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Table of Contents
REVIEW ARTICLE
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 8-13

Microcurrent electrical nerve stimulation in dentistry: A narrative review


Department of Oral Medicine and Radiology, Maratha Mandal's NGH Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India

Date of Submission10-Dec-2019
Date of Decision24-Jan-2020
Date of Acceptance30-Apr-2020
Date of Web Publication03-Jul-2020

Correspondence Address:
Dr. Rohini Sarnaik
Plot No 114, III Stage Hanamannavar Road, Hanuman Nagar, Belgaum - 590 001, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_77_19

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  Abstract 


Application of electricity in the field of medicine is not a new invention. In fact, it has been used over the past 150 years ago to treat bone fractures. Electromedicine was not in much use, and it has been recently revived due to its therapeutic benefits. Electrotherapy modality, especially transcutaneous electrical nerve stimulation (TENS), is traditionally used for a pain relief and also frequently used modality in the management of dental-related pain. However, microcurrent electrical therapy which is fairly a new technology used for tissue repair along with electroanalgesia for a variety of clinical conditions has been less explored in dental practice microcurrent electrical nerve stimulation (MENS) uses theoretically negligible amount of current at cellular level in relieving pain and promoting accelerated healing of damaged and inflamed tissue, which makes it as an efficient treatment modality in the management of pain with least number of side effects than drugs in chronic situations. It is also proposed that MENS is a superior modality in the treatment of masticatory muscle pain due to its electroanalgesia and tissue repair action. Hence, this article briefly reviews the application, effects, and side effects of MENS compared to traditional TENS.

Keywords: Electroanalgesia, Microcurrent electrical nerve stimulation, Pain, Transcutaneous electrical nerve stimulation


How to cite this article:
Sarnaik R, Ammanagi R, Byhatti S. Microcurrent electrical nerve stimulation in dentistry: A narrative review. Indian J Phys Ther Res 2020;2:8-13

How to cite this URL:
Sarnaik R, Ammanagi R, Byhatti S. Microcurrent electrical nerve stimulation in dentistry: A narrative review. Indian J Phys Ther Res [serial online] 2020 [cited 2020 Oct 1];2:8-13. Available from: http://www.ijptr.org/text.asp?2020/2/1/8/288870




  Introduction Top


Development in electromedical expertise has given physicians' effectual mode of management for pain-related disorders. Pain is one of the most serious problems that could be a substantial indicator of any disease process, but this indicator often has minimal diagnostic utility and remains a complicated issue for the clinician. Due to associated side effects and temporary relief observed with drug therapy, the patient seeks alternative medical treatment. Pain in the head, neck, ear, and temporomandibular joint (TMJ) is related to the alteration in occlusal vertical dimensions[1],[2],[3] that are considered as consequences of muscle hyperactivity or because of macrotrauma, one-sided chewing, and bruxism related to occlusal interferences and tensional discharge.[4]

Arterial flow to the contracting muscle may get affected due to sustained increase in the intramuscular pressure which, in turn, may affect the supply of nutrients and elimination of metabolites through arteries and veins, respectively, which, in turn, affects the ionic exchange at cell membranes.[1] This intrusion and interference are typically seen in conditions where the muscles are in a contracted state for a period of time (chewing or bruxism). This sustained isometrically contracted state leads to elevation of pyruvic and lactic acid, glycogen diminution, oxygen deficit, and decline in metabolite clearance.[4],[5],[6]

Physical therapy, occlusal therapy, medications, and even psychotherapy can relieve muscle pain. Physical therapy mainly aims at pain relief through muscle relaxation and enhanced movement of the lymph and blood to improve muscle physiology.[7]


  Traditional Therapy and Transcutaneous Electrical Nerve Stimulator Top


The traditional transcutaneous electrical nerve stimulation (TENS) has been in use for pain relief since the 16th century which provides pain relief by gate control theory with release of endorphins and by automatic and involuntary contraction of muscle.[8],[9]

