Surface raw electromyography has a moderate discriminatory capacity for differentiating between healthy individuals and those with TMD: A diagnostic study

Systematic Review and Meta-Analysis of Electromyography Potential to Discriminate Muscular or Articular Temporomandibular Disorders and Healthy Patients

Background/Objectives: New devices such as surface electromyography (sEMG) have been proposed to support traditional gnathological examination and diagnostic protocols. The aim of this study is to investigate whether sEMG can be considered a diagnostic instrument to discriminate between healthy subjects and patients with temporomandibular disorders (TMDs) of an articular or muscular nature. Methods: A systematic review was conducted according to PRISMA guidelines using literature searches of MEDLINE (via PubMed), Scopus, and Web of Science. Inclusion criteria: recent clinical studies (≤10 years) in English or Italian, involving electromyography in TMD diagnosis, with a control group of healthy patients. Data considered to be homogenous were subjected to meta-analysis (95% confidence interval [CI]; α = 0.05). Hedge g was calculated because all variables were continuous. Articles meeting the inclusion criteria were checked for further consideration, and relevant data were collected into two tables. In total, 18 studies were included after full-text reading. Meta-analyses were carried out for the static impact index (IMP), percentage overlapping coefficient (POC), and torque coefficient, and dynamic Symmetrical Mastication Index (SMI). Results: Patients with TMD had lower values in all parameters except IMP. sEMG registered a reduction in masseter activity, lower chewing efficiency, and an increase in fatigue during contractions in TMD patients. Conclusions: sEMG is not reliable to distinguish healthy from TMD patients, but despite the limitations related to the high variability in the studies (type of electromyography, static or dynamic tests, and population characteristics), the sEMG results are reliable considering the POC and SMI parameters, encouraging more in-depth studies for a predictable clinical practice. Patients with TMD had lower values in the dynamic index SMI and in static indexes POC and torque coefficient, except IMP. EMG might performs better if employed in muscle forms.

Baseline masticatory muscles' performance may predict pain relief in temporomandibular disorders

OBJECTIVES

To compare masticatory muscles' recruitment in patients with temporomandibular disorders and asymptomatic control subjects. To evaluate if the masticatory muscles' recruitment pattern may predict symptoms' improvement after temporomandibular disorders treatment.

MATERIALS AND METHODS

Standardized surface electromyography of anterior temporalis and superficial masseters muscles were recorded and compared at baseline in 26 patients with arthrogenous temporomandibular disorders (study group) and 26 asymptomatic subjects (control group). The study group was treated pharmacologically and by means of five arthrocentesis sessions. Pre-, during-, and post-treatment pain and mandibular function were assessed and compared among timepoints. Clinical improvement in terms of pain and mandibular function was correlated with pre-treatment standardized surface electromyography values.

RESULTS

Temporomandibular disorders patients showed improved maximum mouth opening and pain during and after treatment with arthrocentesis compared to baseline (T-test p < 0.01). Standardized surface electromyography values were significantly different in temporomandibular disorders subjects compared to controls (T-test p < 0.05). Improvement in pain at rest after treatment was inversely correlated with pre-treatment masseters standardized surface electromyography symmetry (R-coefficient 0.3936; p < 0.05).

CONCLUSIONS

Temporomandibular disorders patients showed a different muscular recruitment pattern compared to controls. The lesser the pre-treatment masseters symmetry, the greater the improvement of pain at rest after treatment.

Surface electromyography evaluation of selected manual and physical therapy interventions in women with temporomandibular joint pain and limited mobility. Randomized controlled trial (RCT)

