Association of Masseter Muscle Activities during Awake and Sleep Periods with Self-Reported Anxiety, Depression, and Somatic Symptoms.

AIM AND BACKGROUND: The objective of this study was to determine if duty factors (DF) of low-magnitude MMA during awake and sleep periods were associated with self-reports of anxiety, depression, and somatic symptoms, and if so, whether or not any associations were modified by gender or the presence of pain. Limited information is currently available in the literature regarding the association of low-magnitude masseter muscle activities (MMA) in habitual environmental settings and the presence of psychological symptoms. MATERIALS AND METHODS: Sixty-eight consenting participants were classified using the Diagnostic Criteria for Temporomandibular Disorders examination and validated self-reporting psychological symptom evaluation questionnaires. Each subject also had masseter electromyography recordings during standardized biting tasks in 2 laboratory sessions to calibrate the in-field MMA collected during 3 awake and 3 sleep periods. RESULTS: During awake periods, subjects with self-reported depression and somatic symptoms had statistically high odds of having higher DF of low-magnitude MMA (defined by ≥ 75th percentile of sample). The association between high DF of low-magnitude MMA and self-reported depression symptoms was significantly augmented among male participants, whereas, the association between high DF of low-magnitude MMA and self-reported somatic symptoms was significantly increased among female participants without pain. CONCLUSION: These pilot data support associations of low-magnitude masseter muscle activities with self-reported depression and somatic symptoms during awake periods.

Effect of botulinum toxin injection on nocturnal bruxism: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of botulinum toxin type A on nocturnal bruxism. DESIGN: Twelve subjects reporting nocturnal bruxism were recruited for a double-blind, randomized clinical trial. Six bruxers were injected with botulinum toxin in both masseters, and six with saline. Nocturnal electromyographic activity was recorded in the subject's natural sleeping environment from masseter and temporalis muscles before injection, and 4, 8, and 12 wks after injection and then used to calculate bruxism events. Bruxism symptoms were investigated using questionnaires. RESULTS: Bruxism events in the masseter muscle decreased significantly in the botulinum toxin injection group (P = 0.027). In the temporalis muscle, bruxism events did not differ between groups or among times. Subjective bruxism symptoms decreased in both groups after injection (P < 0.001). CONCLUSIONS: Our results suggest that botulinum toxin injection reduced the number of bruxism events, most likely mediated its effect through a decrease in muscle activity rather than the central nervous system. We controlled for placebo effects by randomizing the interventions between groups, obtaining subjective and objective outcome measures, using the temporalis muscle as a control, and collecting data at three postinjection times. Our controlled study supports the use of botulinum toxin injection as an effective treatment for nocturnal bruxism.

Temporomandibular joint loads in subjects with and without disc displacement.

The likelihood of development of degenerative joint disease (DJD) of the temporomandibular joint (TMJ) is related to the integrity of the TMJ disc. Predilection for mechanical failure of the TMJ disc may reflect inter-individual differences in TMJ loads. Nine females and eight males in each of normal TMJ disc position and bilateral disc displacement diagnostic groups consented to participate in our study. Disc position was determined by bilateral magnetic resonance images of the joints. Three-dimensional (3D) anatomical geometry of each subject was used in a validated computer-assisted numerical model to calculate ipsilateral and contralateral TMJ loads for a range of biting positions (incisor, canine, molar) and angles (1-13). Each TMJ load was a resultant vector at the anterosuperi or-most mediolateral midpoint the condyle and characterized in terms of magnitude and 3D orientation. Analysis of variance (ANOVA) was used to test for effects of biting position and angle on TMJ loads. Mean TMJ loads in subjects with disc displacement were 9.5-69% higher than in subjects with normal disc position. During canine biting, TMJ loads in subjects with disc displacement were 43% (ipsilateral condyle, p=0.029) and 49% (contralateral condyle, p=0.015) higher on average than in subjects with normal disc position. Biting angle effects showed that laterally directed forces on the dentition produced ipsilateral joint loads, which on average were 69% higher (p=0.002) compared to individuals with normal TMJ disc position. The data reported here describe large differences in TMJ loads between individuals with disc displacement and normal disc position. The results support future investigations of inter-individual differences in joint mechanics as a variable in the development of DJD of the TMJ.

