Control of human mandibular posture during locomotion

Selected muscle tone and asymmetry of the occlusal plane in case of intracapsular temporomandibular joint disorder

Objective: To discover the extent of the connection between occlusal plane asymmetry and the rest tone of the four muscle groups of the orofacial region with temporomandibular joint pathology.Methods: Eighty-seven subjects were divided into two groups. The following methods were applied: clinical examination, roentgenological examination, and electromyography. Data were evaluated and statistically analyzed.Results: The variability of occlusal plane inclination in relation to the porion plane was 0-4.6º.The tonus of masseter muscle was higher in the experimental group: 1.45 mV more than in the control group: 1.23 mV (p < 0.05).Conclusion: Asymmetry of the occlusal plane inclination was found for nearly all subjects in both groups. It can be compensated for by adaptation mechanisms and does not cause temporomandibular joint disorders. Undertaken research shows the existence of a proven correlation between TMJ disorders and the resting tonus of the masseter muscle.

Is There a Correlation between Dental Occlusion, Postural Stability and Selected Gait Parameters in Adults?

Background: There is still an ongoing debate about the role of the craniomandibular system, including occlusal conditions, on postural stability. This study aims to assess the role of antero-posterior malocclusion on postural control and plantar pressure distribution during standing and walking. Methods: 90 healthy volunteers (aged 19 to 35) were qualified for the study. The subjects were assigned to three groups, depending on the occlusion type. Each group (Angle Class I, II and III) consisted of 30 people. The research procedure included a clinical occlusal assessment performed by a dentist. Postural control measurements were carried out using a force platform by measuring plantar pressure distribution during standing (six trials with and without visual control) and walking test conditions. Results: The tendency to shift the CoP forward is demonstrated by Angle Class II subjects and backwards by Class I and III subjects (p < 0.001). Individuals with a malocclusion demonstrated significantly higher selected stabilographic parameters while standing on both feet (with eyes open and closed) and during the single-leg test with eyes open (p < 0.05). The analysis of the dynamic test results showed no significant correlations between Angle Classes and the selected gait parameters. Conclusions: Analyses conducted among individuals with malocclusions showed the impact of occlusion on static postural stability. In order to diagnose and effectively treat malocclusion, a multidisciplinary approach with the participation of dentists and physiotherapy specialists is necessary, with the use of stabilometric and kinematic posture assessments.

Wearable Orofacial Technology and Orthodontics

Wearable technology to augment traditional approaches are increasingly being added to the arsenals of treatment providers. Wearable technology generally refers to electronic systems, devices, or sensors that are usually worn on or are in close proximity to the human body. Wearables may be stand-alone or integrated into materials that are worn on the body. What sets medical wearables apart from other systems is their ability to collect, store, and relay information regarding an individual's current body status to other devices operating on compatible networks in naturalistic settings. The last decade has witnessed a steady increase in the use of wearables specific to the orofacial region. Applications range from supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and better understanding the jaw's functional and parafunctional activities. Orofacial wearable devices may be unimodal or incorporate multiple sensing modalities. The objective data collected continuously, in real time, in naturalistic settings using these orofacial wearables provide opportunities to formulate accurate and personalized treatment strategies. In the not-too-distant future, it is anticipated that information about an individual's current oral health status may provide patient-centric personalized care to prevent, diagnose, and treat oral diseases, with wearables playing a key role. In this review, we examine the progress achieved, summarize applications of orthodontic relevance and examine the future potential of orofacial wearables.

