Chronic daily headache: suggestion for the neuromuscular oral therapy

Effects of an intraoral device (IOD) on electromyographic activity on the masseter and temporal muscles in Class III patients

OBJECTIVE

Class III malocclusion is characterized by a loss of vertical dimension associated with muscle imbalance. The present study was designed to determine electromyographic amplitude changes in temporal (T) and masseter (M) at rest and during clenching in Class III patients treated with an intraoral device (IOD) over a 24-hour period for 30 days with transcutaneous electrical nerve stimulation (TENS).

METHODS

Twelve patients with Class III (mean age 27.7 ± 1.2 years) were treated with TENS and IOD. Ten untreated patients composed the control group. Data were analyzed using Wilcoxon test and ANOVA.

RESULTS

Patients treated with TENS and IOD showed a marked decrease in hyperactivity of M and T at rest (p = 0.001) and an increase during clenching (p = 0.001). The control group maintained similar activity in both positions.

CONCLUSION

This study confirms that using TENS and IOD in patients improves muscle activity of T and M.

Predictive role of gnathological techniques for the treatment of persistent idiopathic facial pain (PIFP)

INTRODUCTION/BACKGROUND

Persistent idiopathic craniofacial pain (PIFP) is a heterogeneous group of pain syndromes whose main characteristic is the daily presence of persistent pain for at least 3 months. The pathophysiology of PIFP is still not entirely known and probably related to biological and psychological factors. Although PIFP has been attributed to the central neuron activity, the importance of masticatory muscles as a possible pathogenic mechanism was recently demonstrated. The main purpose of our paper was to identify the physiological rest position of the mandible with minimal tonus of both the elevator and depressor muscles and the neuromuscular trajectory of mouth closing obtained by transcutaneous electrical stimulation (TENS) and maintained with the use of an occlusal device, known as orthotic.

MATERIALS AND METHODS

The VAS scale for facial pain and the migraine disability assessment score (MIDAS) index for patient quality of life were evaluated at the beginning of the study for the 38 subjects that came to our attention. Our research included two phases. The first phase consisted of kinesiographic and electromyographic (EMG) examinations of the masticatory muscles and a 45-min application of TENS in order to deprogram the muscular activity. Kinesio-electromyographic examinations were repeated in the second phase. The main evaluated parameter was jaw deflection or deviation on the sagittal and frontal planes before and after TENS during patient tooth occlusion. Patients that showed a significant modification of this parameter were treated with orthotics for 12 months.

RESULTS

The results of a 12-month follow-up show a sharp reduction of the VAS (pre-orthotic 9.05, range 8-10, SD 0.8; post-orthotic 5.87, range 1-5, SD 0.7) and an improvement in the quality of life (MIDAS).

CONCLUSIONS

Our study demonstrated the usefulness of TENS as a screening method for the application of orthotics. This non-invasive and/or non-painful procedure could be a useful complementary treatment in this patient population. The results of the study also confirm the role of masticatory muscle dynamics as a possible pathogenic mechanism in patients with PIFP.

Usefulness of an occlusal device in the treatment of medication overuse headache and persistent idiopathic facial pain: preliminary results

There is a debate in literature about the therapeutic usefulness of oral devices in patients suffering from Medication Overuse Headache (MOH) or in patients suffering from Persistent Idiopathic Facial Pain (PIFP). From the case histories of 3356 patients, referred to us with a diagnosis of chronic craniofacial pain for assessment of the eventual application of an occlusal device to correct an impaired neuromuscular relationship between the mandible and the maxilla, we selected, following the criteria of the International Classification of Headache Disorders (ICHD-3beta), two groups of patients suffering from MOH and PIFP. All patients of the two groups underwent a Kinesiographic exam and an EMG to evaluate the freeway space (FWS). Patients presenting an impaired FWS were placed in treatment with the application of an occlusal device. At the follow-up after 6 months and after 1 year, we found a significant decrease in pain with regard to the intensity resulting in the reduction of clinical disability. The preliminary data collected using the VAS scale and the MIDAS questionnaire confirm that the neuromuscular cranio-mandibular system can have an important role in the diagnostic process of the MOH and the PIFP, suggesting the usefulness of treatment with an occlusal device, where there is adequate FWS.

An assessment of the usefulness of Kinesiograph as an aid in the diagnosis of TMD: a review of Manfredini et al.'s studies

AIM

Performing a literature review of publications by Dr. Manfredini et al. related to their temporomandibular joint (TMJ) injection therapy outcome with conclusions on the clinical utility of computerized measurement devices used in the management of temporomandibular disorders (TMDs). In addition, reviewing their published opinion on an occlusion: TMD versus a biopsychosocial paradigm for TMD. Manfredini et al. authored an article published in the Journal of the American Dental Association (JADA) 2013, "An Assessment of the usefulness of jaw kinesiography in monitoring temporomandibular disorders," the most recent of 12 articles. In all studies, subjects received TMJ injections with an objective measurement outcome criterion; increased maximum mouth opening (MMO) and subjective symptom improvement of pain and chewing function. In the 2013 JADA article, the Mandibular Kinesiograph, referred to as KG, measured MMO before and after therapy. In 11 prior articles, all subject groups with limited mouth opening exhibited very significant increased MMO post-treatment, documenting treatment success using the same 2013 protocol. The 2013 study showed a 1·1 mm improved MMO, described as insignificant. The authors did not critique or explain the aberrant, skewed 2013 outcome data contrasted with their prior studies, which showed overwhelmingly significant increased MMO. Instead, they concluded that the MMO recording device was clinically useless. This motivated a literature review of the authors' TMD publications.

CONCLUSION

The publications by Manfredini et al. recognized proponents of the psychosocial model of TMD, including the 2013 article, appear to be part of a campaign denying an occlusion: TMD relationship and disparaging the specific computerized measurement devices and the dentists using them in the management of their TMD patients using neuromuscular occlusion dental treatment.

The effects of ULF-TENS stimulation on gnathology: the state of the art

AIMS

The aim of this study was to evaluate the state of the art in the current literature regarding the effect of ultra low frequency-transcutaneous electrical nerve stimulation (ULF-TENS) on patients with temporomandibular disorders (TMD).

METHODOLOGY

The authors reviewed the literature through a thorough manual and electronic research on PubMed database (using the Medical Subject Headings thesaurus) and subsequent analysis of all the found papers regarding the effect of TENS on TMD patients. No randomized controlled trials on the investigated topic were found. Only eight papers regarding controlled clinical trials (CCT) were selected according to the search strategy selection criteria.

RESULTS

According to the available literature and the authors' experience, ULF-TENS seems to be a valid support in the management of TMD patients, but also a 'provocative' tool, so its application should always be monitored by electromyographic and electrognathographic analysis (before and after TENS).

CONCLUSIONS

Further clinical studies (mainly randomized controlled trials) on ULF-TENS application in neuromuscular gnathology are needed.