Antero-posterior activity changes in the superficial masseter muscle after exposure to experimental pain

Experimental pain and fatigue induced by excessive chewing

Background

The study was aiming to optimize excessive gum chewing as an experimental model to induce jaw muscle pain and fatigue similar to those in painful TMDs with durations that would allow immediate investigations of jaw-motor function. Further, if any sex differences would be detected in the expression of pain.

Methods

This randomized, double blinded study included 31 healthy participants of both sexes. A standardized chewing protocol of either 40- or 60-min of chewing was used with a wash-out period of 1 week. Subjective fatigue, pain characteristics and functional measures were assessed. For statistical analyses, Wilcoxon Signed Rank test, Mann–Whitney Rank Sum test and Friedman’s ANOVA with Tukey post-hoc test were used.

Results

High subjective fatigue scores that lasted up to 20 min after the end of the trial were significantly induced both in the 40- and 60-min chewing trials (P <  0.001*). Significant but mild pain was induced only in the 60-min trial (P = 0.004*) and only in men (P = 0.04*). Also, the induced pain area was significantly bigger in the 60-min trial (P = 0.009*). However, this increase in pain and pain area did not last to the first 10-min follow-up. There were no significant differences neither between the 40- and 60-min chewing trials, except regarding the pain area (P = 0.008*), nor between the sexes.

Conclusion

Taken together, excessive chewing in its current form does not seem to be a proper pain experimental model. The model needs further adjustments in order to mimic TMD-pain especially in women and to prolong the pain duration.

Reorganization of motor unit activity at different sites within the human masseter muscle during experimental masseter pain

The aims were to test the hypotheses that experimental masseter muscle pain leads to recruitment and/or derecruitment of motor units at different sites within the masseter and that the patterns of change in motor unit activity differ between sites. Single motor unit (SMU) activity was recorded at two sites within the right masseter [superior/anterior, inferior/posterior (IP)] during isometric biting tasks (ramp, step level) on an intraoral force transducer in 17 participants during three experimental blocks comprising no infusion (baseline), 5% hypertonic saline infusion (pain), or isotonic saline infusion (control). A visual analog scale (VAS) was used to score pain intensity. The VAS scores were statistically significantly greater during infusion of hypertonic saline than during infusion of isotonic saline. No significant differences in force levels and rates of force change were found between experimental blocks. In comparison with isotonic saline infusion, SMUs could be recruited and derecruited at both sites during hypertonic saline infusion. The frequency of recruitment or derecruitment, in comparison with no change, was statistically significantly greater at the IP site than at the superior/anterior site. Experimental noxious masseter stimulation results in a reorganization of motor unit activity throughout the muscle, and the pattern of reorganization may be different in different regions of the muscle.

The influence of induced shoulder muscle pain on rotator cuff and scapulothoracic muscle activity during elevation of the arm

BACKGROUND

Altered recruitment of rotator cuff and scapulothoracic muscles has been identified in patients with subacromial impingement syndrome. To date, however, the cause-consequence relationship between pain and altered muscle recruitment has not been fully unraveled.

METHODS

The effect of experimental shoulder pain induced by injection of hypertonic saline in the supraspinatus on the activity of the supraspinatus, infraspinatus, subscapularis, trapezius, and serratus anterior activity was investigated during the performance of an elevation task by use of muscle functional magnetic resonance imaging in 25 healthy individuals. Measurements were taken at 4 levels (C6-C7, T2-T3, T3-T4, and T6-T7) at rest and after the elevation task performed without and with experimental shoulder pain.

RESULTS

During arm elevation, experimentally induced pain caused a significant activity reduction, expressed as reduction in T2 shift of the IS (P = .029). No significant changes in T2 shift values were found for the other rotator cuff muscles or the scapulothoracic muscles.

CONCLUSIONS

This study demonstrates that acute experimental shoulder pain has an inhibitory effect on the activity of the IS during arm elevation. Acute experimental shoulder pain did not seem to influence the scapulothoracic muscle activity significantly. The findings suggest that rotator cuff muscle function (infraspinatus) should be a consideration in the early management of patients with shoulder pain.