Convergent innervations of mesencephalic trigeminal and vestibular nuclei neurons onto oculomotor and pre-oculomotor neurons-Tract tracing and triple labeling in rats

In studies of vestibulo-ocular reflex (VOR), the horizontal VOR circuit is much clearer than vertical-torsional VOR. The circuit and mechanism of gravity-related vertical-torsional VOR is probably weak. "Somatosensory vestibular interaction" is a known extra source to facilitate VOR, and cervico-ocular reflex is a representative for torsional VOR compensation. Whereas, how the cervical afferents finally reach the oculomotor system is less documented. Actually, when the head tilts, which generates cervico-ocular reflex, not only the neck muscle is activated, but also the jaw muscle is stretched by gravity dragged mandible and/or tissue-muscle connection between the mandible and clavicle. We have previously identified a projection from the jaw muscle afferent mesencephalic trigeminal nucleus (Vme) neurons to oculomotor nuclei (III/IV) and their premotor neurons in interstitial nucleus of Cajal (INC)-a well-known pre-oculomotor center manipulating vertical-torsional eye movements. We hypothesized that these projections may interact with vestibulo-ocular signals during vertical-torsional VOR, because effects of gravity on jaw muscles and bones has been reported. Thus, we injected different anterograde tracers into the Vme and medial vestibular nucleus (MVN)-the subnuclear area particularly harboring excitatory vestibulo-ocular neurons, and immunostained III/IV motoneurons. Retrograde tracer was injected into the III in the same animals after dual anterograde tracers' injections. Under confocal microscope, we observed the Vme and MVN neuronal endings simultaneously terminated onto the same III/IV motoneurons and the same INC pre-oculomotor neurons. We consider that jaw muscle proprioceptive Vme neurons projecting to the III/IV and INC would sense spindle activity if the jaw muscle is stretched by gravity dragged mandible or connection between mandible and clavicle during head rolling. Therefore, the convergent innervation of the Vme and MVN neurons onto the oculomotor and pre-oculomotor nuclei would be a neuroanatomic substrate for interaction of masticatory proprioception with the vestibulo-ocular signals upon the oculomotor system during vertical-torsional VOR.

Effects of Wearing a 50% Lower Jaw Advancement Splint on Biophysical and Perceptual Responses at Low to Severe Running Intensities

Acute ergogenic effects of wearing occlusal splints have been reported for aerobic and anaerobic exercises, but the literature centered on performance improvement by using jaw repositioning splints is scarce. We aimed to analyze the effect of wearing a 50% lower jaw advancement splint on biophysical and perceptual responses at low to severe running intensities. Sixteen middle- and long-distance runners performed twice a 7 × 800 m intermittent running protocol (with 1 km·h⁻¹ increments and 30 s rest periods) in an outdoor track field using two lower intraoral splints (a placebo and a lower jaw advancer). These devices were custom manufactured for each participant and a randomized and repeated measure design was used to compare conditions. No differences between placebo and lower jaw advancer were found (e.g., 52.1 ± 9.9 vs. 53.9 ± 10.7 mL·kg⁻¹·min⁻¹ of oxygen uptake, 3.30 ± 0.44 vs. 3.29 ± 0.43 m of stride length and 16 ± 3 vs. 16 ± 2 Borg scores), but small effects were sometimes observed (e.g., 109.2 ± 22.5 vs. 112.7 ± 25.2 L·min⁻¹ of ventilation, ES = −0.42). Therefore, this jaw advancement splint had no substantial ergogenic effect on biophysical and perceptual responses when running at different intensities.

Effect of jaw clenching on head acceleration during a predictable load impact

BACKGROUND

Jaw clenching is considered to reduce head acceleration while receiving a strong impact on the body during sport activities.

OBJECTIVE

The present study aimed to clarify the effect of jaw clenching on reduction of head acceleration during a predictable load impact to the body.

METHODS

Seven healthy participants were exposed to a predictable load impact with and without jaw clenching. We recorded the electromyographic activity of the masseter (MA) and digastricus (DIG) muscles, occlusal pressure and head acceleration throughout the experiment.

RESULTS

When participants were not instructed to clench their jaws, they naturally positioned their jaws without occlusal contact at the time of pendulum impact by co-contracting the jaw opener and closer muscles. When participants were instructed to clench their jaws, neither the activity of the jaw opener muscle nor the head acceleration differed at the time of pendulum impact when compared with when participants were not instructed to clench their jaws.

