Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Effect of Experimental Muscle Fatigue on Muscle Pain and Occlusal Pattern

실험적으로 유발되는 근피로가 근통증 및 교합양상에 미치는 영향

  • Kim, Jae-Chang (Department of Oral Medicine, College of Dentistry, Wonkwang University) ;
  • Lim, Hyun-Dae (Department of Oral Medicine, College of Dentistry, Wonkwang University) ;
  • Kang, Jin-Kyu (Department of Oral Medicine, College of Dentistry, Wonkwang University) ;
  • Lee, You-Mee (Department of Oral Medicine, College of Dentistry, Wonkwang University)
  • 김재창 (원광대학교 치과 대학 구강내과학 교실) ;
  • 임현대 (원광대학교 치과 대학 구강내과학 교실) ;
  • 강진규 (원광대학교 치과 대학 구강내과학 교실) ;
  • 이유미 (원광대학교 치과 대학 구강내과학 교실)
  • Published : 2008.09.30
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Abstract

This study aimed to make an analysis of the occlusion in the state of muscle fatigue produced by excessive mouth opening and clenching during the dental treatment to control the dental pain and to evaluate the sensory nerve in the muscle pain state. Most of the reasons why patients visit the dental office result in pain-either conceivably the dental origin pain or the non-dental origin pain. The dental offices have many therapeutic actions to produce the masticatory muscle fatigue for the treatment. Dental treatment with long minutes of mouth opening can cause some headaches, masticatory muscle pain and mouth opening difficulties. Patients with mastication problems who visits a dental office to alleviate pain run against another unexpected pain with other aspects. This study uses T-scan II system(Tekscan Co., USA) for the evaluation on the occlusal pattern in the experimental muscle fatigue after clenching, opening the mouth excessively and chewing gum. The occlusal contact pattern is analyzed by the contact timing, namely first, intercuspal, maximum and end point of contact. This inspection was performed at frequencies of 2000Hz, 250 Hz and 5 Hz before and after each experimental muscle pain was produced to 24 subjects who had normal occlusion without the orthodontic treatment or a wide range of the prosthesis by using $neurometer^{\circledR}$ CPT/C(Neurotron, Inc. Baltimore, Maryland, USA). The measuring sites were mandibular nerve experimental muscle fatigue respectively. This study could obtain the following results after the assessment of occlusion and sensory nerve of the experimental muscle fatigue. 1. There were the fastest expression after the excessive mouth opening in muscle fatigue and after tooth clenching in muscle pain. In the visual analog scale that records the subjective level, there was the highest scale after the clenching in the muscle fatigue in jumping off the point of pain. 2. Tooth contact time, contact force, relative contact force on the point of the first contact had no difference, and there were decreases in the contact force after the excessive mouth opening on intercuspal position point, after the excessive mouth opening and the gum chewing on the point of the maximum, and in the contact time after all the experimental muscle fatigue state on the point of the end contact. 3. There was no statistic significance in the current perception threshold before and after the experimental muscle fatigue. 4. There was no significant difference in the contact number, the maximal contact number on the point of the first contact, and the contact number after the mouth opening and gum chewing on the point of the intercuspal position and the contact number after the experimental muscle fatigue on the maximum point, and showed significant decreases. In conclusion, it was found that the occlusal pattern can cause the changes on the case of the clinical muscle weakness by intra-external oral events. It was important that the sedulous attention to details is required during dental treatment in case of excessive mouth opening, mastication and clenching.