Small vertical changes in jaw relation affect motor unit recruitment in the masseter

Strategies for recruitment of masseter muscle motor units (MUs), provoked by constant bite force, for different vertical jaw relations have not previously been investigated. The objective of this study was to analyse the effect of small changes in vertical jaw relation on MU recruitment behaviour in different regions of the masseter during feedback-controlled submaximum biting tasks. Twenty healthy subjects (mean age: 24·6 ± 2·4 years) were involved in the investigation. Intra-muscular electromyographic (EMG) activity of the right masseter was recorded in different regions of the muscle. MUs were identified by the use of decomposition software, and root-mean-square (RMS) values were calculated for each experimental condition. Six hundred and eleven decomposed MUs with significantly (P < 0·001) different jaw relation-specific recruitment behaviour were organised into localised MU task groups. MUs with different task specificity in seven examined tasks were observed. The RMS EMG values obtained from the different recording sites were also significantly (P < 0·01) different between tasks. Overall MU recruitment was significantly (P < 0·05) greater in the deep masseter than in the superficial muscle. The number of recruited MUs and the RMS EMG values decreased significantly (P < 0·01) with increasing jaw separation. This investigation revealed differential MU recruitment behaviour in discrete subvolumes of the masseter in response to small changes in vertical jaw relations. These fine-motor skills might be responsible for its excellent functional adaptability and might also explain the successful management of temporomandibular disorder patients by somatic intervention, in particular by the use of oral splints.

Static balancing behaviour of the mandible

The objective of this study was to investigate the mechanisms of physiological control of the craniomandibular system during force-controlled biting: in intercuspation, restricted by predetermined anatomic-geometrical conditions [i.e. biting in intercuspation (BIC)]; and on a hydrostatic system [i.e. auto-balanced static equilibrium of the mandible (BAL)], in which the mandible is balanced under unrestricted occlusal conditions. For 20 healthy subjects, the spatial positions of the condyles, the lower molars, and the incisal point were measured, and the electromyographic (EMG) activity of the musculus masseter and musculus temporalis anterior were recorded bilaterally, during force-controlled biting (50, 75, 100 N) on a hydrostatic device. The results were compared with those obtained during BIC. During BAL, the neuromuscular system stabilizes one condyle, so it behaves as a virtual fulcrum, and all available biomechanical degrees of freedom of the opposite side are used to achieve a bilaterally equal vertical distance between the upper and lower dental arches. The variability of the positions of the molars was significantly smaller than for the condyles. The EMG co-contraction ratios calculated for homonymous muscle regions revealed significant differences between BIC and BAL, specifically, greater symmetry during BAL with substantial asymmetry of approximately 25% remaining. In conclusion, the results revealed precise neuromuscular control of the position of the lower dental arch; this information might form the basis for interference-free tracking of the mandible in intercuspation under different conditions.

Precision of jaw-closing movements for different jaw gaps

Jaw-closing movements are basic components of physiological motor actions precisely achieving intercuspation without significant interference. The main purpose of this study was to test the hypothesis that, despite an imperfect intercuspal position, the precision of jaw-closing movements fluctuates within the range of physiological closing movements indispensable for meeting intercuspation without significant interference. For 35 healthy subjects, condylar and incisal point positions for fast and slow jaw-closing, interrupted at different jaw gaps by the use of frontal occlusal plateaus, were compared with uninterrupted physiological jaw closing, with identical jaw gaps, using a telemetric system for measuring jaw position. Examiner-guided centric relation served as a clinically relevant reference position. For jaw gaps ≤4 mm, no significant horizontal or vertical displacement differences were observed for the incisal or condylar points among physiological, fast, and slow jaw-closing. However, the jaw positions under these three closing conditions differed significantly from guided centric relation for nearly all experimental jaw gaps. The findings provide evidence of stringent neuromuscular control of jaw-closing movements in the vicinity of intercuspation. These results might be of clinical relevance to occlusal intervention with different objectives.

Successful therapy for temporomandibular pain alters anterior insula and cerebellar representations of occlusion

AIM

Craniomandibular disorders (CMD) are widespread, but we know little about the cerebral representations associated with this pain syndrome and nothing about changes in cerebral representations of occlusion induced by common therapy approaches.