CONCLUSIONS

A slightly distanced jaw position (co-contracting the jaw opener and closer muscles without occlusal contact) might serve inherently safety for reduction of head acceleration during predictable body impact, while jaw clenching does not contribute to reduction of head acceleration in response to pendulum impact more than the distanced jaw position does. Notably, DIG activation to minimise the head acceleration in response to pendulum impact was similar in clenching and no clenching positions. This suggests that DIG may play a crucial role in the reduction of head acceleration, regardless of MA muscle activity.

Effect of a sports mouthguard on the functional range of motion of the spine and the upper body posture in taekwondo

Background

The aim is to investigate to what extent the different oral protections compared to the habitual occlusion affect the upper body posture in statics and during taekwondo-specific movement.

Methods

12 Taekwondoka (5 f/7 m) of German national team were measured by using a 3d back scanner and an ultrasonic distance measuring (upright stand, taekwondo attack and defense movement, two taekwondo specific combinations) in habitual occlusion, with a custom-made and ready-made mouth protection

Results

There are no significant changes in the upper body posture (p ≥ 0.05). Depending on the dynamic measurements, different significant reactions of the spinal position were found while wearing the custom made mouthguard or the ready-made mouthguard according to the conducted movement.

Conclusion

The measured changes in dynamic movements are not clinical relevant. Based on the positive responses from the participants, the custom-made mouth protection can be recommended combined with an individual analysis.

Entrainment of chewing rhythm by gait speed during treadmill walking in humans

It remains unclear whether the rhythmic processes of chewing and gait synchronize during concurrent execution in humans. To evaluate the entrainment of chewing rhythm by gait speed, we measured electromyography from the masseter and tibialis anterior muscles during chewing at a habitual rhythm while walking on a linear treadmill in 12 healthy volunteers. Vertical movement of the head was also measured using an accelerometer. Each 5-min session included gait tasks using a treadmill at three speeds: Auto: the participant's self-selected gait speed, High: Auto × 1.3, and Low: Auto ÷ 1.3. Electromyography from the masseter muscles were also measured during chewing while stationary (Chew-Only). Chewing rhythm during walking was the same as that for head movement, occurring at twice the speed of the walking rhythm, in nine participants (Low), eight participants (Auto), and eight participants (High). For these participants, chewing rhythm in the Auto and High conditions differed significantly from that in the Chew-Only condition. Significant differences in chewing rhythm were also observed among gait speeds　(Low vs. Auto vs. High). Our findings demonstrate that entrainment of habitual chewing rhythm to gait speed is a significant phenomenon, and that the dominant ratio of chewing-walking-head movement rhythms is 2:1:2.

A kinematic analysis on the immediate effects of occlusal splints in gait and running body sway patterns

Objective: This study aims to determine whether changes in dental occlusion are correlated to body posture during walking and running.Methods: Fifteen healthy subjects were assessed by a prosthodontist and deemed asymptomatic. Analyses of gait and running were performed in three conditions, in random order: a) occlusal splint; b) placebo splint; and c) no splint. The occlusal splint used in this study positioned the mandible in a stable position. Kinematic data was collected using a 3D motion capture system.Results: Changes in dental occlusion induced by occlusal splints did not influence body sway during gait or running. No significant differences were found between any of the test conditions.Conclusion: Occlusal splints have no effect on body sway during gait or running. High inter-subject variability in kinematic parameters was found, which should be considered in future studies.

