Objectives: Previous studies in the Oral Neurophysiology Laboratories in Dundee have defined the electromyographic properties of the inhibitory jaw reflex that can be evoked in human subjects by electrical stimulation of the lip. This reflex, in contrast with the more widely studied biphasic inhibitory reflexes evoked by stimulation of intra-oral nerves, consists of just a single phase of inhibition and usually requires the application of stimuli which excite nociceptive nerves. The aims of the present studies were to define the mechanical manifestations of this reflex in the form of changes in biting forces, and to investigate whether the mechanical manifestation of the inhibitory jaw reflex evoked by stimulation of the human upper lip, can be modulated by experimentally-controlled conditions that mimic symptoms of a myogenous temporomandibular disorder.
Methods: Three series of experiments were performed on 49 volunteer subjects in total. The experiments involved recording bite forces between the anterior teeth and electromyograms (EMGs) from the masseter muscles. Transcutaneous electrical stimuli were applied to the hairy skin of upper lip while the subjects maintained a biting force of around 50N with the aid of visual feedback. In the first series of experiments, a range of electrical stimuli below and above the nociceptive threshold was delivered. In the second set of experiments, double stimuli with a range of different inter-stimulus intervals were applied. Finally in a third series of experiments, electrical stimulation was repeated before, immediately after, and 5 and 10 minutes following a 3-minute accelerated chewing task. This task consisted of chewing 1.5g of a tough chewing gum at 1.5 times the subject’s natural chewing rate and in 18 cases, muscle fatigue and/or pain were reported by the subjects.
Results: Following stimulation at intensities that were described as sharp or painful, all the subjects showed both a suppression of the masseter EMG and a reduction of biting force. When analysing the maximum responses in each subject, the mean reduction in the EMG inhibition was to 15.78 ± 14.4% and 10.39 ± 7.92% of the baseline (for the ipsi- and contra-lateral EMGs respectively), whereas the biting force was reduced only to 83.98 ± 11.04% of baseline (+ S.D.). The latencies of onset of these responses were: 38.17 ± 3.58ms, 38.97 ± 4.49ms and 51.83 ± 6.23ms respectively. The response observed in the force record was weaker than in that observed in either EMG (Paired t tests, P < 0.005 in both cases). When applying double stimuli, it was found that the prolongation of the EMG inhibitory jaw reflex (to 144.70 ± 46.93% of the control level) evoked by double stimulation of the upper lip (with a 10 ms inter-stimulus interval) resulted in a greater increase in the depth of the accompanied relaxation (to 223.63 ± 70.88% of that seen in the control responses) compared to a relatively smaller increase in the duration of the relaxation (to 128.32 ± 27.23% of that seen in the control responses). Following the accelerated chewing task, 17 out of 22 subjects reported pain and/or fatigue in one or both of the masseter muscles. The integral for the bite force relaxation significantly decreased in size immediately following the conditioning procedure (to 76.04 ± 35.63% of the control level, P = 0.014; single sample t-test with Bonferroni correction, test value 100).
Conclusion: The inhibitory jaw reflex evoked by stimulation of the human lip can be demonstrated mechanically as well as electromyographically although the mechanical version of the response appears less marked. In addition to that, the onset of reflex relaxation in bite force lags several milliseconds behind the corresponding reductions in electromyographic activity. The depth of force relaxation can be increased by increasing the duration of EMG recorded inhibitory reflex. Finally, the results from a chewing task suggest that induced acute pain and/or fatigue cause clear changes in the mechanical manifestation of this inhibitory jaw reflex.
|Date of Award||2014|
|Supervisor||Samuel Cadden (Supervisor) & Mervyn Lyons (Supervisor)|
- Jaw reflex
- Bite force
- Temporomandibular Disorders
- Masseter muscle