Identification and assessment of factors contributing to variability of the jaw jerk

Reflex control of human jaw muscles

The aim of this review is to discuss what is known about the reflex control of the human masticatory system and to propose a method for standardized investigation. Literature regarding the current knowledge of activation of jaw muscles, receptors involved in the feedback control, and reflex pathways is discussed. The reflexes are discussed under the headings of the stimulation conditions. This was deliberately done to remind the reader that under each stimulation condition, several receptor systems are activated, and that it is not yet possible to stimulate only one afferent system in isolation in human mastication experiments. To achieve a method for uniform investigation, we need to set a method for stimulation of the afferent pathway under study with minimal simultaneous activation of other receptor systems. This stimulation should also be done in an efficient and reproducible way. To substantiate our conviction to standardize the stimulus type and parameters, we discuss the advantages and disadvantages of mechanical and electrical stimuli. For mechanical stimulus to be delivered in a reproducible way, the following precautions are suggested: The stimulus delivery system (often a probe attached to a vibrator) should be brought into secure contact with the area of stimulation. To minimize the slack between the probe, the area to be stimulated should be taken up by the application of pre-load, and the delivered force should be recorded in series. Electrical stimulus has advantages in that it can be delivered in a reproducible way, though its physiological relevance can be questioned. It is also necessary to standardize the method for recording and analyzing the responses of the motoneurons to the stimulation. For that, a new technique is introduced, and its advantages over the currently used methods are discussed. The new method can illustrate the synaptic potential that is induced in the motoneurons without the errors that are unavoidable in the current techniques. We believe that once stimulation, recording, and analysis methods are standardized, it will be possible to bring out the real "wiring diagram" that operates in conscious human subjects.

Depression of an inhibitory reflex, the masseteric silent period, in recovering alcoholics

Because inhibitory deficits may contribute to motor incoordination of alcoholics, we proposed that the duration of the masseteric silent period (SP), an inhibitory reflex, might be shorter in alcoholics (ALs) than in nonalcoholics (NAs). To test this hypothesis, we measured the SP in a racially mixed group of 12 ALs and 12 NAs matched for age (31-49 years) and sex. All subjects were normotensive, had full dentition, and reported no major medical problems. Sensory and motor conduction velocities of the anterior tibialis, ulnar, and medial nerves were measured for each subject, and were not different in ALs and NAs. Jaw jerk and SP were evoked by tapping the chin manually with a rubber hammer containing a circuit to trigger the oscilloscope display of the masseter EMGs. Averaged mean latencies and durations of the SPs were not significantly different between the right and left masseters. SP latencies were significantly (0.7 msec) shorter in ALs than NAs (p < 0.01). The mean SP duration for ALs (13.9 +/- 1.6 msec) was also significantly shorter than that of the NAs (24.4 +/- 2.4 msec; p < 0.001). Results support the hypothesis that chronic alcoholism may interfere with inhibitory mechanisms in the CNS.

A method for standardization of silent period measurements in human masseter muscle

The effect of bite force and stimulus intensity on the electrically induced SP has been studied. The results from the present study and earlier investigations suggest that the following guidelines should be used in future SP studies. (i) The electrical rather than mechanical way of stimulation should be preferred since the stimulus parameters and the receptors stimulated can easily be determined. (ii) The sensory perception threshold (T) of subjects should be used when studying and comparing the SP between individuals rather than the actual values of the electrical stimulation since the value of the sensory perception threshold varies from subject to subject. (iii) Rectified and averaged EMG records should be used rather than single raw traces since it is not possible to measure the duration of SPs from single traces. (iv) The subject should be asked to perform 25% of his/her MBF and the BF should be given as a feedback. (v) A stimulus intensity of about 6T should be used so that small changes in the BF would not affect the SPD. (vi) A jaw separation of about 10 mm should be selected in the subjects with normal overjet (2-3 mm), this being slightly thicker than the average isometric force transducer. The transducer can be brought to this thickness using acrylic resin. (vii) A head rest should be used to keep the head position constant (and hence constant jaw position with respect to the transducer) since the head position alone may change the reflexes elicited in the jaws region.