METHODS

In a longitudinal therapy study, we applied functional magnetic resonance imaging (fMRI) in 14 patients with mild CMD during occlusal movements. fMRI, pain scoring, kinematic investigations of occlusal movements, and jaw muscle electromyography (EMG) were measured before and after two weeks of therapy with an individually optimized Michigan splint.

RESULTS

The patients' subjective pain ratings decreased, and the symmetry of condylar movements increased over the period of therapy. After therapy, EMG of the jaw muscles demonstrated more relaxed resting conditions and increased activity during maximal occlusion. fMRI during occlusion showed an activation decrease in the right anterior insula and right cerebellum over the course of therapy. Correlation analysis between pain score and fMRI activation decreases identified right anterior insula, left posterior insula and left cerebellar hemisphere. Left cerebellar and right primary motor activation magnitude was negatively associated with symmetry of the condylar movements.

CONCLUSIONS

Our findings highlight the impact of the anterior insula for the internal monitoring and the anticipation of temporomandibular joint (TMJ) pain. In addition, an increase of symmetry of condylar movements after therapy has been associated with a decrease of activation magnitude in primary motor and cerebellar regions.

[Clinical management of masticatory muscle pain: an update of the recommendations]

Besides the different forms of odontalgia, myalgias of the masticatory muscles are the most frequent noninfectious complaints in the orofacial region. After summarizing the recommendations set forth by the Interdisciplinary Working Group of Orofacial Pain within the German Chapter of the IASP (German Pain Society), we present the current state of knowledge regarding the etiology, diagnosis, and therapeutic options, based on an extensive literature search. A systematic literature search was carried out in PubMed, the Cochrane Library, and the database of the Deutsche Zahnärztliche Zeitschrift. The results corroborate our previous recommendations that for the majority of patients pain reduction or pain relief can be achieved with noninvasive, reversible methods. Short- and long-term trials have added more evidence to the fact that different therapeutic measures have similar efficacy. In patients with chronic myalgias of the jaw muscles, involvement of a psychotherapist is crucial. Patient education, oral appliances, physiotherapeutic exercises, and acupuncture are recommended therapeutic measures, while physical therapy, pharmacotherapy, and psychological therapy received a limited recommendation.

Comparison of immediate complete denture, tooth and implant-supported overdenture on vertical dimension and muscle activity

PURPOSE

To compare the changes in the occlusal vertical dimension, activity of masseter muscles and biting force after insertion of immediate denture constructed with conventional, tooth-supported and Implant-supported immediate mandibular complete denture.

MATERIALS AND METHODS

Patients were selected and treatment was carried out with all the three different concepts i.e, immediate denture constructed with conventional (Group A), tooth-supported (Group B) and Implant-supported (Group C) immediate mandibular complete dentures. Parameters of evaluation and comparison were occlusal vertical dimension measured by radiograph (at three different time intervals), Masseter muscle electromyographic (EMG) measurement by EMG analysis (at three different positions of jaws) and bite force measured by force transducer (at two different time intervals). The obtained data were statistically analyzed by using ANOVA-F test at 5% level of significance. If the F test was significant, Least Significant Difference test was performed to test further significant differences between variables.

RESULTS

Comparison between mean differences in occlusal vertical dimension for tested groups showed that it was only statistically significant at 1 year after immediate dentures insertion. Comparison between mean differences in wavelet packet coefficients of the electromyographic signals of masseter muscles for tested groups was not significant at rest position, but significant at initial contact position and maximum voluntary clench position. Comparison between mean differences in maximum biting force for tested groups was not statistically significant at 5% level of significance.

CONCLUSION

Immediate complete overdentures whether tooth or implant supported prosthesis is recommended than totally mucosal supported prosthesis.

Persistent orofacial muscle pain

The pathophysiology of persistent orofacial myalgia has been the centre of much controversy. In this article we suggest a novel descriptive term; 'persistent orofacial muscle pain' (POMP) and review current evidence that supports the hypothesis that the induction of POMP involves the interplay between a peripheral nociceptive source in muscle, a faulty central nervous system component and decreased coping ability. In this context it is widely accepted that a complex interaction of variable intrinsic and extrinsic factors act to induce POMP and dysfunction.