Prediction of Ergogenic Mouthguard Effects in Volleyball: A Pilot Trial

Dental occlusion may affect static and dynamic balance. The effects of a mouthguard on pinpoint accuracy in volleyball were investigated in 28 players who completed a volleyball specific test. Also, masticatory electromyographic tests were performed. The mean pinpoint accuracy was significantly higher with a mouthguard (68.6±9.3 vs. 64.0±7.0 points from 100; p< 0.006). However, differential mouthguard effects were seen, and three subgroups were classified: Group 1 (markedly improved pinpoint accuracy), Group 2 (improved pinpoint accuracy), and Group 3 (reduced pinpoint accuracy). Group 1 had a high masseter resting tone, the masseter activity was low in MVC (maximum voluntary clench) and increased in BOC (maximum bite on cotton rolls; p< 0.04). This indicates a masseter weakness, which would be compensated by a mouthguard. In Group 2, the masseter activity in MVC was high-normal with an imbalance which was improved in BOC (p< 0.01), indicating a possible mouthguard benefit. In Group 3, MVC and BOC were in a high-normal range and showed no relevant deficits. In these subjects the mouthguard had adverse effects. Overall, subjects with masticatory deficits had a benefit from the mouthguard in pinpoint accuracy. Positive or negative mouthguard responders may be detectible from electromyographic tests.

Influence of the Lower Jaw Position on the Running Pattern

Introduction

The effects of manipulated dental occlusion on body posture has been investigated quite often and discussed controversially in the literature. Far less attention has been paid to the influence of dental occlusion position on human movement. If human movement was analysed, it was mostly while walking and not while running. This study was therefore designed to identify the effect of lower jaw positions on running behaviour according to different dental occlusion positions.

Methods

Twenty healthy young recreational runners (mean age = 33.9±5.8 years) participated in this study. Kinematic data were collected using an eight-camera Vicon motion capture system (VICON Motion Systems, Oxford, UK). Subjects were consecutively prepared with four different dental occlusion conditions in random order and performed five running trials per test condition on a level walkway with their preferred running shoes. Vector based pattern recognition methods, in particular cluster analysis and support vector machines (SVM) were used for movement pattern identification.

Results

Subjects exhibited unique movement patterns leading to 18 clusters for the 20 subjects. No overall classification of the splint condition could be observed. Within individual subjects different running patterns could be identified for the four splint conditions. The splint conditions lead to a more symmetrical running pattern than the control condition.

Discussion

The influence of an occlusal splint on running pattern can be confirmed in this study. Wearing a splint increases the symmetry of the running pattern. A more symmetrical running pattern might help to reduce the risk of injuries or help in performance. The change of the movement pattern between the neutral condition and any of the three splint conditions was significant within subjects but not across subjects. Therefore the dental splint has a measureable influence on the running pattern of subjects, however subjects individuality has to be considered when choosing the optimal splint condition for a specific subject.

The effects of a temporarily manipulated dental occlusion on the position of the spine: a comparison during standing and walking

BACKGROUND CONTEXT

The relationship between dental occlusion and body posture or even the spine position is often analyzed and confirmed. However, this relationship has not been systematically investigated for standing and walking.

PURPOSE

To examine whether a symmetric or asymmetric dental occlusion block, using 4 mm thick silicon panels, can significantly change the spine position (cervical, thoracic, or lumbar region) during standing and walking.

STUDY DESIGN

The following study is a cross-sectional study.

PATIENT SAMPLE

This study was carried out with 23 healthy subjects (18 women, 5 men) without discomfort in the temporomandibular system or body movement apparatus.

OUTCOME MEASURES

Position changes (millimeter) of the spine (cervical, thoracic, lumbar) in frontal, sagittal, and transverse planes of motion.

METHODS

The upper spine position was quantified with an ultrasonic distance measurement system (sonoSens Monitor). Every subject placed the 4 mm thick silicon panel systematically between the left/right premolars or the front teeth. Differences between the habitual and manipulated occlusion positions were determined by the Friedman test, followed by pairwise comparisons with applied Bonferroni-Holm correction.

RESULTS

During standing and walking there were significant (p≤.05) differences between the occlusion block conditions and the habitual dental position in all body planes except in the right lumbar region during walking. In addition, differences within the manipulated occlusion position could be detected. Significant differences were also shown between the standing and walking trials in the frontal, sagittal, and transverse planes, particularly with respect to the lumbar region (p≤.001).

