib F. Musculoskeletal Etiology and Therapy of Craniomandibular Pain and Dysfunction. Cranio Clinics Intl 1991; 163-173.
  8. Lynn, J.M. and Mazzocco, M. Intraoral splint therapy: muscles objectively. Funct Orthodont. p 11-27 Nov/Dec 1991.
  9. Jankelson, R.R. Validity of surface electromyography as the “gold standard” for measuring muscle postural tonicity in TMD patients. Anthology of Craniomandibular Orthopedics Vol. II, ed. Coy, R. pp. 103-125, 1992.
  10. Lynn J, Mazzocco M, Miloser S, Zullo T. Diagnosis and Treatment of Craniocervical Pain and Headache based on Neuromuscular Parameters, American Journal of Pain Management 1992; 2:3, 143-151.
  11. Hickman DM, Cramer R, Stauber WT. The effect of four jaw relations on electromyographic activity in human masticatory muscles. Archs Oral Biol 1993; 38:3, 261-264.
  12. Hickman DM, Cramer R. The effect of different condylar positions on masticatory muscle electromyographic activity in humans. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86(1):2-3.
  13. Deng M, Long X, Dong H, Chen Y, Li X. Electrosonographic characteristics of sounds from temporomandibular joint disc replacement. Int J Oral Maxillofac Surg. 2006; 35(5):456-60. Epub 2006; 19.
  14. Widmalm SE, Lee YS, McKay DC: Clinical Use of Qualitative Electromyography in the Evaluation of Jaw Muscle Function: A Practitioner’s Guide. J Craniomandib Pract 2007; 25:1-11
  15. Hugger A, Hugger S, Schindler H. Surface electromyography of the masticatory muscles for application in dental practice. Current evidence and future developments. Int J Comput Dent 2008; 11(2):81-106.
  16. Cooper B, Kleinberg I. Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients. J Craniomandibular Practice, 2008; 26(2) 104-115.
  17. Cooper B.  The role of bioelectric instrumentation in the documentation of management of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endo 1997; 83:1, 91-100.
  18. Weggen H, Schindler H, Hugger A: Effects of myocentric vs. manual methods of jaw position recording in occlusal splint therapy – a pilot study. Journal of Craniomandibular Function 3 (2011), No. 3: 177-203.
  19. Weggen T, Schindler H, Kordass B, Hugger A: Clinical and electromyographic follow-up of myofascial pain patients treated with two types of oral splint: a randomized controlled pilot study.Int J Comput Dent. (2013), No.16 (3): 209-24.
  20. Ortu E, Pietropaoli D, Adib F, Masci C, Giannoni M, Monaco A: Electromyographic evaluation in children orthodontically treated for skeletal Class II malocclusion: Comparison of two treatment techniques. Cranio (2017) Nov No.16:1-7.

The Same Pattern Across Borders

The RCDSO 2018 Draft Guidelines dismissed EMG recording, jaw tracking, and sonography as diagnostic aids despite the existence of more than ninety peer-reviewed studies establishing the opposite. The pattern is not isolated. The AAOP’s 2019 application to the American Dental Association explicitly attacked the same instruments — surface EMG and jaw tracking — on pages 22 and 91 of that application, and the ADA approved the language when Orofacial Pain was recognized as a dental specialty on March 31, 2020. The Canadian regulatory dismissal and the American specialty codification are not coincidences. They are two regional expressions of the same institutional framework — a framework that has decided, contrary to sixty years of peer-reviewed evidence, that the bio-physiologic measurement of the masticatory system is not a legitimate part of dental practice. The structural and historical analysis of how this happened is examined in Dentistry Without Occlusion: A Profession Redefining Itself Out of Its Foundation →.

Frequently Asked Questions

What did the RCDSO 2018 Draft Guidelines say about diagnostic aids in TMD?

The Royal College of Dental Surgeons of Ontario’s 2018 Draft TMD Guidelines stated on Page 6 that the clinical value of a number of diagnostic aids in use had not been demonstrated in well-controlled and scientifically based studies, and they specifically named jaw tracking devices, EMG recording, and sonography (Doppler) as among these diagnostic aids. The statement implied that these instruments lacked sufficient evidence to support their clinical use.

How many peer-reviewed studies refute the RCDSO position?

This page documents three reference clusters totaling more than ninety peer-reviewed studies that establish: elevated resting EMG and asymmetrical functional EMG in TMD patients (cluster 1, 56 studies from 1957 to 2009), the clinical efficacy of EMG plus jaw tracking plus joint vibration as diagnostic aids (cluster 2, 17 studies from 1983 to 2006), and the use of these instruments for objective documentation of treatment response (cluster 3, 20 studies from 1969 to 2017). The RCDSO Draft Guidelines were issued in 2018 — well after the great majority of these studies were published.

What does sixty years of EMG research show in TMD patients?

A consistent finding across decades of peer-reviewed research is that TMD patients exhibit elevated resting EMG muscle activity, weak or asymmetrical functional EMG activity, reduced EMG during maximum voluntary clenching, and a shift to lower frequencies of the mean/median power frequency of the EMG power spectrum. These findings are documented from Perry’s 1957 study through more recent investigations in 2008 and 2009. The pattern is not a single laboratory’s claim — it is a consistent, replicated finding across multiple research groups, languages, and continents over more than half a century.

What does the science of jaw tracking and joint vibration recording show?

The peer-reviewed literature on electronic jaw tracking and joint vibration analysis (electrosonography or ESG) documents that these devices produce objective, reproducible measurements of mandibular movement and joint sound conditions that correlate with TMD symptoms and treatment response. The Cooper 1997 study examined 3,681 TMD patients and 1,182 treated cases. The Cooper-Kleinberg 2008 study documented overwhelming symptom relief in 313 TMD patients treated with neuromuscular orthosis therapy guided by these instruments. The combined evidentiary base is one of the largest in chronic pain research.

How does the RCDSO position relate to the broader institutional pattern?

The RCDSO 2018 Draft Guidelines reflect the same pattern that produced the AAOP’s 2019 specialty application to the ADA — dismissing FDA-cleared objective neuromuscular instrumentation despite published evidence. The framework is not American or Canadian; it is a posture organized dentistry has assumed across multiple regulatory bodies. The structural analysis is examined in Dentistry Without Occlusion: A Profession Redefining Itself Out of Its Foundation →.

What does Part 1 of this series cover?

Part 1 of Refuting TMD Guideline Misconceptions about NM Occlusion addresses the RCDSO 2018 Draft Guidelines’ dismissal of neuromuscular occlusion specifically — including the claim that EMG produces inconsistent findings and that there is insufficient evidence for TENS-guided splint therapy. Part 1 cites four foundational peer-reviewed studies that establish the clinical efficacy of NM occlusion. Read Part 1 →

Continued Learning

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Last Updated: May 7, 2026

Written by Clayton A. Chan, D.D.S. — Founder and Director, Occlusion Connections | Las Vegas, Nevada

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