Electromyographic standardized indices in healthy Brazilian young adults and data reproducibility

The determination of normal parameters is an important procedure in the evaluation of the stomatognathic system. We used the surface electromyography standardization protocol described by Ferrario et al. (J Oral Rehabil. 2000;27:33-40, 2006;33:341) to determine reference values of the electromyographic standardized indices for the assessment of muscular symmetry (left and right side, percentage overlapping coefficient, POC), potential lateral displacing components (unbalanced contractile activities of contralateral masseter and temporalis muscles, TC), relative activity (most prevalent pair of masticatory muscles, ATTIV) and total activity (integrated areas of the electromyographic potentials over time, IMPACT) in healthy Brazilian young adults, and the relevant data reproducibility. Electromyography of the right and left masseter and temporalis muscles was performed during maximum teeth clenching in 20 healthy subjects (10 women and 10 men, mean age 23 years, s.d. 3), free from periodontal problems, temporomandibular disorders, oro-facial myofunctional disorder, and with full permanent dentition (28 teeth at least). Data reproducibility was computed for 75% of the sample. The values obtained were POC Temporal (88.11 +/- 1.45%), POC masseter (87.11 +/- 1.60%), TC (8.79 +/- 1.20%), ATTIV (-0.33 +/- 9.65%) and IMPACT (110.40 +/- 23.69 microV/microV.s %). There were no statistical differences between test and retest values (P > 0.05). The Technical Errors of Measurement (TEM) for 50% of subjects assessed during the same session were 1.5, 1.39, 1.06, 3.83 and 10.04. For 25% of the subjects assessed after a 6-month interval, the TEM were 0.80, 1.03, 0.73, 12.70 and 19.10. For all indices, there was good reproducibility. These electromyographic indices could be used in the assessment of patients with stomatognathic dysfunction.

Synergist coactivation and substitution pattern of the human masseter and temporalis muscles during sustained static contractions

OBJECTIVE

Previous reports indicated that between-muscle substitution of active motor unit pools can be found in a variety of synergist muscles, including shoulder and leg muscles, but little information is available for the masticatory muscles. We hypothesized that, during a prolonged clenching effort performed at low- to moderate-bite force levels, a substitution pattern of activity can be found also in the masseter and anterior temporal muscles.

METHODS

Ten healthy volunteers were recruited and were asked to clench unilaterally on a force transducer for 10min at 10%, 15%, and 20% of the maximum bite force. During each session, bite force, perceived muscle pain and electromyographic activity were continuously assessed. Data analyses were performed by means of cross-correlation and periodogram analyses.

RESULTS

During sustained static contractions, different contraction patterns of jaw elevator muscles could be identified. These included a coactivation pattern, a substitution pattern, and several intermediate situations between coactivation and substitution.

CONCLUSIONS

The findings support the concept that the masticatory muscles are functionally heterogeneous and provide evidence that the neuromuscular strategies used by the masticatory system to perform sustained static contractions differ between individuals.

SIGNIFICANCE

Individual neuromuscular strategies might play a role in the development of masticatory muscle pain conditions.

The NTI-tss device for the therapy of bruxism, temporomandibular disorders, and headache - where do we stand? A qualitative systematic review of the literature

BACKGROUND

The NTI-tss device is an anterior bite stop, which, according to the manufacturer, is indicated for the prevention and treatment of bruxism, temporomandibular disorders (TMDs), tension-type headaches, and migraine. The aim of this systematic review was to appraise the currently available evidence regarding the efficacy and safety of the NTI-tss splint.

METHODS

We performed a systematic search in nine electronic databases and in NTI-tss-associated websites (last update: December 31, 2007). The reference lists of all relevant articles were perused. Five levels of scientific quality were distinguished. Reporting quality of articles about randomized controlled trials (RCTs) was evaluated using the Jadad score. To identify adverse events, we searched in the identified publications and in the MAUDE database.