Non-invasive approach is gaining an increasing recognition in the TMD patients management. It is therefore reasonable to conduct RCTs evaluating the effectiveness of both physical and manual physiotherapy interventions. The aim of this study was to evaluate the short-term efficacy of selected physiotherapeutic interventions and their effect on the bioelectrical function of the masseter muscle in patients with pain and limited TMJ mobility. The study was conducted on a group of 186 women (T) with the Ib disorder diagnosed in DC/TMD. The control group consisted of 104 women without diagnosed TMDs. Diagnostic procedures were performed in both groups. The G1 group was randomly divided into 7 therapeutic groups in which the therapy was carried out for 10 days: magnetostimulation (T1), magnetoledotherapy (T2), magnetolaserotherapy (T3), manual therapy- positional release and therapeutic exercises (T4), manual therapy - massage and therapeutic exercises (T5), manual therapy - PIR and therapeutic exercises (T6), self therapy - therapeutic exercises (T7). In the T4 and T5 groups, the treatments led to complete resolution of pain after the 10th day of therapy and to the largest minimal clinically significant difference in the MMO and LM parameter. GEE model for PC1 values using treatment method and time point showed that T4, T5 and T6 treatments had the strongest effect on the parameters studied. Therefore, it may be concluded that SEMG testing is a helpful indicator to assess the therapeutic effectiveness of physiotherapeutic interventions.

BACKGROUND

Non-invasive approach is gaining an increasing recognition in the TMD patients management. It is therefore reasonable to conduct RCTs evaluating the effectiveness of both physical and manual physiotherapy interventions in a qualitative and quantitative manner. However, there were numerous controversies reported regarding the use of surface electromyography (SEMG) in Orofacial Pain patients. Therefore, we wanted to assess the effectiveness of physiotherapy interventions in TMD patients using SEMG.

PURPOSE

Evaluation of the short-term efficacy of selected physiotherapeutic interventions and their effect on the bioelectrical function of the masseter muscle in patients with pain and limited TMJ mobility.

MATERIAL AND METHODS

The study was conducted on a group of 186 women (T) with the Ib disorder diagnosed in DC/TMD (Ib - myofascial pain with restricted mobility). The control group consisted of 104 women without diagnosed TMDs (normal reference values for TMJ ROM and masseter muscle SEMG bioelectric activity). Diagnostic procedures were performed in both groups (SEMG of the masseter muscles at baseline and during exercise, measurement of TMJ mobility, assessment of pain intensity - NRS scale). The G1 group was randomly divided into 7 therapeutic groups in which the therapy was carried out for 10 days: magnetostimulation (T1), magnetoledotherapy (T2), magnetolaserotherapy (T3), manual therapy- positional release and therapeutic exercises (T4), manual therapy - massage and therapeutic exercises (T5), manual therapy - PIR and therapeutic exercises (T6), self-therapy - therapeutic exercises (T7). Each time after therapy, the intensity of pain and TMJ mobility were assessed. Sealed, opaque envelopes were used for randomization. After 5 and 10 days of therapy, bilateral SEMG signals of the masseter muscles were acquired. PC1 factor analysis was performed. A score of 99% in the PC1 parameter, demonstrates the clinical relevance of electromyography (MVC).

RESULTS

Synergism of physical factors will lead to a higher MID on the NRS scale. Evaluating the MID of the therapeutic interventions used showed a better therapeutic effect of manual interventions over physical and self-therapy. In the T4 and T5 groups, the treatments led to complete resolution of pain after the 10th day of therapy and to the largest minimal clinically significant difference in the MMO and LM parameter. GEE model for PC1 values using treatment method and time point showed that T4, T5 and T6 treatments had the strongest effect on the parameters studied.

CONCLUSIONS

1. Exercise SEMG testing is a helpful indicator to assess the therapeutic effectiveness of physiotherapy interventions. 2. Manual therapy treatments are superior to physical treatments in their relaxation and analgesic efficacy and should therefore be prescribed as a first line non-invasive intervention for TMD pain patients.