CONCLUSIONS

Symmetrical and asymmetrical occlusion blocks in the premolar region can be associated with changes in all three spine regions during standing and walking. The results showed highly similar reaction patterns in all spine positions, regardless of the location of the silicon panel. Between standing and walking, the main differences were in the lumbar spine. The results suggest a relationship between the chewing and the movement system. However, it must be stated that this study has no direct clinical impact. The study design cannot determine the causality of the observed associations; also the clinical significance of the small postural changes remains unknown.

Postural loads during walking after an imbalance of occlusion created with unilateral cotton rolls

Background

It was showed that stomatognathic functions correlate with alterations in locomotion, that are detectable through the analysis of loading during walking. For example, subjects with symptoms of Temporomandibular disorders (TMDs) showed a significant higher load pressure on the two feet, respect to health subjects, when cotton rolls were inserted. This previous study appeared to suggest that the alteration of postural loads associated to a particular alteration of stomatognathic condition (in this case, the cotton rolls inserted between the two dental arches) is detectable only in TMD's subjects, while it resulted not detectable in health subjects, because in that study, health subjects did not show any significant alteration of postural loads related to the different stomatognathic tested conditions. In other words, in that previous study, in the group of health subjects, no significant difference in postural loads was observed among the different test conditions; while TMD subjects showed a significant higher load pressure on the two feet when cotton rolls were inserted, respect to all the other tested conditions. Thus, the aim of this study was to better investigate these correlations in health subjects without TMD's symptoms, testing other different intra-oral conditions, and to verifywhether an experimentally induced imbalance of occlusion, obtained putting an unilateral cotton roll, could cause an alteration of postural loading on feet during walking.

Findings

In a sample of thirty Caucasian adult females (mean age 28.5 ± 4.5), asymptomatic for TMDs, when a cotton roll was positioned on the left or the right sides of dental arches, so causing a lateral shift of the mandible, the percentage of loading and the loading surface of the ipsi-lateral foot, left or right, were found to be significantly lower than in habitual occlusion (p < 0.05). Males were not included because of their different postural attitude respect to females. Further studies in a sample of males will be presented.

Conclusions

This study showed that in health subjects without TMD's symptoms, an experimentally induced imbalance of the occlusion, obtained through an unilateral cotton roll, is associated to detectable alterations in the distribution of loading on feet surface, during walking.

Dental occlusion and body posture: a surface EMG study

The influence between dental occlusion and body posture has been discussed in the past ten years by several authors with controversial conclusions. The objective of this study was to access, using surface electromyography (EMG), the rest activity of paired sternocleidomastoids, erectors spinae at L4 level, and soleus muscles in a group of 24 volunteer subjects (12 males, 12 females, aged 23-25 yrs) affected by sub-clinical dental malocclusions in different situations of dental occlusion. The subjects' occlusion was balanced (neuromuscularly) (registered on an acrylic wafer). Rest activity was assessed using the sEMG. The measurements were achieved on subjects while standing barefooted, before (Test 1), and 15 minutes after they wore the acrylic wafer (Test 2). The result was a significant reduction of the mean voltage for each muscle. Paired muscles were registered and the balancing rate between right and left muscles showed improvement for all the paired muscles (Wilcoxon test p < 0.05). No significant difference was noted in the relaxation and balancing rates between the muscles tested. The data confirmed a beneficial effect of balancing the occlusion with an acrylic wafer on the following paired postural muscles: sternocleidomostoid, erector spinae, and soleus.