Phasic stretch reflex of the abdominal muscles

This analysis of the abdominal stretch reflex (ASR) evoked by a tap to the abdomen was designed to explore how abdominal motoneurons process signals from respiratory and nonrespiratory sources. We recorded surface EMGs from the external and internal oblique muscles in standing subjects. Amplitudes of the abdominal stretch reflex varied despite constant tap forces, but strong taps evoked a larger reflex than weak taps. Trunk rotation toward the recording side, or voluntary contraction of the external and internal oblique muscles increased the reflex amplitudes, whereas contralateral rotation reduced their occurrence. An abdominal stretch reflex during a voluntary contraction was followed by a silent period of 40 to 80 ms. Often a late wave followed a reflex by 20 to 40 ms. Amplitudes during breathholds at residual lung volume were larger than those evoked during a breathhold at functional residual capacity, suggesting that abdominal stretch reflex amplitudes are inversely proportional to static lung volume. During quiet breathing the reflex amplitude reached a maximum slightly before end-expiration and decreased progressively to a minimum close to end-inspiration. During rebreathing, background abdominal activity was augmented with highest activity in late expiration. Abdominal stretch reflex amplitudes continued to wax and wane in phase with respiration, and the maximal reflex occurred progressively earlier in expiration. In summary, the abdominal stretch reflex reflects strong control from abdominal muscle spindles, lung proprioceptors, and chemoreceptors. The relative contributions of these inputs need to be determined.

Real-time analysis of electromyograms in clinical dentistry

A neurophysiologic real-time data acquisition and analysis system with a versatile hardware/software combination to be applied in clinical dentistry is introduced. Its application in the clinical environment allowed the analysis of jaw reflexes and the generation of a hard copy output in approximately 3 1/2 minutes. Such a system may provide the basis for advanced diagnostics in dentistry.

Effects of whole-body rotation on masseteric motoneuron excitability

Vestibular stimulation is a popular clinical treatment for enhancing the excitability of spinal motoneurons innervating trunk and limb muscles, but whether vestibular stimulation can also influence trigeminal motoneurons is not known. We determined whether or not vestibular stimulation evoked by rotation of a seated subject would modify the excitability of masseteric motoneurons. The amplitude and frequency of occurrence of masseteric compound action potentials evoked by standard chin taps provided measures for assessing masseteric motoneuron excitability. Eleven healthy adults with no orofacial or otologic disorders served as subjects. Each sat in a motorized dental chair with his head stabilized by a halo head-piece so that chair rotation caused labyrinthine excitation. The frequency (3/s) of chin taps and their impact force were maintained constant by microcomputer control. After each tap, a 16-ms sample of EMG recorded from surface electrodes over the right masseter was digitized and stored for subsequent visual inspection. Only compound action potentials meeting rigorous criteria in terms of latency, amplitude, duration, and waveform were accepted as responses. The mean frequencies of occurrence and the mean amplitudes of the responses showed wide variability. Histogram displays of every response for each subject, however, revealed enhanced output from the masseteric motoneuron pool during the decleration and postrotation phases. In subjects not immediately retested this enhancement was persistent but decayed during the next 5 min. In five subjects the experiment was repeated after 1 min. The changes in response variables during phases 3 and 4 were significantly less than on the first trial, suggesting habituation. These results provide quantitative evidence that the dynamic input from vestibular ampullary receptors in response to rotation enhances masseteric motoneuron output.

The effect of stimulus intensity and gape on electrically-evoked jaw reflexes in man

The changes in masseter EMG and biting force evoked by electrical stimulation of the lip were measured in normal people. Stimulation at noxious intensities elicited a characteristic, biphasic inhibitory response in the masseter EMG and a transient reduction in the biting force. The pattern of masseter inhibition and force change varied both with stimulus intensity and with inter-incisal separation. In general, the decrease in biting force was greater at intermediate jaw positions than in the open and closed positions. The duration of the EMG inhibitory period increased as the stimulus intensity increased but was independent of the jaw separation. Reflex thresholds could not be correlated with pain thresholds because subjects found it difficult to decide at what level an electrical stimulus became painful. Nevertheless this stimulation of high-threshold afferents may be useful in estimating the rate of relaxation of tension in the jaw muscles.