Convergent Validity between Electromyographic Muscle Activity, Ultrasound Muscle Thickness and Dynamometric Force Measurement for Assessing Muscle

Muscle fatigue is defined as a reversible decline in performance after intensive use, which largely recovers after a resting period. Surface electromyography (EMG), ultrasound imaging (US) and dynamometry are used to assess muscle activity, muscle morphology and isometric force capacity. This study aimed to assess the convergent validity between these three methods for assessing muscle fatigue during a manual prehension maximal voluntary isometric contraction (MVIC). A diagnostic accuracy study was conducted, enrolling 50 healthy participants for the measurement of simultaneous changes in muscle thickness, muscle activity and isometric force using EMG, US and a hand dynamometer, respectively, during a 15 s MVIC. An adjustment line and its variance (R²) were calculated. Muscle activity and thickness were comparable between genders (p > 0.05). However, men exhibited lower force holding capacity (p < 0.05). No side-to-side or dominance differences were found for any variable. Significant correlations were found for the EMG slope with US (r = 0.359; p < 0.01) and dynamometry (r = 0.305; p < 0.01) slopes and between dynamometry and US slopes (r = 0.227; p < 0.05). The sample of this study was characterized by comparable muscle activity and muscle thickness change between genders. In addition, fatigue slopes were not associated with demography or anthropometry. Our findings showed fair convergent associations between these methods, providing synergistic muscle fatigue information.

Surface electromyography in the assessment of masticatory muscle activity in patients with pain-related temporomandibular disorders: a systematic review

Background

Temporomandibular disorders (TMD) are a set of painful conditions affecting the orofacial region that are prevalent and constitute the most frequent type of non-dental pain complaint in the maxillofacial area. Pain-related TMD (TMD-P) is characterized by ongoing pain in the masticatory muscles, the temporomandibular joint, or surrounding structures. Due to the multiple factors that contribute to the development of this condition, it can be challenging to accurately diagnose. One of the useful method for assessing patients with TMD-P is surface electromyography (sEMG). The aim of this systematic review was to provide a comprehensive overview of the current scientific literature on the evaluation of masticatory muscle activity (MMA) in individuals diagnosed with TMD-P, through the utilization of sEMG.

Methods

To gather relevant information, electronic databases such as PubMed, Web of Science, Scopus, and Embase were searched using specific keywords including: "pain" AND ("temporomandibular disorder*" OR "temporomandibular dysfunction*") AND "surface electromyography" AND "masticatory muscle activity." The inclusion criteria were studies assessing MMA in patients with TMD-P using sEMG. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies was utilized to evaluate the quality of the studies that were included in the review.

Results

The search strategy identified 450 potential articles. Fourteen papers met the inclusion criteria. Global quality rating for significant part of the articles was weak. Most studies showed greater sEMG activity of the masseter (MM) and temporal anterior (TA) muscles at rest in TMD-P subjects than in the asymptomatic controls, while the MM and TA muscles were less active in the pain-related TMD group compared to the non-TMD group during maximal voluntary clenching (MVC).

Conclusion

There were differences in MMA in the TMD-pain population compared to a healthy control group during various tasks. The diagnostic efficacy of surface electromyography in assessing individuals with TMD-P remains unclear.

Masticatory Myoelectric Side Modular Ratio Asymmetry during Maximal Biting in Women with and without Temporomandibular Disorders

There is no consensus on the role of electromyographic analysis in detecting and characterizing the asymmetries of jaw muscle excitation in patients with temporomandibular disorders (TMD). To analyze the TMD patients (n = 72) in comparison with the healthy controls (n = 30), the surface electromyography (sEMG) of the temporalis anterior muscle (TA) and masseter muscle (M) was recorded while a maximal biting task was performed. The differences in the asymmetry of the relationship between the masseter muscles were assessed in a module to determine the sensitivity (Sn) of binomial logistic models, based on the dominance of the TA or the M muscle, in accurately predicting the presence of TMD. All assumptions were met, and comparisons between the groups showed significant differences for the TA muscle ratio (p = 0.007), but not for the M muscle ratio (p = 0.13). The left side was predominant over the right side in the TMD group for both the TA (p = 0.02) and M muscles (p = 0.001), while the non-TMD group had a higher frequency of the right side. Binary logistic regression showed a significant model (χ² = 9.53; p = 0.002) for the TA muscle with Sn = 0.843. The model for the M muscle also showed significance (χ² = 8.03; p = 0.005) with Sn = 0.837. The TMD patients showed an increased TA muscle ratio and asymmetry of left dominance, compared to the healthy subjects. Both of the binomial logistic models, based on muscle dominance TA or M, were moderately sensitive for predicting the presence of TMD.

