Scand.J. Dent. Res. 1977; 85: 456-470 (Kcv- words: acupuncture; keJ
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EFFECT OF ACUPUNCTURE
The decrease in postural activity was especially marked when the posttreatment stage was compared with the pretreatment stage (differences III-I, Tables 4 and 5). For both the anterior temporal and masseter muscles the mean reductions in most instances were significant at the 1% or 5% level. The mean decrease in postural activity' was more pronounced in the initial recordings (A) than in the terminal recordings (B) and, as a rule, numerically greater for the anterior temporal than for the masseter muscles. The results are illustrated by the diagram Fig. 2, which shows the mean values and standard errors of the means for the initial postural activity with closed eyes at the three stages of observation. The figure shows the marked mean decrease in temporal postural activity during acupuncture and at the aftertreatment stage, while for the masseter muscles fairly slight changes were pv
465
observed. For the temporal postural activit)' a reduction in standard error of the means on completion of the acupuncture treatment was also noted. The average decrease in postural activity of the anterior temporal muscles during acupuncture and after completed treatment is turther illustrated by the mean \'alue diagrams of the initial recordings with closed eyes (Fig. 3A) and with open eyes (Fig. 3B). A more pronounced postural activity with open eyes than with closed eyes, as well as greater standard errors of the means, were noted at al! three stages of observation. On the other hand, the reduction in postural activity between the stages of observation did tiot, display any marked differences between the recordings with open and closed eyes. The individual variations in postural activit)' with closed eyes of the right anterior temporal muscle in the 21 experi-
POSTURAL ACTrVITY ( CLOSED EYES I INITIAL RECORDINGS
4
HTA LTA RM LM
: : .:
RIGHT ANT. TEMPORAL LEFT ANT. TEMPORAL RIGHT MASSETER LEFT MASSETEB
1 '
RTA LTA m
LIM
I. BEFORE T R E A T M E N T
BTA iTA mvi LM II. ACUPUNCTURE Fig. 2.
RTA LTA RIM LM III. AFTER TREATMENT
466
JENSEN, TALLGREN, TROEST AND JENSEN POSTURAL ACTIVITY 1 CLOSED EYES I ANTERIOR TEMPORAL MUSCLES INITIAL RECORDINGS
I. BEFORE TREATMENT
II. ACU. PUNCTURE
tlV
III. AFTER TREATMENT
POSTURAL ACTIVITY ( OPEN EVES ) ANTERIOR TEMPORAL MUSCLES INITIAL RECORDINGS
I. BEFORE TREATMENT
II. ACU. PUNCTURE
B
Fig. JA, B
mental subjects during initial recordings (A) and terminal recordings (B) at the three stages of observation are shown graphically in Fig. 4. The electromyographic recordings from a subject with pronounced reduction of postural activity in the left temporal muscle during and after acupuncture are shown in Fig. 5. PCSTtJB*.l ACTIVITY niGHT WNTIEniDN TE>
INITIAL *N0 Tl
III. AFTER TREATMENT
Discussion
In the present study of the efFect of acupuncture on headache of myogenic etiology, the clinical results (Table 2) indicated that a single acupuncture treatment relieved the headache in about 6096 of the 21 experimental subjects for a period of at least 1-4 months. The results obtained are in fairly good agreement with those reported by others. MANN & HAUFHIDE (1963) treated 42
Fig. 4
patients for various types of headache with acupuncture, giving from one to 14 treatments, and obtained considerable improvement in 7596 of the cases. PERLOW (1973) reported that 56% of 119 patients suffering from migraine were cured or their condition much improved after an average of six acupuncture treatments. Furthermore, MANN et cd. (1973) administered acupuncture to 18 patients with intractable pain and reported good results in most of the subjects. In two
EFFECT OF ACUPUNCTURE
fiRMTtllOR
CUKES ElU
.
467
TOKRILIS
KfCH m
fi^. 5, Electromyograms (EMG) and mean voltage {MV) of jaw muscle postural activity in one of the experimental subjects (No. 2,O.S.) during die three stages of obseivation. cases of temporomandibular joint pain, however, the acupuncture treatment was
CHAPMAN
1974,
KAADA
el
al.
