How Effective Is the Neuromuscular Occlusion Approach in diagnosing and treating TMD?
This summary is based on the Rapid Response Report developed by the Canadian Agency for Drugs and Technologies in Health: Neuromuscular Occlusion Concept-based Diagnosis and Treatment of Tempromandibular Joint Disorders: A Review of the Clinical Evidence
- The use of electromyograms (EMG) is not supported by evidence.
- There is insufficient evidence to determine the diagnostic value of kinesiography.
- Electrical stimulation is not supported by evidence.
- The efficacy of occlusal splints is uncertain.
Temporomandibular disorder (TMD) is a group of clinical problems involving the chewing muscles, the temporomandibular joint (TMJ), and related structures. Symptoms may include headache, muscle and joint pain, difficulty chewing, and TMJ clicking or stiffness. TMD may be diagnosed using a clinical examination called the Research Diagnostic Criteria for TMD that groups people into three categories depending on the results of the examination and their symptoms (muscular, disc displacement in the TMJ, or arthralgia/osteoarthritis/osteoarthrosis).
The term dental occlusion refers to the way in which the teeth come together. Neuromuscular occlusion (NMO) considers the entire system that controls the positioning and function of the jaw — the teeth, muscles, and joints ―and seeks a balanced relationship between them. This is done through various means including transcutaneous electrical nerve stimulation (TENS), electromyograms (EMG), computerized mandibular scans, electrosonography,and kinesiography. Using these techniques, the rest position of the jaw is determined and is then used as a reference to establish the ideal mandibular position. The dental occlusion is then altered or adjusted to produce the new mandibular position. This can be achieved by surgery, an occlusal splint (an appliance that stabilizes the occlusion in a particular position), or other means.
Various studies related to the diagnostic values of the electromyography in TMD patients showed that the technology produced a wide range and inconsistent values of specificity and sensitivity that prevent its adoption as a diagnostic test for TMD. The EMG indices were not consistently different between TMD patients and the healthy controls. Furthermore, the EMG indices correlated poorly with the clinical signs and symptoms of TMD, such as pain and function.
Other studies on the electrical stimulation of muscular muscles showed that the use of contingent electrical stimulation was not different from the use of placebo in changing the clinical outcome or the electromyographic evaluation.
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