Changes in Maximum Mandibular Mobility Due to Splint Therapy in Patients with Temporomandibular Disorders

Splint therapy is widely used in the treatment of myofascial pain, but valid studies on the efficacy of this therapy are rare. The purpose of the present study was to investigate which qualifiable and quantifiable effects of splint therapy are detectable. For this purpose, 29 patients (21 women, mean age 44.6 ± 16 years) diagnosed with myofascial pain (RDC/TMD) were investigated in this prospective clinical trial (10/6/14An). Patients were treated with Michigan splints applied overnight for three months. Before (T1) and after three months of treatment (T2), patients were registered with an electronic ultrasound device with qualitative and quantitative evaluation of the registrations and a qualitative assessment of pain symptoms using a verbal analog scale. Significant differences were found between maximum mouth opening (MMP) (p < 0.001) and right condylar movement (CM) at MMP (p = 0.045). Qualitative assessment revealed that 24 of 29 patients experienced an improvement in pain symptoms, 17 of whom experienced complete remission. The results of the qualitative and quantitative analysis provide indications of the effectiveness of the splint therapy. In addition to quantitative measurements, the ultrasound facebow technique was also able to provide qualitative information.

Accuracy of Surface Electromyography in the Diagnosis of Pain-Related Temporomandibular Disorders in Children with Awake Bruxism

The study assessed masticatory muscle electromyographic (EMG) activity in both children diagnosed with pain-related temporomandibular disorders (TMD-P) and awake bruxism (AB) and in children without TMD, as well as the diagnostic value of surface electromyography (sEMG) in diagnosing TMD-P in subjects with AB. After evaluation based on the Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), 30 children diagnosed with myofascial pain were included in the myofascial pain group and 30 children without TMD diagnosis comprised the control group (mean age of 9.49 ± 1.34 years). The activity of the anterior temporal (TA) and masseter (MM) muscle was assessed bilaterally using a DAB-Bluetooth device (zebris Medical GmBH, Germany) at rest and during maximum voluntary clenching (MVC). The receiver operating characteristic (ROC) curve was used to determine the accuracy, sensitivity, and specificity of the normalized sEMG data. Statistically significant intergroup differences were observed in TA and MM muscle EMG activity at rest and during MVC. Moderate degree of sEMG accuracy in discriminating between TMD-P and non-TMD children was observed for TAmean, left MM, and MMmean EMG muscle activity at rest. sEMG can be a useful tool in assessing myofascial TMD pain in patients with AB.

Is jaw muscle activity impaired in adults with persistent temporomandibular disorders? A systematic review and meta-analysis

Understanding jaw muscle activity changes in temporomandibular disorders (TMD) is crucial to guide clinical management. The nature of these changes is currently unclear. Explore changes in jaw muscle activity in TMD. Electronic databases (PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane) and bibliographies were searched from inception to 9 July 2020 for eligible studies, including grey literature. Case-control and interventional studies reporting time-domain and frequency-domain electromyographic measures of jaw muscle activity in TMD and control groups were included. SIGN checklist for case-control studies was used to evaluate risk of bias. Results were pooled for meta-analysis using random-effects model. Confidence in cumulative evidence was established using American Academy of Neurology guidelines. Forty-five studies were included. Most were rated moderate risk of bias. Activity of four muscles (masseter, temporalis, lateral pterygoid, suprahyoids) was assessed across six domains (resting, clenching, chewing, swallowing, concentrating, resisted mandibular movements), with partial meta-analysis scope. Masseter and temporalis activity were significantly higher at rest (P = .05, P < .0001), but lower during brief maximal clenching (P = .005, P = .04) in TMD vs controls. Insufficient data precluded meta-analysis of remaining outcomes and subgroup analysis. Confidence in cumulative evidence ranged from moderate to very low. Changes in jaw muscle activity exist in TMD, which are both task-specific and muscle-specific. It remains unclear whether jaw muscle activity changes vary between TMD subgroups. Muscle function should be considered in clinical management of TMD. Insufficient subgroup data highlight future direction for research.