Waking-state oral parafunctional behaviors: specificity and validity as assessed by electromyography.

In contrast to sleep-related oral parafunctional behaviors, little is known about waking oral parafunctional behaviors. The Oral Behaviors Checklist contains terms referring to a variety of non-observable behaviors that are reliable when prompted (e.g. 'clench') but validity data are absent. Our goal was to assess whether (i) each behavioral term is distinct electromyographically, and (ii) temporomandibular disorder (TMD) subjects differ from non-TMD subjects in their performance. Surface electromyographic (EMG) activity was used to measure bilateral masseter, temporalis, and suprahyoid muscles while subjects (27 patients with TMD; 27 healthy controls) performed ten oral behaviors without explanation. Electromyographic data were averaged between bilateral muscles and two trials. A multivariate construct (jaw muscle activity) was analyzed using Wilks lambda within multivariate analysis of variance (manova). Obvious behaviors (e.g. clench, read, tongue press) exhibited expected EMG patterns, and patients and controls produced identical profile plots of the EMG data. Of 10 tested behaviors, nine were found to be associated with significantly differing proportions of amplitudes across muscles and were thus unique. Behaviors with similar terms were associated with different EMG patterns. The present data support the specificity of behavioral terms and performances. Implications include causation related to TMD based on subtle behaviors that occur at a high frequency.

Malocclusion as a risk factor in the etiology of headaches in children and adolescents.

INTRODUCTION: The purpose of this study was to determine the importance of occlusal factors in recurrent headaches in children and adolescents without other signs or symptoms of temporomandibular disorders or related craniomandibular disorders. METHODS: A sample of 50 children and adolescents, ages 8 to 16, who reported headaches was obtained from the University at Buffalo Orthodontic Clinic records; a control group of 50 children and adolescents, matched for age and sex, was also obtained. Plaster models, made during the routine collection of orthodontic records, were used to obtain the following occlusal trait measurements: Angle classification, overjet, anterior and posterior crossbite, scissors-bite, overbite, open bite, dental midline discrepancy, crowding, spacing, and dental development stage. RESULTS: Overbite, overjet, and posterior crossbite showed statistically significant associations (chi-square) with increased risk for headaches. Logistic regression analysis demonstrated that overjet was a significant factor only because of its correlation with overbite and posterior crossbite. Overjet was not significant after adjusting for the other 2 variables, whereas overbite and posterior crossbite were associated with significantly increased risk (>3:1) of headache. The combination of 2 or more of these 3 occlusal factors increased the risk of headache even more (8.5:1). CONCLUSIONS: Posterior crossbite and overbite > or =5 mm were associated with significantly increased risk of headache in children and adolescents.

Individual variations in numerically modeled human muscle and temporomandibular joint forces during static biting.

AIMS: To test the effects of occlusal force (OF) angle on the variations in predicted muscle and temporomandibular joint (TMJ) forces during unilateral molar bites. METHODS: The craniomandibular (CM) geometries of 21 individuals were determined from lateral and posteroanterior cephalometric radiographs. These geometries were used in a numerical model based on minimization of muscle effort. This model was previously validated for this subject group through the use of jaw tracking and electromyographic data. The model predicted muscle and TMJ forces associated with static OFs on the right mandibular first molar. OF angle was varied from vertical to 40 degrees in the buccal and lingual directions, in increments of 10 degrees. RESULTS: Intra- and intersubject variations in predicted muscle and TMJ forces for unilateral molar biting were dependent on OF angle and CM geometry. Nonvertical OFs were associated with either large anterior temporalis muscle forces (> 100% of applied OF in 3 subjects) or large inferior lateral pterygoid muscle forces (> 90% of applied OF in 3 subjects). On average, vertically and buccally directed OFs were associated with higher mean contralateral TMJ forces (60% of applied OF, SD 12%). Two subjects had large ipsilateral or contralateral TMJ forces (> 90% of applied OF). CONCLUSION: In a group of healthy subjects, depending on the individual CM geometry, large muscle and/or TMJ forces were predicted to be associated with specific unilateral molar OF angles. Propensities to increased muscle or joint forces may be predisposing factors in the development of myofascial pain or intracapsular disease. The results may explain, in part, the variation in location of symptoms in individuals who first present with temporomandibular disorders.