1974,
A.MDRUPrfa/. 1975). The type of headache from which the not successful. HIEP & STALLARD (1974), on the other hand, found that present test subjects were suffering may be acupuncture relieved pain symptoms in 17 considered to have a multifactorial of 22 patients (77%) suffering from etiology including bruxism or clenching myofascial pain dysfunction syndrome. of teeth, occlusal disharmonies, muscle The number of treatments was not tension or spasms, temporotnandibtilar .specified, however. The somewhat lower joint dysfunction and psychic tension rate of improvement obser\'ed in the (PERRY 1956, BERLIN & DESSNER 1960). present study may be due to the fact that Aggravation of the headache symptoms is in contrast to the above-mentioned probably caused by an interaction of authors, only one acupuncture treatment several of these factors. The favorable was administered to each subject. results of acupuncture in the present Moreover, the needle was inserted only study, indicated by absence or reduction at one specified site in order to make the of the painful symptoms in 14 of the 21 subjects, may be due to breaking of a individual reactions comparable. The mechanism of action by .which vicious circle by release of muscle tension acupuncture exerts its pain-relieving effect (CHAPMAN 1974). A possible mediating has been widely discussed in the literature, analgesic effect of the acupuncture but no definite conclusions have yet been treatment should also be considered reached. The explanations range irom the (KAADAd al. 1974). classic Chinese meridian theor)' (MANN The electromyographic results obtained 1972a),, which is not considered to be in the present study would seem- to quite compatible with Western medical support the above hypothesis of muscle science (K/LiiDA et al. 1974), to the relaxation. The postural recordings of the involvement of neurophysiological anterior temporal and masseter muscles mechanisms (MAN & CHEN 1972, obtained before, during ,and immediately ANDERSSON et al. 1973, KROGER 1973, after the acupuncttire treatment thus
JENSEN, TALLGREN, TROEST AND JENSEN
468
showed an average marked decrease, particularly of the temporal activity. The reduction was especially pronounced when the posttreatment postural activity was compared with the pretreatment stage, both in the recordings with the eyes closed and in those with eyes open. As further illustrated in Fig. 4, the dispersion in postural activity between the subjects was markedly decreased at the posttreatment stage. It would have been of interest to extend the electromyographic part of the study beyond this stage, but this was not possible.
of the postural activity in different samples and under diflferent conditions are indicated. In the present sample the mean postural activity of the anterior temporal and masseter muscles at the pretreatment stage was lower than that reported by Lous et al. (1970) in the dysfunctional group and in the normal sample, and was approximately of the same order of magnitude as that observed in the abovementioned studies by TALLGREN et al. (1975) and TALLGREN et al. (1976). The present findings of a more marked Regarding the individual results, some postural activity of the anterior temporal than of the masseter muscles is in of the subjects who showed a pronounced accordance with previous eiectromyoinitial postural activity of the anterior graphic observations, among others, the temporal muscles displayed a noticeable decrease at the terminal stage of the pre- above-mentioned studies. Moreover, as illustrated in Fig. 4, pronounced changes treatment recording, particularly in the great individual variations in recordings with closed eyes (Fig. 4). As the and temporal activity were seen. The terminal part (B) of the recording was observations of a more marked electroobtained after a sequence of tapping, myographic response of the temporal biting and swallowing recordings, these than of the masseter muscles is in actions to some degree might have agreement with the widely held view of a quieted down the increased postural great sensitivity of the temporal muscles activity. Psychic factors should also be to different variables (MOVERS 1949, considered (SAINSBURY & GlBSON 1954, KYDD
1959). Lous, SHEIK-OL-ESLAM &
MOLLER (1970) studied jaw muscle postural activity in a normal sample and in subjects with functional disorders in the masticatory system and found stronger postural activity irt the dysfunctional group. The comparison was based on the average of an initial and terminal recording. In electromyographic studies of children with oral dysfunction (TALLGREN,