치과에 내원하는 주된 이유 중의 하나는 통증이며 이런 통증 치료시에 장시간의 개구는 저작근에 근육문제를 야기할 수 있다. 장시간의 근피로를 유발할 수 있는 치과진료실내에서의 치료로 인하여 두통, 저작근의 통증, 개구 장애, 저작 곤란 등을 유발할 수 있으며, 통증을 치료하기위하여 내원한 환자로서는 예상하지 못한 다른 국면의 통증에 맞부딪치게 된다. 물론 이악물기등의 악습관 그리고 과도한 껌저작등으로 인해서도 임상적으로 근쇠약감이 호소하며 이에 대해서는 실험적 근피로유도후에 근전도등을 이용하여 연구가 이루어져왔다. 근쇠약감 및 근피로로 인하여 교합양상의 변화를 주관적으로 호소하며 이 상태에서의 근육의 근전도 평가가 이루어져 왔던 것에 비하여 교합의 변화에 대해서는 평가가 미진하였다. 과도한 이악물기나 개구 및 껌 저작으로 인한 근피로가 교합양상에 미치는 변화를 평가하고 감각신경 변화로 인하여 근통증에 영향을 미치는 조사하고자 측두하악장애 증상이 없고 정상 범주의 교합을 가졌으며 교정치료나 3개 이상의 보철 치료를 받지 않은 지원자 총 24명(평균나이 25.7세)을 대상으로 하였다. 근 피로를 실험적으로 유발하기 위하여 이악물기, 장시간 개구 상태 유지, 주저작측으로 껌 저작을 시행하여 근피로를 느끼도록 하였다. 본 연구에서는 전기적 자극을 이용하는 뉴로미터를 이용하여 근통증시에 주저작측 삼차신경의 감각신경을 측정하였고, 근통증을 느끼는 시점에 근쇠약감이나 저작근 기능 장애로 인한 교합상태의 변화를 평가하기 위하여 T-scan II system을 이용하여 교합접촉, 교합력 등을 조사하여 다음의 결과를 얻었다. 1. 근피로는 장시간 개구 후에 가장먼저 느꼈으며 근통증을 느끼는 시간은 이악물기 후에 가장 빨리 나타났다. 근피로, 통증을 느끼는 시점에서의 근피로, 통증의 정도는 이악물기 후에 가장 높았다 2. 최초접촉시의 접촉시간 접촉력은 차이가 없었으며 교두간 접촉위에서 껌저작후 접촉시간, 장시간 개구 후와 껌저작후에 접촉력이 감소하였다. 최대접촉위에서는 장시간 개구후와 껌저작후에 접촉력이 감소하였다. 최종접촉위에서는 모든 실험적 근피로후에 접촉시간이 감소하였고 접촉력은 껌저작후에 감소하였다. 3. 실험적 근피로가 유발된 근육에서의 감각 변화는 보이지 않았다. 4. 접촉수는 실험적 근피로 유발후에 최초접촉위 최대 접촉위 그리고 최종접촉위에서 감소되는 양상을 보였다. 5. 접촉수의 주저작측에 따른 비교에서 좌측으로 껌을 저작한 군은 접촉수에 좌우측 차이를 보이지 않았으며, 우측으로 껌을 저작한 군에서는 좌측이 많았다. 결론적으로 구강내외에 발생하는 일련의 사건은 임상적으로 근쇠약감을 호소하는 경우 교합양상에 변화를 초래 할 수 있음을 확인 할 수 있었으며, 장시간의 개구나 이악물기, 과도한 저작등의 악구강계에 영향을 미칠 수 사건은 특히 치과치료 시에 교합 변화에 주의를 요함을 확인할 수 있었다.