In order to rehabilitate the injuries, clinicians routinely use neuromuscular electrical stimulators. Comparable electrotherapy equipment also employs a gentle form of electrically induced pain as in TENS to wedge the ability of the body to perceive the pain being treated.[10],[11] Endorphin output may increase when patients are treated with TENS at apprehended lower frequency levels (8 pulses per se cond or less) leading to temporary relief in about 50% of people. It is thought that the action of TENS works by activating A-beta pain-suppressing nerve fibers to overpower chronic C-fibers.[8] Similarly, by continually tapping the painful areas with a dull object, similar results could be achieved. Manipulation, cold, and heat also help soothe pain. Amperage (amp) is a time-set measure of current. Interferential therapy, TENS, and high-voltage pulsed galvanic stimulators deliver milliamperage (mA) current stimulus that generally exceeds the thresholds of nerve firing. This results in gentle tingling to extreme muscle throbbing sensations. Traditionally, TENS often worked with a current of up to 80 mA when the current was high enough to sense. Patients are instructed to locate the current at optimum acceptable tolerance, but the nervous system constantly accommodates the current level, creating similar resistance to that of chemical analgesics, but it induces mild electrical burns by raising the current. Through this technique, no major lasting impact was found, and the industry had little attention.

Hence, TENS as a substitute technique in the management of pain has limited awareness in dentistry. As far as microcurrent electrical nerve stimulation (MENS) is concerned, it is widely used in health-care setup due to its less side effects and cost, which can be self-administered by patients themselves.


  Microcurrent Electrical Nerve Stimulation Top


Besides TENS, MENS is also a method of electrically induced pain control, which has received little attention in dentistry. MENS used in dentistry provides current lower than 1000 μA. This type of current cannot stimulate motor fibers. A study suggested that many clinicians are applying microamperage stimulation to relieve pain and to aid in wound healing. Microcurrent electrical nerve therapy is a major development in fast pain control and also in speeding up healing process. The usage of current is 1000 times lesser microampere compared to that of TENS with less threshold of sensation. With a microcurrent device, the pulse or the length of time the current is transmitted and is much longer than previous technologies. A pulse in traditional TENS unit lasts only for about 0.5 s as compared to a standard microcurrent pulse that lasts for about 2500 times longer than TENS. In comparison to TENS unit in terms of electronic circuitry, a high-quality microcurrent unit has about ten times better circuitry than that of a TENS unit. A pocket-sized first home care MEN stimulator device was introduced in 1982, which provided the same results as more exclusive models.[12] It is easy for patients to learn how to apply it to control their pain. Unlike TENS, MENS is normally delivered by hand seized probes placed so that the current flows for 10 s through the painful region. The huge amount of pain problems can be treated with 10 s probe procedures with <10 applications. Most patients are pain free within 2 min of application, and there is usually a major carryover or residual effect of MENS, lasting for minimum of 8 h up to 3 weeks or longer.[12]

When the body is wounded at an exacting spot, the electrical equilibrium gets disturbed. It is assumed that the use of MENS over the injured site would realign this flow while helping to restore tissue. Since long time chronic masticatory muscle pain due to bruxism and muscle tenderness over masseter muscle with morning stiffness in the TMJ have been treated with various physiotherapy techniques, MENS is a comparatively new technology used in the management of pain.

It is believed that MENS could be better modality in the treatment of masticatory muscle pain by its electroanalgesia and tissue repair act.[3],[4],[6]


  Mechanism of Action of Microcurrent Electrical Nerve Stimulation Top


MENS works by treating the cause by its capability to excite cellular structure and augmentation of cell repair. Muscle spasm that occurs as a protective reaction to any trauma hampers blood supply leading to limited hypoxia, thereby causing building up of harmful metabolites and pain, which sequentially leads to fall of Adenosin Triphosphate (ATP) synthesis. MEN stimulus aids in refill of ATP leading to repair of the cells. A classic study showed that ATP production could be increased by nearly 500%, but by increasing the current, the results actually decreased. The study also verified its ability to increase amino acid and protein synthesis.[13] The therapeutic influence of MENS was seen in which trauma had influenced the electrical impulse of damaged cells.[14] The affected area showed high electrical resistance relative to the adjacent tissue, resulting in reduced electrical conductance through the traumatized area and reduced cellular efficiency,[14] impairing the healing process. Precise application of MENS to injured site increases the flow of endogenous current, allowing injured cells to recover to their ability, and the cellular membrane resistance is decreased. This permits easy flow of bioelectricity and enables in restoring homeostasis. This procedure helped to enable biochemical reactions that occur in healing.