MELSEN
& HANSEN
1975),
and of partially edentulous individuals and complete denture wearers (TALLGREN, MCCALL,
WALKER
&
LANG
1976),
comparisons between initial and terminal postural activity showed tendencies to decrease, but the differences were not significant. Further studies for evaluation
JARABAK 1956, RAMFORD 1961, GARNICK
& RAMFJORD 1962). The present finding that the postural activity of the anterior temporal muscles was greater with open eyes than with closed eyes is in accordance with observations by KAWAMURA & FujlMOTo(1957). Regarding the clinical results of the acupuncture treatment it is realized that a possible placebo effect cannot be completely ruled out. Methods for studying this problem have been proposed and clinically tried by CROZE, ANTONIETTI &
DuCLAUX (1976), but as emphasized by MANN et al. (1973) and KAADA et al. (1974)
it is extremely difficult to establish a realistic control sample for placebo studies. Most subjects are acutely aware of
EFFECT OE ACUPUNCTURE the insertion of the needle, and the use of placebo points in the vicinity of acupuncture points selected for the experiment might produce identical effects (CROZE et al. 1976). Further studies for evaluation of this problem are needed. The clinical part of the present study has shown that acupuncture treatment can relieve headache of myogenic etiology. The results suggest that acupuncture may be considered an alternative or at least palliative treatment for patients suffering from chronic pain located to the head, face and neck, when severe organic diseases have been excluded as causative factors. The electromyographic investigation of postural activity in jaw muscles performed before treatment, during acupuncture, and immediately after completed treatment indicates that electromyographic recording of muscle activity can provide objective evidence of the effect of acupuncture.
469
electrical stimulation of teeth. Brain Res. 1973:63:393-396. BAKKE, M,: Effect of aeupuncture on the pain perception thresholds of human teeth. Scand.f. Denl. Res. 1976: 84: 404-408. BERLIN, R. Sc DESSNER, I.: Bruxism and chronic headache. Odontol. Tidskr. 1960:68: 261-268. CAPPERAULD, I., COOPER, E. & SALTOUN, D . :
Acupuncture anaesthesia in China. Lancet 1972: i; 1328-1330. CHAPMAN, C. R. : Acupuncture: Some considerations for the control of pain in dentistr). / Prosthet. Dent: 1974: 3 1 : 441-451. CROZE, S., A.NTONIETTI, C. & DUCLAUX, R . :
Changes in burning pain threshold induced by acupuncture in man. Brain Res. 1976: 104: 335-340. DIMOND, E. G . : Acupuncture anaesthesia. Western medicine and Chinese traditional medicine.-J. Am. Med. Assoc. 1971: 2!8: 1558-1563. GARNICK, J . & RAMFJORD, S. P.: Rest position.
An electromyographic and clinical investigation. / . Prosthet. Dent. 1962: 12: 895-911. HAN FENG-YEN, LIN JU-HENG, CH'EM K'O-CHTN & SUN JUNG-K'UN: Eleetroacu-
puncture for dental anaesthesia in exodonAcknowledgments — The authors wish to thank tia. Preliminary report of 100 cases. Chin. Professor Dr.odont. ElGiLfl MOLLER for Ued.J. 1960:80: 100-102. valuable assistance with electromyographic HARTMANN, F. C , NGUYEN VAN NGHI, SC technique, eand.odont.- CARSTEN CHRISTENSEN REBOUL, J. L.: Effects anesthesiques et for statistical assistance, BENTE RASMUSSEN for analgiques de l'acupuncture en odontosecretarial help, the staff members at the Dept. of stomatologie. Rev. OdmitostomatoL 1973: 20: Occlusion for their help, and the 21 dental 147-155. students for their participation in the exHIEP, N . & STALLARD, R. E.: Acupuncture - a periments. The investigation was in part valuable adjunct in the treatment of supported by a grant from D.T.E.'s Foncj til myofascial pain. Ann. Meet. Int. Assoc. st0tte for videnskabelige og praktiske unDent. Res. 1974: Abstr. No. 595. 7. Dent. dersogelserindenforTandlaegekunsten. Res. 1974: 53: Spec. Issue: 203. HOLMDAHL, M. H.: Bedavningseffekten av akupunktur. Laeiartidningen 1973: 70: References 701-706. jARABAK, J. R.: An electromyographic ,analysis AMDRUP, E., HARVALD, B., LUNDBAEK, K., Rirs, of muscular and temporomandibular joint P., SIGGAARD-ANDERSEN, O., SUM, J. C , disturbances due to imbalances in occluSKINHOJ, E. & SORENSEN, S. K.: En dansk sion. Angle Orthod. 1956: 26: 170-190. laegedelegation i Den Kinesiske Folke- JENSEN, S. B., JENSEN, J. S. & JENSEN, L. B: republik 1975. Ugeskr. laeger 1975: 137: Akupunktur analgesi. Tandlaegebladet. 1973: 1865-1890. 77:695-702. ANDERSSON, S. A., ERICSON, T., HOLMGREN, E.