Keywords

References

  1. Sundqvist B. Individual Prediction of Treatment Outcome in Patients with Temporomandibular disorders A quality improvement model. Swed Dent J 2007;186(s):1-42
  2. Okeson JP. Management of Temporomandibular Disorders and Occlusion. 6th ed., St. Louis, 2008, Mosby, pp.130-163
  3. de Leeuw R. Orofacial pain: Guidelines for Assessment, Diagnosis, and Management/ the AAOP 4th ed, 2008, Chicago, Quintessence Publishing Co. Inc., pp.1-59
  4. Okeson JP. Bell's Orofacial Pains The Clinical Management of Orofacial Pain 6th ed, Chicago, 2005, Quintessence Publishing Co. Inc., pp.287-328
  5. Cruccu G, Agostino R, Inghilleri M et al. The masseter inhibitory reflex is evoked by innocuous stimuli and mediated by A beta afferent fibers. Exp Brain Res 1989;77:447-450 https://doi.org/10.1007/BF00275005
  6. Cruccu G, Ongerboer de Visser BW. The jaw reflexes. The International Federation of Clinical Neurophysiology. Clin Neurophysiol Suppl 1999;52:243-247
  7. Wang K, Svensson P, Arendt-Nielsen L. Modulation of exteroceptive suppression periods in human jaw-closing muscles by local and remote experimental muscle pain. Pain 1999;82:253-262 https://doi.org/10.1016/S0304-3959(99)00058-5
  8. Svensson P, McMillan AM, Graven-Nielsen T, Wang K, Arendt-Nielsen L. Modulation of an inhibitory reflex in single motor units in human masseter by tonic painful stimulation. Pain 1999;83:441-446 https://doi.org/10.1016/S0304-3959(99)00124-4
  9. Bendtsen L, Jensen R, Brennum J, Arendt-Nielsen L, Olesen J. Exteroceptive suppression of temporal muscle activity is normal in chronic tension-type headache and not related to actual headache state. Cephalalgia 1996;16:251-256 https://doi.org/10.1046/j.1468-2982.1996.1604251.x
  10. Schoenen J, Jamart B, Gerard P, Lenarduzzi P, Delwaide PJ. Exteroceptive suppression of temporalis muscle activity in chronic headache. Neurology 1987;37:1834-1836 https://doi.org/10.1212/WNL.37.12.1834
  11. Tataroglu C, Kanik A, Sahin G, ozge A, Yalcinkaya D, Idiman F. Exteroceptive suppression patterns of masseter and temporalis muscles in central and peripheral headache disorders. Cephalalgia 2002;22:444-452 https://doi.org/10.1046/j.1468-2982.2002.00389.x
  12. Cadden SW, van der Glass HW, van der Bilt A. Modulation of jaw reflexes by remote noxious stimulation and mental state: possible association with psychological measurements of mental stress and occupation. J Oral Rehabil 1999;26:952-961 https://doi.org/10.1046/j.1365-2842.1999.00457.x
  13. van der Glas HW, Cadden SW, van der Bilt A. Mechanisms underlying the effects of remote noxious stimulation and mental activities on exteroceptive jaw reflexes in man. Pain 2000;84:193-202 https://doi.org/10.1016/S0304-3959(99)00208-0
  14. Wang K, Svensson P, Arendt-Nielsen L. Modulation of exteroceptive suppression periods in human jaw-closing muscles by local and remote experimental muscle pain. Pain 1999;82:253-262 https://doi.org/10.1016/S0304-3959(99)00058-5
  15. Svensson P. What can human experimental pain models teach us about clinical TMD? Archive oral biol 2007;52:391-394 https://doi.org/10.1016/j.archoralbio.2006.11.015
  16. Graven-Nielsen T, Arendt-Neilsen L, Sevensson P, Jensen TS. Experimental muscle pain: a qunatitative study of local and reffered pain in humans following injection of hypertonic saline. J Musculoskel Pain 1997;5:49-69 https://doi.org/10.1300/J094v05n01_04
  17. Jubeau M, Zory R, Gondin J, Martin A, Maffiuletti NA. Effect of electrostimulation training--detraining on neuromuscular fatigue mechanisms. Neuroscience Letters 2007;424:41-46 https://doi.org/10.1016/j.neulet.2007.07.018