  Rapid Pain Management Top


MENS, the furthermost value, aids in pain control.[13] MENS helps to reduce inflammatory signs such as edema or swelling, improves the range of motion and strength of muscle, assists in muscle relaxation, and accelerates wound healing,[15] particularly being effective in soft-tissue injuries, such as sprains,[16],[17] wounds, postoperative wounds, and long-term persistent pain caused by postoperative scars.[18] It is also proved to be beneficial in the treatment of arthritis, headaches, neuropathies, TMJ syndrome, bursitis, and tendinosis. Clinical knowledge shows that it can be used in sinus congestion, earaches, sore throats, toothache, skin ulcers, postherpetic neuralgia, conjunctivitis, and pressure neuropathies such as carpal tunnel syndrome as an adjunctive therapy. It also aids in prevention of delayed onset muscle soreness that occurs after strenuous exercise.[19] Postexercise muscle fatigue enhancement was observed after application of the current for 20 min after exercise over the exercise muscles. MENS does not function in a minority of patients or offers only brief palliative relief. Studies have shown to control hypertension,[20] failed back syndrome,[21],[22] arthritis,[23] Raynaud's phenomenon,[24],[25] tinnitus,[26],[27] and postanesthesia emesis.[28] In the field of dentistry, it is mostly used as an alternate for local anesthesia[29],[30] and to manage pain related with orthodontic treatment.[31]


  Cancer Pain Top


Patients with head-and-neck cancers having severe pain have been treated effectively with MENS, even in some cases immune to morphine.[32] There was relief of pain lasting from 8 h to more than 3 weeks after about 10 min of MENS application. The technique was used productively in MD Anderson Center at the University of Texas.[33]


  Fractures Top


A fracture in the bone more than half the bone diameter or synovial pseudarthrosis may cause collapse.[34] A number of methods have been found that are used to stimulate bone growth, with minimum being around 3–6 months of treatment. It is not new to use electrical therapy to treat nonunion of fractures. This application for fracture healing was first reported more than 150 years ago.[35] Electrical current stimulation provides a nonsurgical option for repair of the fracture. It is also being explored for its application in conditions such as osteonecrosis and osteoporosis. Further, Fukada and Yasuda[36] suggested that mechanically stressed bone generates a small unconstructive direct electrical current that stimulates bone development. Bassett and Becker[37] conducted research that contributed to the use of electrotherapy to treat bone fractures. By 1976, more than 100 articles describing the effects of electricity had been published unfolding the beneficial effect of electricity on bone augmentation and repair.[38] Electrotherapy has successfully treated thousands of cases of fracture nonunion and aseptic necrosis.

The foremost scientific experiment of the shortest current surgical implant in humans was done in the United States,[39] which in further study achieved results in 4 months in a large proportion of cases[40] and showed that electrodes that were made of stainless steel with 5–20 μA of current resulted in superior effect, while current above 20 microamps in reality causes stainless steel electrode files to die.[41] A pulsed electromagnetic field (PEMF) functions by generating a magnetic field around the nonunion site.[42] These devices are powered by the battery and are handy. Patients can wear the device for about 3–10 h in a day, and treatment continues for about 6 months. Many researchers concluded remedial rates of 90% with this approach.[43],[44],[45],[46]


  Tendon and Ligament Repair Top


Application of MENS seems to improve cell growth in connective tissue and accelerates the structure and formation of new collagen in injured tendons. Accelerated ligament and tendon healing has been reported,[47] and tendon healing has been shown to increase by over 250%. The microcurrent supplied in a PEMF format was also helpful in controlling shoulder refractory propensity.[48] Wilson in 1972 published studies on the treatment of soft-tissue injuries,[49] while Nessler used direct current (DC) application through implantable electrodes in severed dog tendons.[50]


  Wound Healing Top


Over 300 years ago, electricity was first used to treat surface wounds with charged gold leaf so as to prevent scars resulting from smallpox. The use of DC predates the use of electromagnetic fields, and numerous studies show promising results using this electrical modality. Previous experiments on animal models have shown accelerated epithelialization with DC and lead to a formation of stronger scar tissue. The first human study on three patients using direct electrical current reported complete cure of chronic venous ulcers of leg with 6 weeks of treatment. Leg ulcerations make up a chief share among chronic wounds, which poses a great therapeutic challenge. Ninety percent of leg ulcers are due to venous stasis, affecting women more than men in the sixth decade of their life. The use of Micro Electric Current Therapy (MET) is quick, secure, and competent and can have a tremendous impact on the improvement of wound healing. One in five out of 30 million lacerations is sufficiently serious that require ancillary care.[12] A researcher Becker[51] has shown that living tissues have numerous DC surface potential to form a robust bioelectric field. He assumed that trauma to the tissue caused a localized change in the current flow causing repair and referred to it as the current of injury (COI). Galvanic first identified COI in 1786, which was later confirmed in the 80s.[52],[53] Such authors examined children who had qualified for an accidental amputation of their digits. They found that the current peaked 8 days after the injury at 22 μA and then gradually decreased back to zero. This COI is believed to have caused biological repair, and later work has proven that the epidermis[54],[55] actually contains a battery-like component that can manipulate wound healing by somehow influencing physiology. Occlusive dressings speed up the wound healing by promoting a moist environment which resurfaces 40% faster than air-exposed wounds.[56],[57] Electrical stimulation of a wound receptors increases the formation of collagen through increase in the concentration of growth factor.[58] This may be important given the hypothesis that the removal of growth factors by venous hypertension is a major mechanism in causing ulceration.[59]