& LiNDQvisT, G.: Electro-acupuncture. Effect on pain threshold measured with
KAADA, B., HOEL, E., LESETH, K., NYGAARDOSTBY, B., SETEKLEIV, J. & STOVNER, J.:
Acupuncture
analgesia
in the People's
JENSEN, TALLGREN, TROEST AND JENSEN
470
Republic of China — with glimpses of other graphic analysis. Am. f. Orthod. 1949: 35: aspects of Chinese medicine. Tidskr. Nor. 837-857. Laegeforen. 1974: 94: 417-422. MUMFORD, J. & BOWSHER, D . : ElectroKAWAMURA, Y. & FUJIMOTO, J.: Some acupuncture and pain threshold. Lancet physiologic considerations on measuring 1973: ii: 667. rest position of the mandible. Med. J. Osaka PERLOW, B. W . : Acupuncture: Its theory and Univ. 1957: ,8: 247-255. use in general practice. Proc. R. Soc. Med. KERR, N . W. : Acupuncture for therapy and 1973: 66: 426-428. analgesia. A possible application in dental PERRY, H . T., Jr.: Facial, cranial and cervical surgery. Br. Dent.f.: 1973: 134: 201-204. pain associated with dysfunction of the occlusion and articulations of the teeth. KROGER, W . S. : Acupunctural analgesia. Its Angle Orthod. 1956: 26: 121-132. explanation by conditioning theorj', autogenic training and hypnosis. Am. J. RAMFJORD, S. P : Bruxism, a clinical and Psychiat. 1973: 130: 855-860. electromyographic study. / . Am. Dent. Assoc. 1961:62:21-44. KYDD, W. L . : Psychosomatic aspects of ROGCIA, L.: L'azione analgesia dell'agopuntura temporomandibular joint dysfunction. / . in odontoiatria. Minerva Stomatol. 1972: 21: Am. Dent. Assoc. 1959: 59: 31-44. 106-108. LEE, M . H . M . , TENG, P., ZARETSKY, H . H . & SAINSBURY, P. Sc GIBBON, J. G.: Symptoms of RUBIN, M . : Acupuncture anesthesia in anxiety and tension and the accompanying dentistry. N.Y. Dent.f. 1973: 39: 299-301. physiological changes in the muscular Lous, L, SHEIK-OL-ESLAM, A. ,8= MOLLER, E . : system./. Neurol. Neurosurg. Psychiat. 1954: Postural activity in subjects with functional 17: 216-224. disorders of the chewing apparatus. Scand. J. Dent. Res. 1970: 78: 404-410. SOKAL, R. R. Sc ROHLF, F. J . : Biometry. The MAN, P . L. ,fe CHEN, C. H . : Mechanism of
principles and practice of statistics in biological
acupunctural anesthesia. The two-gate control theory. Dis. Nerv. Syst. 1972: 3S: 730-735.
research. W. H. Freeman, San Francisco 1969.