Quality of reporting masticatory muscle electromyography in 2004: a systematic review

This study evaluated the quality of reporting electromyography in studies evaluating the masticatory muscles published during 2004. Several electronic databases were searched. Abstracts and later articles were selected by a consensus from the five reviewers. An adaptation of the methodological checklist published by the International Society of Electrophysiology and Kinesiology (ISEK) was used. The following information regarding electrodes was reported on the 35 finally selected articles: location (94.3%), interelectrode distance (48.6%), and material (42.9%); detection and amplification: amplification type (54.3%), gain (25.7%), low high pass filters (60%) and cut-off frequencies (60%); electromyography (EMG) processing: sampling rate (74.2%), rectification (46.6%), root-mean square (RMS) (39.2%); number of bits and model of A/D card (17.1%); and normalization procedure (40%). Reasons for the poor reporting are discussed. Because of the general poor quality of reporting of the analysed studies, findings of studies using surface electromyography of masticatory muscles should be interpreted with caution.

Insights into the bilateral cortical control of human masticatory muscles revealed by transcranial magnetic stimulation

In this brief review I describe details of the functional organisation of the bilateral corticobulbar projections to the trigeminally innervated masticatory muscles, as revealed by transcranial magnetic stimulation of the human brain. The motor cortices of both hemispheres are involved in control of trigeminal motoneurons, however the contralateral hemisphere has the greater excitatory influence. Corticomotoneuronal cells in each hemisphere project to jaw-closer and jaw-opener motoneurons. Less is known about cortically mediated inhibitory effects in the trigeminal motor system, but the available evidence suggests that drive to jaw muscles on each side is affected similarly by intracortical inhibitory processes activated in one hemisphere. Functional studies reveal that the two hemispheres play distinct roles in control of ipsilateral and contralateral muscles, particularly for jaw-closers. Masseter and digastric motor units recruited during low-force contractions do not receive uniform inputs from each hemisphere; the majority of masseter motor units are excited only from the contralateral hemisphere, and while digastric motor units are usually excited from both hemispheres the direct CM cell influence appears to be augmented on the contralateral side by corticobulbar activation of segmental excitatory interneurons. Differences in bilateral cortical control of jaw-closer and jaw-opener muscles may contribute to the more independent control of jaw-closers on each side during functional tasks. Corticobulbar control of the trigeminal muscles during natural tasks such as chewing and speech remains to be investigated with TMS.

Postural control of the human mandible

This article reviews recent experimental evidence explaining the mechanisms that support the mandible in its rest or postural position when the head is stationary and during locomotion. At rest, and during slow jaw movements, there is alternating activation of the jaw-opening and jaw-closing muscles which arises from a central pattern generator. However, this cannot account for the rest position of the mandible even when the head is stationary. Jaw movements and masticatory muscle activity were measured in subjects who stood, walked and ran on a treadmill. Even during walking, there are no bursts of masseter EMG time-locked to heel-landing. However, when subjects ran, the downward movement of the mandible in each step evokes a burst of EMG in the masseters. This is a stretch reflex in the jaw-closing muscles, which acts to limit the downward movement of the mandible relative to the maxilla during locomotion, and to restore the mandibular position towards its rest position. Thus, when the head is stationary, the low-level activity in the jaw-opening and jaw-closing muscles does not contribute to the rest position. Instead, the mandible is supported by passive viscoelastic forces in perioral soft tissues which limit vertical jaw movements even when the head moves gently up and down during walking. When the head moves more vigorously up and down, stretch reflexes in the jaw-closing muscles limit the movement of the mandible. That is, both passive forces and active reflex responses maintain jaw posture within narrow limits during brisk head movements.