RESULTS

Nine of 68 relevant publications reported about the results of five different RCTs. Two RCTs concentrated on electromyographic (EMG) investigations in patients with TMDs and concomitant bruxism (Baad-Hansen et al 2007, Jadad score: 4) or with bruxism alone (Kavakli 2006, Jadad score: 2); in both studies, compared to an occlusal stabilization splint the NTI-tss device showed significant reduction of EMG activity. Two RCTs focused exclusively on TMD patients; in one trial (Magnusson et al 2004, Jadad score: 3), a stabilization appliance led to greater improvement than an NTI-tss device, while in the other study (Jokstad et al 2005, Jadad score: 5) no difference was found. In one RCT (Shankland 2002, Jadad score: 1), patients with tension-type headache or migraine responded more favorably to the NTI-tss splint than to a bleaching tray. NTI-tss-induced complications related predominantly to single teeth or to the occlusion.

CONCLUSION

Evidence from RCTs suggests that the NTI-tss device may be successfully used for the management of bruxism and TMDs. However, to avoid potential unwanted effects, it should be chosen only if certain a patient will be compliant with follow-up appointments. The NTI-tss bite splint may be justified when a reduction of jaw closer muscle activity (e.g., jaw clenching or tooth grinding) is desired, or as an emergency device in patients with acute temporomandibular pain and, possibly, restricted jaw opening.

Surface electromyography in the assessment of jaw elevator muscles

Surface electromyography (EMG) allows the non-invasive investigation of the bioelectrical phenomena of muscular contraction. The clinical application of surface EMG recordings has been long debated. This paper reviews the main limitations and the current applications of the surface EMG in the investigation of jaw elevator muscles. Methodological factors associated with the recording of the surface EMG may reduce the reliability and sensitivity of this technique and may have been the cause of controversial results reported in different studies. Despite these problems, several clinical applications of surface EMG in jaw muscles are promising. Moreover, technological advances in signal detection and processing have improved the quality of the information extracted from the surface EMG and furthered our understanding of the anatomy and physiology of the stomatognathic apparatus.

The lateral pterygoid muscle, a heterogeneous unit implicated in temporomandibular disorder: a literature review

Based on its anatomical relationships, the lateral pterygoid muscle is strongly linked with the temporomandibular joint (TMJ). It plays a major role in mastication. Embryological, histological, and anatomical knowledge define the lateral pterygoid muscle as a single muscle with a penniform structure. The various results of electromyographic (EMG) studies describe a complex physiology with a chronological contraction of the layers during the masticatory cycle. The sequential contraction of the layers of the lateral pterygoid muscle is the result of a selective neuronal activation induced by the masticatory Central Pattern Generator (mCPG). This neurophysiological theory highlights the essential role of the reticular formation in oral motor control. The sensitivity of those neurological structures to chronic emotional stress is one of the possible explanations for the appearance of oral parafunctions accompanied by a modification of pain perception and a disorganized muscular activation, determining factors in temporomandibular disorders.

Masticatory muscle pain and disordered jaw motor behaviour: Literature review over the past decade

The clinically important relationship between masticatory muscle pain (MMP) and disordered jaw motor behaviour is subject of this concise, evidence-based review of the literature that was published during the past 10 years. Mainly based on studies that used some sort of experimental MMP (e.g., the intramuscular injection of noxious substances like hypertonic saline), it was concluded that MMP has pronounced effects on jaw motor functions like maximal clenching and mastication. The pain-related modulation of oral reflexes further illustrated the effects of MMP on masticatory motor control. Protecting the painful muscle tissues against further damage and allowing for time to heal the damaged tissues by immobilization of the masticatory system seem to be the key outcomes of these effects. Further, MMP was shown to influence the cervical motor system, which may partly explain the mechanism behind the frequently observed co-occurrence of pain in the neck and the jaw. Finally, it was concluded that, even though the evidence is not yet conclusive, also remote pain (non-MMP) can modulate jaw motor behaviour, which indicates the involvement of central mechanisms in this modulation.

Heterogeneous activation of the medial pterygoid muscle during simulated clenching

The aim of this study was to investigate whether the medial pterygoid muscle shows differential activation under experimental conditions simulating force generation during jaw clenching. To answer this question, the electromyographic activity of the right medial pterygoid was recorded with two intramuscular electrodes placed in an anterior and posterior muscle region, respectively. Intraoral force transfer and force measurement were achieved by a central bearing pin device equipped with strain gauges. The activity distribution in the muscle was recorded in a central mandibular position during generation of eight different force vectors at a constant amount of force (F=150 N). The investigated muscle regions showed different amounts of EMG activity. The relative intensity of the activation in the two regions changed depending on the task. In other words, the muscle regions demonstrated heterogeneous changes of the EMG pattern for various motor tasks. The results indicate a heterogeneous activation of the medial pterygoid muscle under test conditions simulating force generation during clenching. This muscle behaviour might offer an explanatory model for the therapeutic effects of oral splints.