M A N N , F . : The ancient Chinese art of healing, 2nd
ed. W. Heinemann Medical Books, London 1972a. MANN,- F. : Acupuncture analgesia in dentistry. Lancet 1972b: i: 898-899. MANN,
F . SC HALFHIDE, A.: Treatment
of
headache by acupuncture. Med. World 1963: 98: 284-287. MANN,
E.,
BOWSHER,
D.,
MUMFORD,
J.,
LiPTON, S. & MILES, J.: Treatment of intractable pain by acupuncture. Lancet 1973: ii: 57-60. M O L L E R , E . : The chemng apparatus. An electromyographic study of the action of the muscles of mastication and its correlation to facial morphology. Thesis, Acta Physiol. Scand. 1966:
69: Suppl. 280. MOYERS, R. E . : Temporomandibular muscle cotitraction patterns in Angle Class II, diwsion 1 malocclusions: an electromyoAddress: Royal Dental College Vennelyst Boulevard DK-SOW Aarhus C Denmark
TALLGREN, A.: Changes in adult face height due to ageing, wear and loss of teeth and prosthetic treatment. .4 roentgen cephalometric study mainly on Finnish women. Thesis, Acta Odontol. Scand.
1957: 15: Suppl. 24. TALLGREN, A., MCCALL, W. D., Jr., WALKER,
G. F. & LANG, B. R. : Longitudinal study of jaw muscles and facial morpholog)' in denture wearers. Ann. Meet. Int. Assoc. Dem. Res. 1976, Abstr. No. 156. / . Dent. Res. 1976: 55: Spec. Issue B: B 100. TALLGREN, A., MELSEN, B. & HANSEN, M.A. :
An eiectromyographic study of occlusal morpho-functional disharmony in children. Ann. Meet. Int. Assoc. Dent. Res. 1975: Abstr. No. L37S./. Dent. Res. 1975:54: Spec. IssueA:L93. TROELSTRUP,
B. & MOLLER,
E . : Electro-
myography of the temporalis and masseter muscles in children with unilateral crossbite. Scand.f. Dent. Res. 1970: 78: 425-430. A. Tallgren University of Michigan School of Dentistry Dept. of Occlusion Ann Arbor, Michigan YS109 U.S.A.
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EFFECT OF ACUPUNCTURE
The decrease in postural activity was especially marked when the posttreatment stage was compared with the pretreatment stage (differences III-I, Tables 4 and 5). For both the anterior temporal and masseter muscles the mean reductions in most instances were significant at the 1% or 5% level. The mean decrease in postural activity' was more pronounced in the initial recordings (A) than in the terminal recordings (B) and, as a rule, numerically greater for the anterior temporal than for the masseter muscles. The results are illustrated by the diagram Fig. 2, which shows the mean values and standard errors of the means for the initial postural activity with closed eyes at the three stages of observation. The figure shows the marked mean decrease in temporal postural activity during acupuncture and at the aftertreatment stage, while for the masseter muscles fairly slight changes were pv
465
observed. For the temporal postural activit)' a reduction in standard error of the means on completion of the acupuncture treatment was also noted. The average decrease in postural activity of the anterior temporal muscles during acupuncture and after completed treatment is turther illustrated by the mean \'alue diagrams of the initial recordings with closed eyes (Fig. 3A) and with open eyes (Fig. 3B). A more pronounced postural activity with open eyes than with closed eyes, as well as greater standard errors of the means, were noted at al! three stages of observation. On the other hand, the reduction in postural activity between the stages of observation did tiot, display any marked differences between the recordings with open and closed eyes. The individual variations in postural activit)' with closed eyes of the right anterior temporal muscle in the 21 experi-
POSTURAL ACTrVITY ( CLOSED EYES I INITIAL RECORDINGS
4
HTA LTA RM LM
: : .:
RIGHT ANT. TEMPORAL LEFT ANT. TEMPORAL RIGHT MASSETER LEFT MASSETEB
1 '
RTA LTA m
LIM
I. BEFORE T R E A T M E N T
BTA iTA mvi LM II. ACUPUNCTURE Fig. 2.