  18. Torisu T, Wang K, Svensson P, Laat AD, Fujii H, Arendt-Nielsen L. Effects of muscle fatigue induced by low-level clenching on experimental muscle pain and resting jaw muscle activity: Gender differences. Exp Brain Res 2006;174:566-574 https://doi.org/10.1007/s00221-006-0497-4
  19. van Selms MKA, Wang K, Lobbezoo F et al. Effects of masticatory muscle fatigue without and with experimental pain on jaw-stretch reflexes in healthy men and women. Clinical Neurophysiology 2005;116:1415-1423 https://doi.org/10.1016/j.clinph.2005.02.017
  20. Maton B, Rendell J, Gentil M, Gay T. Masticatory muscle fatigue: endurance times and spectral changes in the electromyogram during the production of sustained bite forces. Archs oral Biol 1992;37:521-529 https://doi.org/10.1016/0003-9969(92)90134-T
  21. Palla S, Ash MM. Power spectral analysis of the surface electromyogram of human jaw muscles during fatigue. Archs oral Biol 1981;26:547-553 https://doi.org/10.1016/0003-9969(81)90016-9
  22. Naeije M. Correlation between surface electromyograms and the susceptibility to fatigue of the human masseter muscle. Archs oral Biol 1984;29:865-870 https://doi.org/10.1016/0003-9969(84)90084-0
  23. Kroon GW, Naeije M, Hansson TL. Electromyographic power-spectrum changes during repeated fatiguing contractions of the human masseter muscle. Archs oral Biol 1986;31:603-608 https://doi.org/10.1016/0003-9969(86)90084-1
  24. Leonard CT, Kane J, Perdaems J. et al. Neural modulation of muscle contractile properties during fatigue: afferent feedback dependence. Electroenceph clin neurophysiol 1994;93:209-217 https://doi.org/10.1016/0168-5597(94)90042-6
  25. Graven-Nielsen, T, Arendt-Nielsen, L, Svensson, P, Jensen TS. Stimulus-response functions in areas with experimentally induced referred muscle pain- A psychophysical study. Brain Res 1997;744:121-128 https://doi.org/10.1016/S0006-8993(96)01077-3
  26. Graven-Nielsen T, Fenger-Groon LS, Svensson P et al. Quantification of deep and superficial sensibility in saline-induced muscle pain: A psychophysical study. Somatosens Mot Res 1998;15:46-53 https://doi.org/10.1080/08990229870943
  27. Svensson P, Graven-Nielsen T, Arendt-Nielsen L. Mechanical hyperesthesia of human facial skin induced by tonic painful stimulation of jaw muscles. Pain 1998;74:93-100 https://doi.org/10.1016/S0304-3959(97)00156-5
  28. Seo Yong-Sun, Park Moon-Soo, Jung Jin-Yoo. Influence of muscle fatigue on perception threshold in masseter muscle and on masseteric silence period. Korean Academy of Oral Medicine 2002;27(1):107-116
  29. Kim HS, Kho HS, Kim YK, Lee SW. Reliability and characteristics of current perception thresholds in the territory of the infraorbital and inferior alveolar nerves. J Orofac Pain 2000;14:286-292
  30. Okeson JP. Management of Temporomandibular Disorders and Occlusion. 6th ed., St. Louis, 2008, Mosby, pp.164-331
  31. Baba K, Tsukiyama Y, Clark GT. Reliability, validity, and utility of various occlusal measurement methods and techniques. J Prosthet Dent 2000;83:83-9 https://doi.org/10.1016/S0022-3913(00)70092-8
  32. Ellrich J, Hopf HC, Treede RD. Nociceptive masseter inhibitory reflexes evoked by laser radiant heat and electrical stimuli. Brain Research 1997;764:214-220 https://doi.org/10.1016/S0006-8993(97)00459-9
  33. Sae-Lee D, Wanigaratne K, Whittle T et al. A method for studying jaw muscle activity during standardied jaw movements under experimental jaw muslce pain. J Neurosci Methods 2006;157:285-293 https://doi.org/10.1016/j.jneumeth.2006.05.005
