Establishment of a Temporomandibular Physiological State with Neuromuscular Orthosis Treatment Affects Reduction of TMD Symptoms in 313 Patients

Barry C. Cooper, D.D.S.; Israel Kleinberg, Ph.D., D.D.S., D.Sc.:  Journal of Craniomandibular Practice, April 2008, Vol. 26, No. 2, pp 104-117.


ABSTRACT: 
The objective of this investigation was to test the hypothesis that alteration of the occlusions
of patients suffering from temporomandibular disorders (TMD) to one that is neuromuscularly,
rather than anatomically based, would result in reduction or resolution of symptoms that characterize the
TMD condition. This hypothesis was proven correct in the present study, where 313 patients with TMD
symptoms were examined for neuromuscular dysfunction, using several electronic instruments before
and after treatment intervention. Such instrumentation enabled electromyographic (EMG) measurement
of the activities of the masticatory muscles during rest and in function, tracking and assessment of various
movements of the mandible, and listening for noises made by the TMJ during movement of the
mandible. Ultra low frequency and low amplitude, transcutaneous electrical neural stimulation (TENS) of
the mandibular division of the trigeminal nerve (V) was used to relax the masticatory muscles and to facilitate
location of a physiological rest position for the mandible. TENS also made it possible to select positions
of the mandible that were most relaxed above and anterior to the rest position when the mandible
was moved in an arc that began at rest position. Once identified, the neuromuscular occlusal position
was recorded in the form of a bite registration, which was subsequently used to fabricate a removable
mandibular orthotic appliance that could be worn continuously by the patient. Such a device facilitated
retention and stabilization of the mandible in its new-found physiological position, which was confirmed
by follow up testing. Three months of full-time appliance usage showed that the new therapeutic positions
achieved remained intact and were associated with improved resting and functioning activities of
the masticatory muscles. Patients reported overwhelming symptom relief, including reduction of
headaches and other pain symptoms. Experts consider relief of symptoms as the gold standard for
assessment of effectiveness of TMD treatment. It is evident that this outcome has been achieved in this
study and that taking patients from a less to a more physiological state is an effective means for reducing
or eliminating TMD symptoms, especially those related to pain, most notably, headaches.