Surface Electromyography as a Method for Diagnosing Muscle Function in Patients with Congenital Maxillofacial Abnormalities

Electromyography (EMG) is the most objective and reliable method available for imaging muscle function and efficiency, which is done by identifying their electrical potentials. In global surface electromyography (sEMG), surface electrodes are located on the surface of the skin, and it detects superimposed motor unit action potentials from many muscle fibers. sEMG is widely used in orthodontics and maxillofacial orthopaedics to diagnose and treat temporomandibular disorders (TMD) in patients, assess stomatognathic system dysfunctions in patients with malocclusions, and monitor orthodontic therapies. Information regarding muscle sEMG activity in subjects with congenital maxillofacial abnormalities is limited. For this reason, the aim of this review is to discuss the usefulness of surface electromyography as a method for diagnosing muscle function in patients with congenital malformations of the maxillofacial region. Original papers on this subject, published in English between 1995 until 2020, are located in the MEDLINE/PubMed database.

Electromyography as a Means of Assessing Masticatory Muscle Activity in Patients with Pain-Related Temporomandibular Disorders

Aim

The aim of this study was to evaluate masticatory muscle electrical activity in patients with pain-related and pain-free temporomandibular disorders (TMDs) as well as in subjects with no TMD.

Methods

Ninety children with mixed dentition were recruited to the study. Of this total, 30 subjects were diagnosed with pain-related TMD (TMD-P), 30 with pain-free TMD (TMD-PF), and 30 without TMD. We used Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD) to assess the presence of TMD in the examined children. The electromyographical (EMG) potentials of the temporalis and masseter muscles were measured with a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany) at rest and during maximum voluntary clenching (MVC).

Results

An analysis of the EMG recordings showed statistically significant intergroup differences in masticatory muscle electrical activity at rest and during MVC. Significantly higher rest temporalis muscle activity was noted in pain-related TMD subjects compared with that children from the pain-free TMD and non-TMD groups, as well as in TMD-PF children in relation to those without TMD. The EMG potentials of the temporalis muscle during MVC were much lower in patients with TMD-P than in pain-free TMD and non-TMD subjects. Masseter muscle activity at rest in the TMD-pain group was significantly greater, and masseter muscle EMG potentials during clenching were markedly lower than in patients with no TMD diagnosis.

Conclusion

The use of electromyography to assess masticatory muscle function revealed alterations in the pattern of temporalis and masseter muscle activity in patients with pain-related TMD compared with the pain-free subjects.

Identification of arthropathy and myopathy of the temporomandibular syndrome by biomechanical facial features

Background

Temporomandibular disorders (TMDs) are pathological conditions affecting the temporomandibular joint and/or masticatory muscles. The current diagnosis of TMDs is complex and multi-factorial, including questionnaires, medical testing and the use of diagnostic methods, such as computed tomography and magnetic resonance imaging. The evaluation, like the mandibular range of motion, needs the experience of the professional in the field and as such, there is a probability of human error when diagnosing TMD. The aim of this study is therefore to develop a method with infrared cameras, using the maximum range of motion of the jaw and four types of classifiers to help professionals to classify the pathologies of the temporomandibular joint (TMJ) and related muscles in a quantitative way, thus helping to diagnose and follow up on TMD.

Methods

Forty individuals were evaluated and diagnosed using the diagnostic criteria for temporomandibular disorders (DC/TMD) scale, and divided into three groups: 20 healthy individuals (control group CG), 10 individuals with myopathies (MG), 10 individuals with arthropathies (AG). A quantitative assessment was carried out by motion capture. The TMJ movement was captured with camera tracking markers mounted on the face and jaw of each individual. Data was exported and analyzed using a custom-made software. The data was used to identify and place each participant into one of three classes using the K-nearest neighbor (KNN), Random Forest, Naïve Bayes and Support Vector Machine algorithms.

