The purpose of our article was to investigate the known scientific literature in the area of SEMG and to draw conclusions regarding its usefulness. Only articles with sound research designs were selected from refereed journals. Unfortunately, controlled clinical trials are lacking in this area.
Dr. Jenkins "was surprised to find that, with all the search words the authors used, they did not run across the words ‘neuromuscular’ or ‘Myotronics.’ " In fact, a review of 40 years of PubMed only revealed three articles with the combination of these terms, and only one had actual data.1 That article reported on muscle activity during chewing, which was unrelated to the topic of our review article.
Researching the words "neuromuscular dentistry" and "surface EMG" in PubMed revealed only 15 articles in a 40-year period. Only one of these was related to the topic of our article, and it was included in our references.2 The others reported data on subjects in which surface electrodes were attached and a variable was introduced. In a controlled experimental design study, this is a legitimate use of SEMG, since the recording devices remain constant, and the differences in measurements before and after the specific variable studied was introduced could be accurately measured. We found only two references in PubMed related to "Myotronics" and "surface EMG," and the experimental designs were similar to the manner described above.3,4
We realize that Myotronics (a company name) and neuromuscular dentistry have been around for a long time, and much has been said and written about them. A review of the available scientific databases, however, reveals a lack of well-designed published studies in refereed journals supporting these concepts. We felt the data that needed to be referenced in a review article for JADA should come from refereed journals. We found 116 articles that provided the bases for our review.
Dr. Jenkins refers to "the gold standard in cardiology was a stethoscope. Now the gold standard is an electrocardiogram: an SEMG" as an analogy for justification for its use in the field of temporomandibular disorders (TMDs). When the field of cardiology progressed from the stethoscope to the electrocardiogram as a major diagnostic tool, the evolution was based on the scientific merit of reliability, validity, sensitivity and specificity. Using these same criteria and applying them to SEMG and its use in the diagnosis and treatment of TMD, does not yield comparable scientific results.
Therefore, as stated in our article, the current "gold standard" in the diagnosis and treatment of TMD remains a comprehensive evaluation of the patient’s history and clinical examination supplemented, when deemed appropriate, with imaging. It is only through using a sound scientific approach that we can ensure that our patients are given the highest quality of care, based on the best available scientific evidence, thereby preventing unnecessary or inappropriate treatments.
Dr. Jenkins also is concerned that Dr. Okeson has a financial interest in an enterprise that opposes neuromuscular dentistry and, therefore, should have disclosed this interest. Dr. Okeson does offer a DVD lecture series, but in none of the 28 DVDs offered does he mention neuromuscular dentistry.
Dr. Jenkins may be referring to an April 29, 2006, presentation made by Dr. Okeson at the California Dental Association’s Spring Scientific Session in Anaheim, "The Clinical Management of Temporomandibular Disorders." In this presentation, he did discuss the pros and cons of five different present-day concepts related to occlusion and jaw position. Neuromuscular dentistry was one of the five concepts. The California Dental Association is selling the recording of his lecture, but Dr. Okeson receives no financial gain from these sales.
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