RTA LTA RIM LM III. AFTER TREATMENT
466
JENSEN, TALLGREN, TROEST AND JENSEN POSTURAL ACTIVITY 1 CLOSED EYES I ANTERIOR TEMPORAL MUSCLES INITIAL RECORDINGS
I. BEFORE TREATMENT
II. ACU. PUNCTURE
tlV
III. AFTER TREATMENT
POSTURAL ACTIVITY ( OPEN EVES ) ANTERIOR TEMPORAL MUSCLES INITIAL RECORDINGS
I. BEFORE TREATMENT
II. ACU. PUNCTURE
B
Fig. JA, B
mental subjects during initial recordings (A) and terminal recordings (B) at the three stages of observation are shown graphically in Fig. 4. The electromyographic recordings from a subject with pronounced reduction of postural activity in the left temporal muscle during and after acupuncture are shown in Fig. 5. PCSTtJB*.l ACTIVITY niGHT WNTIEniDN TE>
INITIAL *N0 Tl
III. AFTER TREATMENT
Discussion
In the present study of the efFect of acupuncture on headache of myogenic etiology, the clinical results (Table 2) indicated that a single acupuncture treatment relieved the headache in about 6096 of the 21 experimental subjects for a period of at least 1-4 months. The results obtained are in fairly good agreement with those reported by others. MANN & HAUFHIDE (1963) treated 42
Fig. 4
patients for various types of headache with acupuncture, giving from one to 14 treatments, and obtained considerable improvement in 7596 of the cases. PERLOW (1973) reported that 56% of 119 patients suffering from migraine were cured or their condition much improved after an average of six acupuncture treatments. Furthermore, MANN et cd. (1973) administered acupuncture to 18 patients with intractable pain and reported good results in most of the subjects. In two
EFFECT OF ACUPUNCTURE
fiRMTtllOR
CUKES ElU
.
467
TOKRILIS
KfCH m
fi^. 5, Electromyograms (EMG) and mean voltage {MV) of jaw muscle postural activity in one of the experimental subjects (No. 2,O.S.) during die three stages of obseivation. cases of temporomandibular joint pain, however, the acupuncture treatment was
CHAPMAN
1974,
KAADA
el
al.
1974,
A.MDRUPrfa/. 1975). The type of headache from which the not successful. HIEP & STALLARD (1974), on the other hand, found that present test subjects were suffering may be acupuncture relieved pain symptoms in 17 considered to have a multifactorial of 22 patients (77%) suffering from etiology including bruxism or clenching myofascial pain dysfunction syndrome. of teeth, occlusal disharmonies, muscle The number of treatments was not tension or spasms, temporotnandibtilar .specified, however. The somewhat lower joint dysfunction and psychic tension rate of improvement obser\'ed in the (PERRY 1956, BERLIN & DESSNER 1960). present study may be due to the fact that Aggravation of the headache symptoms is in contrast to the above-mentioned probably caused by an interaction of authors, only one acupuncture treatment several of these factors. The favorable was administered to each subject. results of acupuncture in the present Moreover, the needle was inserted only study, indicated by absence or reduction at one specified site in order to make the of the painful symptoms in 14 of the 21 subjects, may be due to breaking of a individual reactions comparable. The mechanism of action by .which vicious circle by release of muscle tension acupuncture exerts its pain-relieving effect (CHAPMAN 1974). A possible mediating has been widely discussed in the literature, analgesic effect of the acupuncture but no definite conclusions have yet been treatment should also be considered reached. The explanations range irom the (KAADAd al. 1974). classic Chinese meridian theor)' (MANN The electromyographic results obtained 1972a),, which is not considered to be in the present study would seem- to quite compatible with Western medical support the above hypothesis of muscle science (K/LiiDA et al. 1974), to the relaxation. The postural recordings of the involvement of neurophysiological anterior temporal and masseter muscles mechanisms (MAN & CHEN 1972, obtained before, during ,and immediately ANDERSSON et al. 1973, KROGER 1973, after the acupuncttire treatment thus
JENSEN, TALLGREN, TROEST AND JENSEN
468
showed an average marked decrease, particularly of the temporal activity. The reduction was especially pronounced when the posttreatment postural activity was compared with the pretreatment stage, both in the recordings with the eyes closed and in those with eyes open. As further illustrated in Fig. 4, the dispersion in postural activity between the subjects was markedly decreased at the posttreatment stage. It would have been of interest to extend the electromyographic part of the study beyond this stage, but this was not possible.