Origin of sound-evoked EMG responses in human masseter muscles

Sound is a natural stimulus for both cochlear and saccular receptors. At high intensities it evokes in active masseter muscles of healthy subjects two overlapping reflexes: p11/n15 and p16/n21 waves, whose origin has not yet been demonstrated. Our purpose was to test which receptor in the inner ear is responsible for these reflexes. We compared masseter EMG responses induced in normal subjects (n = 9) by loud clicks (70-100 dB normal hearing level (NHL), 0.1 ms, 3 Hz) to those evoked in subjects with a selective lesion of the cochlea (n = 5), of the vestibule (n = 1) or with mixed cochlear-vestibular failure (n = 5). In controls, 100 dB clicks induced bilaterally, in the unrectified mean EMG (unrEMG), a clear p11 wave followed by a less clear n15 wave and a subsequent n21 wave. Lowering the intensity to 70 dB clicks abolished the p11/n15 wave, while a p16 wave appeared. Rectified mean EMG (rectEMG) showed, at all intensities, an inhibitory deflection corresponding to the p16/n21 wave in the unrEMG. Compared to controls, all deaf subjects had a normal p11 wave, together with more prominent n15 wave; however, the p16/n21 waves, and their corresponding inhibition in the rectEMG, were absent. The vestibular patient had bilaterally clear p11 waves only when 100 dB clicks were delivered bilaterally or to the unaffected ear. Stimulation of the affected ear induced only p16/n21 waves. Data from mixed patients were consistent with those of deaf and vestibular patients. We conclude that click-induced masseter p11/n15 waves are vestibular dependent, while p16/n21 waves depend on cochlear integrity.

Human jaw and muscle modelling

Dynamic mathematical modelling is an invaluable method to help understand the biomechanics of the anatomically and functionally complex masticatory system. It provides insight into variables which are impossible to measure directly such as joint loads and individual muscle tensions, and into physical relationships between jaw structure and function. Individual parameters can be modified easily to understand their influence on function. Our models are constructed with best available structural and functional data, and evaluated against human jaw behaviour. Image data provide hard and soft tissue morphology and the jaw's inertial properties. The drive to the system is provided by actuators which simulate active and passive jaw muscle properties. In whole-jaw modelling, muscle models which behave plausibly rather than mimic the ultra-structural cross-bridge interactions are common since they are computationally feasible. Whole-jaw models have recently incorporated flexible finite-elements to explore tissue distortion in the temporomandibular joint and tongue movements. Furthermore, the jaw has been integrated with laryngeal models to explore complex tasks such as swallowing. These dynamic models have helped better understand joint loading, movement constraints and muscle activation strategies. Future directions will include further incorporation of rigid and flexible model dynamics and the creation of subject-specific models to better understand the functional implications of pathology.

Activity of masticatory muscles in subjects with different orofacial pain conditions

The existence of a pathophysiological link between tonic muscle activity and chronic muscle pain is still being debated. The purpose of this retrospective, controlled study was to evaluate the electromyographic (EMG) activity of masticatory muscles in subjects with different orofacial pain conditions. The temporal and masseter EMG activity at rest and the masseteric reflex were recorded in two groups of patients with either myofascial pain (n=33) or neuropathic pain (n=20), one group of non-pain patients with disc derangement disorders (n=27) and one control group of healthy, asymptomatic subjects (n=32). The EMG activities of both muscles at rest were significantly higher in the pain patient groups compared to the asymptomatic control group. There was no significant difference between the disc derangement disorder group and the control group. The masseteric reflex amplitude was reduced in all patient groups when compared with the control group. In pain patient groups, the increased EMG activity at rest and the reduction of the masseteric reflex amplitude were equally distributed in the pain and non-pain sides. In addition, subjects presenting with bilateral pain showed higher EMG activity at rest than those with unilateral pain. These results suggested that the modulation of muscle activity was not the direct consequence of a peripheral nociceptive mechanism and seemed to indicate that a central mechanism was at work. The contrast between the increased EMG activity at rest and the reduction of the masseteric reflex amplitude may reflect modulations of motoneurones that differed in tonic versus phasic conditions in chronic pain patients.

Effect of experimental posterior temporalis muscle pain on human brainstem reflexes

OBJECTIVE

To study the modulation of jaw-stretch and blink reflexes by experimental posterior temporalis muscle pain.