The most frequently cited study[60] used 200–1000 μA of DC in 67 patients that was replicated in 76 patients with 106 skin ulcers with ischemia.[61],[62] The results of these studies cited significant augmented healing as a result of electrical stimulation. GoIdin et al.[63] studied a group of patients who had 250 different types of ischemic ulcers. The series included 14 controls with ulcers. Compared with controls, there was a fourfold faster healing in response to electrical stimulation. A clear finding in these studies was that after several days of electrotherapy, wounds initially infected with Pseudomonas and/or protease were generally sterile. Other investigators also stated that this technique was the preferred treatment for laid-back ulcers.[64],[65] No substantial adverse effects due to electrotherapy have been documented,[66] and hence, MENS is evidently an effective and safe adjunct means of management for refractory leg ulcers.[67] A clear finding in these studies was that after several days of electrotherapy, wounds initially infected with Pseudomonas and/or protease were generally sterile. One animal study[68] that supports this technique suggests that bipolar current might be a better option for wound cure.[12]


  Potential Mechanisms for Repair Stimulation Top


A study done by Becker[47] showed that an electrical current acted as a stimulus that facilitated healing and regeneration of the tissue in all living organisms following an injury, but this mechanism became less effective over time. He theorizes the self-repair according to which a signal that is generated about specific tissue injury causes another signal to initiate repair process. Becker also indicates that early species do not need to transmit large amounts of complex information and may have had anything similar to an analog system that works by simple DC. Becker speculates that the first living organisms used this kind of electrical system to treat injury and that we still have this rudimentary nervous system located in the perineural cells concealed inside the central nervous system. Perineural cells have semi-conductive properties that allow nonpropagating DC signals to be generated and transmitted this assist in repair and also control the action of body cells by producing specific DC electrical environments in their environs.


  Contraindications Top


Microcurrent should not be used in patients with cardiac pacemakers as that may cause arrhythmias. Its application is also contraindicated during pregnancy due to the fact that electrical stimulation may affect endocrine control systems which, in turn, can potentially result in miscarriage. There are no known major adverse side effects of MENS other than those two conditions.[10]


  Method to Deliver Microcurrent Electrical Nerve Stimulation Top


Subject is made to recline comfortably during the procedure while a particular microcurrent frequency is applied to the targeted tissues. To promote conduction, the therapist uses electrodes to guide the current and places dry, moist towels over the affected area. Unlike the more common TENS devices, which also use electrical current to relieve pain, microcurrent is low because they do not activate the sensory nerves, so it does not have the shock-like feel.

A treatment course typically involves several sessions, and benefits occur over time. MENS therapy is safe, Food and Drug Administration-approved, and has no significant adverse side effects. It is not approved for pregnant women and patients with pacemakers, though. Before and after the treatment, it is also important to be well hydrated.[10],[13]


  Conclusion Top


MENS therapy aids in creating an ideal environment for the human body for self-healing process. It acts by stimulating an electrical field at the cellular level and also in enhancing circulation. Consequently, as the blood flows more actively through the pain area, it supplies more oxygen and promotes a faster and more natural healing process. Although additional studies are obligatory to describe the function of MENS, the outcome of research available till date strongly recommends that it will play an important role in the prospect of health care. It is time for clinicians to accept it as an alternative, with its advantages being easy availability, value-effectiveness, and safe use for a broader range of diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflict of interest.



 
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Mechanism of Act...
Rapid Pain Manag...
Cancer Pain
Fractures
Tendon and Ligam...
Wound Healing
Potential Mechan...
Contraindications
Method to Delive...
Conclusion
References

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