of the postural activity in different samples and under diflferent conditions are indicated. In the present sample the mean postural activity of the anterior temporal and masseter muscles at the pretreatment stage was lower than that reported by Lous et al. (1970) in the dysfunctional group and in the normal sample, and was approximately of the same order of magnitude as that observed in the abovementioned studies by TALLGREN et al. (1975) and TALLGREN et al. (1976). The present findings of a more marked Regarding the individual results, some postural activity of the anterior temporal than of the masseter muscles is in of the subjects who showed a pronounced accordance with previous eiectromyoinitial postural activity of the anterior graphic observations, among others, the temporal muscles displayed a noticeable decrease at the terminal stage of the pre- above-mentioned studies. Moreover, as illustrated in Fig. 4, pronounced changes treatment recording, particularly in the great individual variations in recordings with closed eyes (Fig. 4). As the and temporal activity were seen. The terminal part (B) of the recording was observations of a more marked electroobtained after a sequence of tapping, myographic response of the temporal biting and swallowing recordings, these than of the masseter muscles is in actions to some degree might have agreement with the widely held view of a quieted down the increased postural great sensitivity of the temporal muscles activity. Psychic factors should also be to different variables (MOVERS 1949, considered (SAINSBURY & GlBSON 1954, KYDD
1959). Lous, SHEIK-OL-ESLAM &
MOLLER (1970) studied jaw muscle postural activity in a normal sample and in subjects with functional disorders in the masticatory system and found stronger postural activity irt the dysfunctional group. The comparison was based on the average of an initial and terminal recording. In electromyographic studies of children with oral dysfunction (TALLGREN,
MELSEN
& HANSEN
1975),
and of partially edentulous individuals and complete denture wearers (TALLGREN, MCCALL,
WALKER
&
LANG
1976),
comparisons between initial and terminal postural activity showed tendencies to decrease, but the differences were not significant. Further studies for evaluation
JARABAK 1956, RAMFORD 1961, GARNICK
& RAMFJORD 1962). The present finding that the postural activity of the anterior temporal muscles was greater with open eyes than with closed eyes is in accordance with observations by KAWAMURA & FujlMOTo(1957). Regarding the clinical results of the acupuncture treatment it is realized that a possible placebo effect cannot be completely ruled out. Methods for studying this problem have been proposed and clinically tried by CROZE, ANTONIETTI &
DuCLAUX (1976), but as emphasized by MANN et al. (1973) and KAADA et al. (1974)
it is extremely difficult to establish a realistic control sample for placebo studies. Most subjects are acutely aware of
EFFECT OE ACUPUNCTURE the insertion of the needle, and the use of placebo points in the vicinity of acupuncture points selected for the experiment might produce identical effects (CROZE et al. 1976). Further studies for evaluation of this problem are needed. The clinical part of the present study has shown that acupuncture treatment can relieve headache of myogenic etiology. The results suggest that acupuncture may be considered an alternative or at least palliative treatment for patients suffering from chronic pain located to the head, face and neck, when severe organic diseases have been excluded as causative factors. The electromyographic investigation of postural activity in jaw muscles performed before treatment, during acupuncture, and immediately after completed treatment indicates that electromyographic recording of muscle activity can provide objective evidence of the effect of acupuncture.
469
electrical stimulation of teeth. Brain Res. 1973:63:393-396. BAKKE, M,: Effect of aeupuncture on the pain perception thresholds of human teeth. Scand.f. Denl. Res. 1976: 84: 404-408. BERLIN, R. Sc DESSNER, I.: Bruxism and chronic headache. Odontol. Tidskr. 1960:68: 261-268. CAPPERAULD, I., COOPER, E. & SALTOUN, D . :
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