  34. Graven-Nielsen T, Arendt-Nielsen L, Svensson P, Jensen TS. Stimulus-response functions in areas with experimentally induced referred muscle pain-a psychophysical study. Brain Research 1997;744:121-128 https://doi.org/10.1016/S0006-8993(96)01077-3
  35. Travell JG, Rinzler S, Herman M. Pain and disability of the shoulder and arm. Treatment by intramuscular infiltration with procaine hydrochloride. J Am Med Assoc 1942;120:417-422 https://doi.org/10.1001/jama.1942.02830410005002
  36. Lund JP, Donga R, Widmer CG, Stohler CS. The pain-adaptation model:a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol 1991;69:683-694 https://doi.org/10.1139/y91-102
  37. Svensson P, Graven-Nielsen T. Craniofacial muscle pain: Review of mechanisms and clinical manifestations. J Orofac Pain 2001;15:117-145
  38. Tayor JL, Butler JE, Gandevia SC. Changes in muscle afferents, motorneurons and motor drive during muscle fatigue. Eur J Physiol 2000;83:106-115 https://doi.org/10.1007/s004210000269
  39. Kalezic I, Bugaychenko LA, Kostyukov AI, Pilyavskii AI, Ljubisavljevic M, Windhorst U, Johansson H Fatigue-related depression of the feline monosynaptic gastrocnemius-soleus reflex. J Physiol 2004;556:283-296 https://doi.org/10.1113/jphysiol.2003.053249
  40. Cruccu G, Deuschl G. The clinical use of brainstem reflexes and handmuscle reflexes. Clin Neurophysiol 2000;111:371-387 https://doi.org/10.1016/S1388-2457(99)00291-6
  41. Cruccu G, Iannetti GD, Marx JJ et al. Brainstem reflex circuits revisited. Brain 2005;128:386-394 https://doi.org/10.1093/brain/awh366
  42. Oliveras JL, Woda A, Guilbaud G, Besson JM. Inhibition of the jaw opening reflex by electrical stimulation of the periaqueductal gray matter in the awake, unrestrained cat. Brain Res 1974;72:328-331 https://doi.org/10.1016/0006-8993(74)90875-0
  43. Oliveras JL, Redjemi F, Guilbaud G, Besson JM. Analgesia induced by electrical stimulation of the inferior centralis nucleus of the raphe in the cat. Pain 1975;1:139-145 https://doi.org/10.1016/0304-3959(75)90098-6
  44. Oliveras JL, Hosobuchi Y, Redjemi F, Guilbaud G, Besson JM. Opiate antagonist, naloxone, strongly reduces analgesia induced by stimulation of a raphe nucleus (centralis inferior). Brain Res 1977;120:221-229 https://doi.org/10.1016/0006-8993(77)90902-7
  45. Bar KJ, Greiner W, Letsch A, Kobele R, Sauer H. Influence of gender and hemispheric lateralization on heat pain perception in major depression. J Psychiatr Res 2003;37:345-353 https://doi.org/10.1016/S0022-3956(03)00051-7
  46. Wang K, Svensson P, Arendt-Nielsen L. Modulation of exteroceptive suppression periods in human jaw-closing muscles by local and remote experimental muscle pain. Pain 1999;82:253-262 https://doi.org/10.1016/S0304-3959(99)00058-5
  47. Torisu T, Wang K, Svensson P, Laat AD, Fujii H, Arendt-Nielsen L. Effect of low-level clenching and subsequent muscle pain on exteroceptive suppression and resting muscle activity in human jaw muscles. Clinical Neurophysiology 2007;118:999-1009 https://doi.org/10.1016/j.clinph.2006.11.311
  48. Pettorossi VE, Della Torre G, Bortolami R, Brunetti O. The role of capsaicin-sensitive muscle afferents in fatigue-induced modulation of the monosynaptic reflex in the rat. J Physiol 1999;515:599-607 https://doi.org/10.1111/j.1469-7793.1999.599ac.x
  49. Brunetti O, Della Torre G, Lucchi ML, Chiocchetti R, Bortolami R, Pettorossi VE. Inhibition of muscle spindle afferent activity during masseter muscle fatigue in the rat. Exp Brain Res 2003;152:251-26 https://doi.org/10.1007/s00221-003-1544-z