Transcutaneous electrical nerve stimulation (TENS) in dentistry: A breakthrough in pain management

Pain management is a paramount concern in dentistry. Patients often endure discomfort during various dental procedures, ranging from routine cleanings to more complex treatments such as extractions and root canals. For decades, conventional pain relief methods such as local anesthesia and analgesic medications have been the staples of dental care.

However, an alternative approach is gaining prominence, potentially revolutionizing dental pain management: transcutaneous electrical nerve stimulation (TENS) units. Here’s a look into the historical development, operational principles, current usage, and significant impact of TENS units on dentistry.

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History of TENS

The roots of TENS units can be traced back to the early 1970s when they first emerged as a noninvasive pain relief modality. Initially devised for applications in physical therapy, TENS technology is typically credited to American neurosurgeon Dr. C. Norman Shealy.¹ TENS rapidly gained recognition due to its efficacy in managing diverse pain conditions. The foundation of TENS is rooted in the "gate control theory of pain," originally proposed by researchers Ronald Melzack and Patrick Wall in 1965.² According to this theory, pain signals are conveyed to the brain through nerve pathways, and TENS units operate by disrupting these signals.

How TENS units function

TENS units operate on a simple yet effective principle: by delivering low-voltage electrical currents to the skin's surface through adhesive electrodes. These currents induce a tingling or buzzing sensation, which serves two primary functions in dental pain management:

Pain suppression: The electrical currents generated by TENS units stimulate nerves in the treatment area, effectively "closing the gate" to pain signals. This stimulation interferes with the transmission of pain messages to the brain, diminishing the patient's perception of discomfort.

Endorphin release: TENS units also induce the release of endorphins, the body's natural pain relievers. These endorphins not only alleviate pain but also promote a sense of well-being and relaxation.

Dental uses of TENS

The use of TENS units in dentistry is a newer practice that hasn’t yet been widely adopted, but the technology is showing great promise for a multitude of uses. TENS technology in dentistry has evolved considerably, with numerous devices available to dental professionals. Dentists and patients alike can now benefit from advanced TENS units that cater specifically to dental applications. These units are designed with ease of use, precision, and patient comfort in mind.

Patient experience and comfort

One of the primary advantages of TENS units in dentistry is their ability to enhance the patient’s experience. Patients undergoing dental procedures frequently experience apprehension and pain. TENS technology offers a noninvasive and drug-free alternative to traditional pain management methods, reducing patient anxiety and discomfort.

Dental procedures and TENS

There are no contraindications for TENS unit usage. TENS units are used in a wide range of dental procedures, including:

Tooth extractions: Patients undergoing tooth extractions can benefit from TENS units to manage pain and discomfort after the procedure.

Periodontal treatments: TENS units offer pain relief for patients receiving treatments for periodontal disease. This includes using the TENS units to control pain during periodontal scaling procedures rather than anesthetic injections or topical anesthetic.

Orthodontic procedures: Patients undergoing orthodontic adjustments can experience relief from the discomfort associated with braces and aligners through TENS. The TENS unit can help alleviate the pain after each adjustment.

TMJ disorders: TENS is utilized to alleviate pain and tension in patients with temporomandibular joint (TMJ) disorders. Used inside the mouth, the units can interrupt the pain signal from the inflammation in the joint.

Preventive and cosmetic procedures: TENS technology is also used for pain management during routine cleanings and cosmetic dental procedures. Used prior to probing, TENS can make the experience much more comfortable.

Tooth sensitivity and acute pain: Used directly on the teeth TENS units can interrupt the pain signals from the nerve to stop both sensitivity as well as acute pain from an abscessed/infected tooth.

Teething pain: TENS units are safe to use with babies to help with teething pain. They can be used directly on the tissue to stop the irritation from teething, making the infant or toddler more comfortable.

Ulcer and trauma pain: These units can also be used to reduce or alleviate the pain from bites, aphthous and traumatic ulcers, and other mouth trauma and sores. Used around the injury or lesion, they can make it much more comfortable for the patient to eat or swallow while healing.

The future of TENS in dentistry

As the dental community continues to embrace TENS technology, it is likely to become a more integral component of dental care. The innovation and advancement of TENS units specifically designed for dental applications will further contribute to improved patient comfort and satisfaction during dental procedures.

TENS units represent a groundbreaking advancement in dental pain management. Their historical development, rooted in the gate control theory of pain, their mechanisms of action, and their increasing adoption statistics all attest to their growing significance. TENS units offer patients and dentists a noninvasive, drug-free approach to pain relief, enhancing the overall dental experience. As dental technology continues to evolve, TENS units are poised to play an increasingly pivotal role in dental practices worldwide, redefining patient comfort and quality of care.

References

1. Teoli D, An J. (2023, January 22). Transcutaneous Electrical Nerve Stimulation. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537188
2. Mendell LM. Constructing and deconstructing the gate theory of pain. Pain. 2014;155(2):210-216. doi:10.1016/j.pain.2013.12.010

Lisa Curbow, BAAS, RDH, has been in clinical practice for almost three decades, serving in both periodontal and general offices. She has also served as an office manager and hospital coordinator. Lisa’s passion is in educating and empowering others to be better equipped to treat patients with special needs. She is a member of the SCDA, AADMD, and iADH. Lisa can be contacted at [email protected].