Introduction: The use of Electrical Stimulation (ES) in Myofunctional Therapy has been growing exponentially in the recent years, in many countries around the world, for the treatment of algesias and stimulation of muscle tone, aiming to prevent and recover from disorders in orofacial miology, voice, speech, and in dysphagia. Nowadays is considered extremely important to realize which scientific evidence exists on the use of Transcutaneous Electrical Nerve Stimulation (TENS) and Neuromuscular Electrical Stimulation (NMES), also known as Electrical Muscle Stimulation (EMS), Electromyostimulation or Functional Electrical Stimulation (FES), in orofacial miology.

The purpose of this systematic review was to examine the current evidenced therapeutic possibilities of ES in myofunctional therapy based on neurophysiological principles of action as a mean of supporting further research and clinician’s use of evidence-based practice.

Key words: electrical stimulation, tongue thrust, mastication, temporomandibular dysfunction, mouth breathing

Electrical Stimulation: Therapeutic Possibilities In Miofunctional Therapy

Martins ,S.1,2 Santos, R. 2, 3,4; Mangas, V. 1,2 ; Murteira, A. 1 ; Cruz, A. 1

1 SLP, Centro de Medicina de Reabilitação do Sul, S. Brás de Alportel 2 Teacher, Instituto EPAP

3 SLP, Private Hospital of Trofa 4Teacher, Escola Superior de Tecnologia do Porto

International Symposium on Orofacial Myofunctional Therapy Rome | 6,7 e 8 June 2014

Method:

A systematic search in Electronic databases was completed to identify relevant peer-reviewed literature published in Portuguese, Spanish and English, between 1985 and 2013. It has been searched articles examining the use of NMES as method of intervention in orofacial motor disorders, such as: tongue thrust, miofunctional disturbances in chewing process, mouth breathing and temporomandibular dysfunction (TMD).

Discussion: A total of 16 articles were in agree with the inclusion criteria. 13 included relevant data aiming the effects of TENS on Miofunctional Therapy: - 9 as been effective in reducing the pain in compromised muscle tissues and in cases of TMD including Bruxism, promoving analgesia and relaxation.(1,2,3,4,5,6,7,8,9); - 3 afirm less efficacy of TENS when compared with other currents, like MENS or intereferencial currents. (10,11,12) - 1 referred no effects of TENS, when used as the only therapy, in persons with TMD(13) 2 refered the successfull use of NMES: - 1 improving facial muscle toning (14) - 1 refering the use of NMES for the structural reorganization of the orbicular muscle in a children with congenital lip cleft(15). We didn't found any study referring the use of NMES in mouth breathers patients or tongue thrust. One of the studies referred the use of russian current in hypotonics labial muscles in patients bearing class II - division I, of Angle suggesting effective results of it’s use(17). All the other results for the search of articles peer review that refer the use of NMES in speech therapy were concerned to dysphagia and some for the rehabilitation of facial palsy, as well many of the results for the use of TENS were concerned with dysphonia and as a form of analgesia in orofacial pain in oncological patients, as an alternative treatment for patients whit xerostomia, and as a form of treatment for patients with facial hemispasm. Considerable variation, in many cases even absent, of information about the procedures, was noted in the participants, interventions, and treatment schedules. It was identified significant weaknesses in almost all studies.

Conclusion:

Based on the results of this evidence-based systematic review, there is insufficient evidence to support or refute the use and effects of ES, especially NMES, in motor orofacial disorders. TENS is the one with more evidence-based report in promoting analgesia and relaxation in patients with DTM. Nevertheless this literal review also shows several theoretical principals that indicate the possibilities of the use of NMES in other miofunctional disorders as tongue thurst, chewing disorders and mouth breathers. Having that into consideration we suggest well-designed studies, using well-described participant groups in the use of ES on Miofunctional Therapy, to provide clinicians with evidence-based practice especially for the use of NMES.