Differential activity patterns in the masseter muscle under simulated clenching and grinding forces

The aim of this study was to investigate (i) whether the masseter muscle shows differential activation under experimental conditions which simulate force generation during clenching and grinding activities; and (ii) whether there are (a) preferentially active muscle regions or (b) force directions which show enhanced muscle activation. To answer these questions, the electromyographic (EMG) activity of the right masseter muscle was recorded with five intramuscular electrodes placed in two deep muscle areas and in three surface regions. Intraoral force transfer and force measurement were achieved by a central bearing pin device equipped with three strain gauges (SG). The activity distribution in the muscle was recorded in four different mandibular positions (central, left, right, anterior). In each position, maximum voluntary contraction (MVC) was exerted in vertical, posterior, anterior, medial and lateral directions. The investigated muscle regions showed different amount of EMG activity. The relative intensity of the activation, with respect to other regions, changed depending on the task. In other words, the muscle regions demonstrated heterogeneous changes of the EMG pattern for the various motor tasks. The resultant force vectors demonstrated similar amounts in all horizontal bite directions. Protrusive force directions revealed the highest relative activation of the masseter muscle. The posterior deep muscle region seemed to be the most active compartment during the different motor tasks. The results indicate a heterogeneous activation of the masseter muscle under test conditions simulating force generation during clenching and grinding. Protrusively directed bite forces were accompanied by the highest activation in the muscle, with the posterior deep region as the most active area.

Beeinflussung muskul�rer Gesichtsschmerzen durch Botulinumtoxin�A

OBJECTIVE

Can chronic pain of the masticatory muscles be positively affected by low dose injection of botulinum toxin (BTX-A)?

METHODS

Twenty patients suffering chronic myofacial pain were questioned and examined after injection of 25-50 U Dysport into the affected muscles over a period of 8 weeks.

RESULTS

Four weeks after injection of BTX-A patients reported a significant reduction of pain (p <0.001, paired t-test. Power of performed test with alpha 0.050:1.000). Then the pain remained constant over the next 4 weeks. Concurrently a significant increase of mandubular range of movement was observed (p <0,05, Wilcoxon signed rank test).

CONCLUSIONS

Even though lacking placebo control the findings suggest that patients suffering chronic myofacial pain may benefit from injection of low dose BTX-A into the affected muscles.

Effects of experimental muscle pain on mechanical properties of single motor units in human masseter

OBJECTIVE

Muscle pain is known to influence muscle activity but the details of its effects on the mechanical properties of single motor units (SMU) have not been described. We have recently reported a decreased firing rate of SMU in the human masseter muscle during painful contractions with a constant force output. Force output can be modulated by the SMU discharge rate in relation to the contractile properties of SMU. Therefore, the objective of the present study was to measure the mechanical properties of SMU in the masseter to clarify the mechanism which underlies the decrease in SMU firing rate during jaw-muscle pain.

METHODS

A spike-triggered averaging (STA) technique was used to determine the mechanical properties of low-threshold SMU in the masseter muscle recorded with fine wire electrodes during a voluntary isometric contraction. The twitch amplitude, contraction time, and half-relaxation time were determined from the averaged force records before and during experimental jaw-muscle pain induced by injection of 0.2 ml (100 microg/ml) capsaicin in 8 healthy subjects. Injections of 0.2 ml isotonic saline served as a non-painful control in 11 healthy subjects.

RESULTS

The twitch amplitude was significantly increased during capsaicin-evoked muscle pain (P<0.001) without significant changes of half-relaxation time and contraction time. No significant changes in SMU twitch properties were observed during the control injections.

CONCLUSIONS

Potentiation of twitch force could be a possible compensatory mechanism to maintain a constant force output during painful isometric contractions when SMU firing decreases. This finding therefore provides new information on the adaptation of motor function by muscle pain.