Results

Significant precision and accuracy (over 90%) was reached by KNN when classifying the three groups. The other methods tested presented lower values of sensitivity and specificity.

Conclusion

The quantitative TMD classification method proposed herein has significant precision and accuracy over the DC/TMD standards. However, this should not be used as a standalone tool but as an auxiliary method for diagnostic TMDs.

Effects of Rapid Palatal Expansion on Chewing Biomechanics in Children with Malocclusion: A Surface Electromyography Study

Malocclusion during childhood may affect both morphology and masticatory function and could greatly affect the subsequent growth and development of the jaws and face. The purpose of this study was to evaluate the efficiency of surface electromyography in describing the effects of the rapid palatal expansion (RPE) on Masseter (M) and Temporalis Anterior (T) muscles' activity in 53 children with different types of malocclusion: bilateral posterior crossbite (BPcb), underdeveloped maxillary complex without crossbite (NOcb) and unilateral posterior crossbite on the right (UPCBr) and on the left (UPCBl). The muscular activities during chewing tasks were assessed bilaterally before and after RPE application and three months after removal. Both the envelope's peak (µV) and its occurrence (% of chewing task) were extracted from the surface electromyography signal. Our results showed the presence of statistically significant differences (p < 0.05) on temporomandibular joint muscles, across different assessments, in all the tested populations of subjects. Surface electromyography demonstrated a relationship between the correction of a maxillary transverse discrepancy and the restoration of a muscle's activation patterns comparable to healthy subjects for both T and M.

Cervical spine range of motion, posture and electromyographic activity of masticatory muscles in temporomandibular disorders

Abstract Introduction: Temporomandibular joint disorders (TMD or TMJD) involve clinical problems and symptoms affecting the temporomandibular joint (TMJ) and associated structures. The temporomandibular joints are anatomically connected to the cervical region, where cervical spine movements occur simultaneously to masticatory muscle activation and jaw movements. Objective: Our study sought to assess the relationship between the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), surface electromyography (sEMG) of the masticatory muscles, posture and cervical flexibility in women with TMD. Method: Fifty women with an average age of 27.0 ± 6.37 years, diagnosed with TMD according to RDC/TMD, were assessed for craniocervical posture, cervical flexibility and sEMG of the masticatory muscles. Results: There were no differences in jaw function limitations, depression, pain level and its interference in work ability and daily activities, posture and sEMG between TMD diagnoses or between muscle classification (p > 0.05). Depression scores were higher among participants with biarticular dysfunction (p = 0.023). The group with bruxism exhibited a higher pain level at assessment (p = 0.001) and a greater reduction in work ability (p = 0.039). Subjects with muscular and mixed TMD showed less cervical rotation to the right when compared with those with articular TMD. Conclusion: There was no difference in posture or sEMG values for TMD diagnoses, joint and muscle dysfunctions and the presence of bruxism. Muscle dysfunction is associated with reduced cervical rotation to the right. Jaw function limitations did not interfere in posture or sEMG and depression was associated with pain.

Alterations in Surface Electromyography Are Associated with Subjective Masticatory Muscle Pain

Background

Tenderness of masseters and temporalis can be considered a relevant tool for diagnosis of myo-type craniofacial pain disorders, but a limit of pain score systems is that they are based on subjective pain perception. Surface electromyography (sEMG) is a noninvasive and reliable tool for recording muscle activity. Therefore, we investigated whether a correlation exists between tenderness on masseters and temporalis, assessed by subjective pain scale, and muscles activity, evaluated by sEMG, in patients with painful temporomandibular disorder (TMD) and concurrent tension-type headache (TTH).

Methods

A cross-sectional study on fifty adult volunteer patients with TMD and TTH, who underwent tenderness protocol according to Diagnostic Criteria for TMD (DC/TMD) guidelines, was conducted followed by sEMG recording of temporalis and masseters. Pearson's correlation was performed to investigate the correlation between muscular activity and subjective pain scores.