References: [1] Bassanta, A.D; Sproesser, J.G; Paiva, G..Estimulação elétrica neural transcutânea ("TENS"): sua aplicação nas disfunções temporomandibulares, Rev.odontol.Univ. São Paulo;11(2):109-16, abr.-jun. 1997.; [2] Bazzotti L.Electromyography tension and frequency spectrum analysis at rest of some masticatory muscles, before and after TENS. Electromyogr Clin Neurophysiol. 1997 Sep;37(6):365-78.; [3] EBLE, O.S.; JONAS, I.E.; KAPPERT, H.F. Transcutaneous electrical nerve stimulation (TENS): its short-term and longterm effects on the masticatory muscles. Journal Orofac. Orthop. 61 (2): 100-11, 2000.; [4] Frucht, S.; Jonas, I.; Kappert, H.F. Muscle Relaxation By Transcutaneous Electric Nerve Stimulation (TENS) In Bruxismo. An Electromyographic Study. Fortschr Kieferorthop. 56 (5): 245-53,1995.; [5] Johnson, M.I.; Ashton, C.; Thompson, J.W. The Consistency of pulso frequencies oral pulse patterns of transcutaneous electrical nerve stimulation (TENS) used by chronic pain patients. Pain, 44: 231-234, 1991.; [6] Kato MT, Kogawa EM, Santos CN, Conti PC. TENS and low-level laser therapy in the management of temporomandibular disorders. J Appl Oral Sci. 2006;14:130-5.; [7] Monaco A, Sgolastra F, Pietropaoli D, Giannoni M, Cattaneo R. Monaco. Comparison between sensory and motor transcutaneous electrical nervous stimulation on electromyographic and kinesiographic activity of patients with temporomandibular disorder: a controlled clinical trial. BMC Musculoskeletal Disorders 2013, 14:168.; [8] RODRIGUES, D.; OLIVEIRA, A. S.; BERZIN, F. Effect of conventional TENS on pain and electromyographic activity of masticatory muscles in TDM. Braz. Oral Res, 18 (4): 290-5, 2004.; [9] TREACY, K. Awareness/relaxation training and transcutaneous electrical neural stimulation in the treatment of bruxism. J. Oral. Rehabil, 26: 280-287, 1999.; [13];[10] Arana Ars, Marchese Mp, Barbosa Cmr. Influência Da Neuroestimulação Elétrica Transcutânea (Tens) No Tratamento De Incoordenação Do Complexo Côndilo-disco. Fol.Faculdade De Odontologia De Lis/UNIMEP, Vol.14 Nº1jan/Jun:44-53, 2002.; [11] Linde C, Isacsson G.,Jonsson BG.Outcome of 6-week treatment with transcutaneous electric nerve stimulation compared with splint on symptomatic temporomandibular joint disk displacement without reduction. Acta Odontol Scand. 1995 Apr;53(2):92-8.; [12] Rajpurohit B, Khatri SM, Metgud D, Bagewadi A. Effectiveness of transcutaneous electrical nerve stimulation and microcurrent electrical nerve stimulation in bruxism associated with masticatory muscle pain - A comparative study. Indian J Dent Res 2010;21:104-6.; [13] Alvarez-arenal, A., Junquera, L. M., Fernández, J. P., González, I. And OLAY, S. (2002), Effect Of Occlusal Splint And Transcutaneous Electric Nerve Stimulation On The Signs And Symptoms Of Temporomandibular Disorders In Patients With Bruxism. Journal Of Oral Rehabilitation, 29: 858–863.; [14] Kavanagh S, Newell J,Hennessy M,Sadick N.Use of a neuromuscular electrical stimulation device for facial muscle toning: a randomized, controlled trial. J Cosmet Dermatol. 2012 Dec;11(4):261-6. ; [15] Shmerling MD, Filiushina EE, Plotnikova NA, Buzueva II, Zheleznyĭ PA. Organization of the orbicular muscle of the mouth in children with a congenital cleft of the upper lip undergoing electrostimulation.Arkh Anat Gistol Embriol. 1987 Nov;93(11):81-7. [16] Gugisch, KBB; Aumann, S; Klippel Júnior J H; Nohama P. Aplicação da corrente russa em músculos labiais hipotônicos em pacientes portadores de classe II - divisão I, de Angle, como coadjuvante no tratamento ortodôntico. J. bras. ortodon. ortop. Faciall,10(56):149-158, mar.-abr.2005. ilus, tab.

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Graphic 1 – Research Results