In my opinion, Drs. Gary Klasser and Jeffrey Okeson missed the point in their June JADA review.
They mistakenly joined "diagnosis" and "treatment" as though they are one. While arguing that surface electromyography (SEMG) lacks "specificity" and cannot be used to make an exclusive diagnosis (that is, to rule a diagnosis in or out) of temporomandibular disorder (TMD), the authors ignore the true clinical value and marketed use of SEMG as a measurement device in treatment.
The real damage of this article is their suggestion that dentists who use SEMG could over-diagnose or misdiagnose, and may do harm to patients, while ignoring the positive value of precise measurement in improved care for patients with TMD.
SEMG’s value in the treatment of TMD and in restorative dentistry is its ability to objectively measure and monitor the functional status of the masticatory muscles before treatment, aiding in treatment design and evaluation of treatment progress and outcome. This is "evidence-based dentistry."
The authors acknowledge the value of measurement in Table 1, but deny the value of SEMG measurement of masticatory muscle function in the treatment of patients with TMD. The SEMG device has been recognized by the American Dental Association Council on Scientific Affairs with the Seal of Acceptance as an aid in diagnosis, and by the U.S. Food and Drug Administration with approval to market.
SEMG, used to monitor treatment progress of individual patients, provides valuable intra-patient comparative measurements, thereby eliminating many of the anatomical variables described by the authors. Used to analyze large groups of patients, SEMG permits valuable, statistically significant computation, despite slight variations between individual patients.1
The authors provide no new argument not published a decade ago. Adversaries of the use of computerized measurement devices have republished and rereferenced repeatedly in journals the same denigrating personal opinions. The authors’ opinion that the use of SEMG can lead to mistreatment and overtreatment, with possible biological, psychological and economic consequences, is based on the flawed premise that SEMG is a clinical diagnostic device. SEMG is used properly by trained dentists to measure precisely physical parameters of a patient’s masticatory system, and not to diagnose.2–5 It does not lead to false-positive diagnoses; rather, it is a valuable asset in performing optimal treatment.
The authors state that their "gold standard"—history, examination ruler, muscle and temporomandibular joint palpation and imaging when necessary—is enough to diagnose and treat TMD. That statement is incorrect. In today’s medical and dental practice, diagnostic and treatment decisions should be based not only on history, clinical findings and imaging, but also on available testing procedures.
The authors have incorrectly criticized the clinical utility of SEMG measurements of masticatory muscle function in the treatment of TMD. While the dental profession acknowledges the value of evidence-based dentistry and encourages the use of available science, it should recognize that SEMG provides clinically valuable information to a trained dentist. Its use should be enhanced and encouraged, not disparaged by colleagues in the field of dental education.
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