Results

An overall moderate correlation between muscle tenderness and sEMG values (y = 1 + 1.2 · x; r² = 0.62; p < 0.0001), particularly in the temporalis, was observed. Segregation of data occurred according to tenderness and sEMG values. At the highest pain score, the mean sEMG absolute value was higher at the temporalis than the masseters.

Conclusions

Our study provides evidence that subjective pain perception can be objectively quantified at a magnitude proportional to pain severity. At greater tenderness scores, higher sEMG activity at the level of temporalis could help discriminate clinically prevalent TTH versus prevalent TMD. sEMG confirms to be an accurate tool to reliably objectify the subjective perception of pain. When combined with clinical evaluation and patients' symptoms, sEMG increases diagnostic sensitivity in the field of myo-type craniofacial pain disorders. This trial is registered with NCT02789085.

The Diagnostic Value of Electromyography in Identifying Patients With Pain-Related Temporomandibular Disorders

Introduction: Orofacial pain disorders can be divided into several subgroups. One of them is temporomandibular disorders (TMD) with recognizable signs such as joint noises, limitations in the range of motion, or mandibular deviation during function and symptoms-pain in the muscles or joint. Surface electromyography (sEMG) is a diagnostic tool that ensures reliable and valid evaluation of muscle activity. sEMG detects electrical potentials and on this account may conceivably be employed in the TMD recognition. The aim of this study was to assess the sensitivity, specificity, and accuracy of electromyography in diagnosing subjects with temporomandibular disorders, including pain-free TMD and pain-related TMD. Methods: The sample comprised 88 patients with cleft lip and palate and mixed dentition. TMD has been recognized on the grounds of Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD). To evaluate the electrical activity of the temporal and masseter muscles in the rest position and during maximum voluntary contraction, a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany) was used. The analysis of the receiver operating characteristic (ROC) curve gave information about accuracy, cut-off point value, sensitivity and specificity of the normalized sEMG data. Results: The highest diagnostic efficiency of sEMG in terms of identifying subjects with TMD and pain-related TMD was observed for the mean values of temporal and masseter muscle activity as well as the Asymmetry Index of the masseter muscles in a rest position. A moderate degree of EMG accuracy in differentiating between pain-related TMD and non-TMD children was observed for the mean values of masseter muscle activity and the Asymmetry Index of the masseter muscles at rest. Conclusion: An evaluation of electromyography exhibits its diagnostic usability in recognition of patients with pain-related TMD and it could be used as an adjunctive tool in the identification of this disorder. Clinical Trial Registration: This clinical research was registered in the ClinicalTrials.gov database under the number NCT03308266.

Exodontia-induced muscular hypofunction by itself or associated to chronic stress impairs masseter muscle morphology and its mitochondrial function

Stress is associated with orofacial pain sensitivity and is qualified as a temporomandibular disorder risk factor. During stressful periods, painful thresholds of masticatory muscles in individuals suffering muscle facial pain are significantly lower than in controls, but the exact physiologic mechanism underlying this relation remains unclear. Our hypothesis is that chronic unpredictable stress and masticatory hypofunction induce morphologic and metabolic masseter muscle changes in rats. For test this hypothesis, adult Wistar rats were submitted to chronic unpredictable stress and/or exodontia of left molars and the left masseter muscle was removed for analysis. The parameters evaluated included ultrastructure, oxidative level, metabolism activity and morphological analysis in this muscle. Our data show by histological analysis, that stress and exodontia promoted a variation on diameters and also angled contours in masseter fibers. The masticatory hypofunction increased oxidative metabolism as well as decreased reactive species of oxygen in masseter muscle. The ultrastructural analysis of muscle fibers showed disruption of the sarcoplasmic reticulum cisterns in certain regions of the fiber in stress group, and the disappearance of the sarcoplasmic reticulum membrane in group with association of stress and exodontia. Our findings clarify mechanisms by which chronic stress and masticatory hypofunction might be involved in the pathophysiology of muscular dysfunctions. Masticatory hypofunction influenced oxidative stress and induced oxidative metabolism on masseter muscle, as well as altered its fiber morphology. Chronic stress presented malefic effect on masseter morphology at micro and ultra structurally. When both stimuli were applied, there were atrophic fibers and a complete mitochondrial derangement.