METHODS

Thirty healthy volunteers (15 males, 25.5+/-0.6 years and 15 females, 27.4 +/- 1.2 years) were included. Short-latency stretch reflex responses were evoked in the masseter and temporalis muscles by fast stretches (1 mm displacement, 10 ms ramp time) and the blink reflexes were evoked by painful electrical pulses (0.5 ms duration), delivered by a concentric electrode placed on the left lower forehead close to the supraorbital foramen before, during and 15 min after a period with experimentally induced muscle pain.

RESULTS

The normalized peak-to-peak amplitude of the stretch reflex in the painful temporalis was significantly higher during pain in both males and females compared with pre- and post-pain conditions (P < 0.004). The R2 root mean square (RMS) of the blink reflex decreased significantly during muscle pain as compared to the pre-pain (P < 0.03) in both males and females.

CONCLUSIONS

The present results indicated that experimental posterior temporalis muscle pain facilitates the jaw-stretch reflex, whereas the nociceptive specific blink reflex is inhibited.

SIGNIFICANCE

Present study suggested that these reflexes are suitable models for probing pontine and medullary pain processing.

Voluntary control of human jaw stiffness

Recent studies of human arm movement have suggested that the control of stiffness may be important both for maintaining stability and for achieving differences in movement accuracy. In the present study, we have examined the voluntary control of postural stiffness in 3D in the human jaw. The goal is to address the possible role of stiffness control in both stabilizing the jaw and in achieving the differential precision requirements of speech sounds. We previously showed that patterns of kinematic variability in speech are systematically related to the stiffness of the jaw. If the nervous system uses stiffness control as a means to regulate kinematic variation in speech, it should also be possible to show that subjects can voluntarily modify jaw stiffness. Using a robotic device, a series of force pulses was applied to the jaw to elicit changes in stiffness to resist displacement. Three orthogonal directions and three magnitudes of forces were tested. In all conditions, subjects increased the magnitude of jaw stiffness to resist the effects of the applied forces. Apart from the horizontal direction, greater increases in stiffness were observed when larger forces were applied. Moreover, subjects differentially increased jaw stiffness along a vertical axis to counteract disturbances in this direction. The observed changes in the magnitude of stiffness in different directions suggest an ability to control the pattern of stiffness of the jaw. The results are interpreted as evidence that jaw stiffness can be adjusted voluntarily, and thus may play a role in stabilizing the jaw and in controlling movement variation in the orofacial system.

Stretch reflexes in the human masticatory muscles: a brief review and a new functional role

Stretch reflexes play a vital role in fine-tuning movements and in automatically maintaining posture. This article briefly reviews the operation of the stretch reflex in the human masticatory system. The conventional approach of stretching muscles in an open-loop manner has yielded much valuable information on the operation of this reflex. In particular, it has revealed that stretching the jaw-closing muscles evokes a reflex response with two major components. The short-latency reflex is favoured when stretches are brisk, but slower stretches evoke an additional long-latency component. In the hand muscles, the long-latency response is transcortical: in the masticatory muscles, it is not. In addition to its role in servo-control of muscle length during chewing, the stretch reflex in the jaw-closing muscles maintains the vertical position of the mandible during vigorous head movements such as those that occur during running, jumping, hopping and other vigorous whole-body movements in which the head moves briskly up and down. This is an interesting model system in which to investigate stretch reflexes with natural stimuli under unrestrained, physiological conditions.

Jaw stretch reflexes in children

The substantial morphological transformations that occur during human development present the nervous system with a considerable challenge in terms of motor control. Variability of skilled motor performance is a hallmark of a developing system. In adults, the jaw stretch reflex contributes to the functional stability of the jaw. We have investigated the response properties of the jaw stretch reflex in two groups of young children and a group of young adults. Response latencies increased with development, and all age groups produced stimulus-magnitude-dependent increases in reflex gain and resulting biting force. Reflex gain was largest for the older children (9-10 years), yet net increases in resulting biting force were comparable across age groups. These data and earlier experiments suggest that oral sensorimotor pathways mature throughout childhood in concert with the continued acquisition of complex motor skills.