Electromyographic Analysis of Masticatory Muscles in Cleft Lip and Palate Children with Pain-Related Temporomandibular Disorders

Aim

The aim of this study was to assess the electrical activity of temporalis and masseter muscles in children with cleft lip and palate (CLP) and pain-related temporomandibular disorders (TMD-P).

Methods

The sample consisted of 31 CLP patients with a TMD-P (mean age 9.5 ± 1.8 years) and 32 CLP subjects with no TMD (mean age 9.2 ± 1.7 years). The children were assessed for the presence of temporomandibular disorders (TMD) using Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD). Electromyographical (EMG) recordings were performed using a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany) in the mandibular rest position and during maximum voluntary contraction (MVC).

Results

The rest activity of the temporalis and masseter muscles was significantly higher in TMD-P group compared with non-TMD children. A significant decrease in temporalis muscle activity during MVC was observed in TMD-P patients. There was a significant increase in the Asymmetry Index for temporalis and masseter muscle rest activity in the TMD-P group.

Conclusion

Cleft children diagnosed with TMD-P have altered masticatory muscle activity, and this can affect their muscle function.

Electromyographic ratio of masseter and anterior temporalis muscles in children with and without temporomandibular disorders

OBJECTIVE

This study investigated differences in surface electromyography (sEMG) activity of the masseter and anterior temporalis muscles in children with and without temporomandibular disorders (TMD).

PARTICIPANTS

Thirty-four children aged 8-12 years were recruited, comprising 17 children with TMD and 17 without TMD (control group [CG]). The children were quasi-matched for sex, age, weight, and height. sEMG data were obtained using Myosystem^® Br-1 equipment with 12 channels to evaluate the bilateral masseter, anterior temporalis, and suprahyoid muscles. For sEMG analysis, raw and normalized root mean square (RMS) values were obtained at rest and during maximum clenching. The sEMG ratios of the raw RMS data of the bilateral masseter in relation to the anterior temporalis muscles (sEMG-M/AT ratio) were also assessed. Mann-Whitney tests (p ≤ 0.05) were used to compare sEMG ratio between TMD group and CG.

RESULTS

Significant prevalences of pain during chewing (53% vs. 0%, X² = 5.87, p = 0.01), TMJ pain (58% vs. 0%, X² = 6.67, p = 0.01), neck pain (58% vs. 18%, X² = 3.77, p = 0.05) and pain in the temples (47% vs. 6%, X² = 5.44, p = 0.02) were identified in the TMD group compared to CG. Our results revealed lower sEMG-M/AT ratios during maximum clenching (p = 0.01) in children with TMD compared to those in the asymptomatic CG.

CONCLUSION

The results showed that children with TMD preferentially used their temporalis muscles during maximum voluntary clenching, probably as a consequence of nociceptive inputs in order to obtain pain relief.

A more precise, repeatable and diagnostic alternative to surface electromyography - an appraisal of the clinical utility of acoustic myography

Acoustic myography (AMG) enables a detailed and accurate measurement of those muscles involved in a particular movement and is independent of electrical signals between the nerve and muscle, measuring solely muscle contractions, unlike surface electromyography (sEMG). With modern amplifiers and digital sound recording systems, measurements during physical activity both inside and outside a laboratory setting are now possible and accurate. Muscle sound gives a representation of the work of each muscle group during a complex movement, and under certain forms of movement even reveals both concentric and eccentric activity, something that sEMG is incapable of. Recent findings suggest that AMG has a number of advantages over sEMG, being simple to use, accurate and repeatable as well as being intuitive to interpret. The AMG signal comprises three physiological parameters, namely efficiency/coordination (E-score), spatial summation (S-score) and temporal summation (T-score). It is concluded that modern AMG units have the potential to accurately assess patients with neuromuscular and musculoskeletal complaints in hospital clinics, home monitoring situations as well as sports settings.