J /O A
REVIEW ARTICLES
Use of transcutaneous electrical nerve stim ulation
in dentistry
Richard R. Black, DDS
The literature on the use o f transcutaneous
electrical nerve stimulation in dentistry is
review ed , and w h at effect, i f any, this
method has on the dentist’s ability to control
pain is considered.
T he pain and anxiety caused by the
fe a r o f pain co n c ern d e n tists.
Many m ethods have been used to
alleviate pain experienced by dental pa­
tients including local anesthesia, general
anesthesia, pharm acologic sedation, ni­
trous oxide relative analgesia, and hyp­
nosis .1 An alternate m ethod o f pain con­
tro l ,2'4 which has received little attention
in dentistry, is transcutaneous electrical
nerve stim ulation (TEN S). TEN S has
found its greatest use with the physical
therapists in rehabilitation and chronic
pain co ntrol5; however, th e literatu re
shows that TENS is effective to varying
degrees in the control o f acute pain .2,4
This paper reviews the literature on the
use of TENS in dentistry and attem pts to
determ ine what role, if any, TEN S has in
the dentist’s ability to control pain.
History
T h e earliest written records of using electricity
to reduce pain come from the Greeks. They
used electric fish to num b various painful
areas.6 In the 1770s, Walsh7 and Cavendish8
first described the num bing effects produced
by electricity-producing machines. Francis9 was
the first person to describe relieving dental pain
by the use o f electricity. In 1858, he extracted
teeth while placing one electrode on the tooth
and the other electrode in the patient’s hand.
He states that he extracted 164 teeth with elec­
tricity to num b the area and that most of the
patients felt no pain. G arratt10 too used electri­
cal anesthesia for extraction in the mid-1800s
an d also reco m m en d ed th e te c h n iq u e for
trigem inal neuralgia, toothache, and jawache.
T h ere was much controversy regarding num b­
ing effects o f electricity, and in 1859 the College
o f Dentists o f L ondon” issued statem ents that
w ere skeptical o f th e tech n iq u e. T h ey a p ­
pointed a commission to look into the use o f
electrical anesthesia in dentistry and concluded
that it had no effect. O ne o f the commission
members changed his mind after he did not feel
pain durin g an extraction that was perform ed
with the use of electrical anesthesia.
A fter its initial wave o f popularity, electric
anesthesia was abandoned by most users be­
cause o f the variable and nonreproducible re ­
sults.12 A lthough a few people worked with this
technique over the years,12 it was not until 1967,
when Wall and Sweet13 conducted a study on
the gate control theory o f pain transmission,
that TENS began to come back into favor and
receive serious scientific study.
Mechanism of action
T h e use o f TENS is based on several in terre­
lated th eo ries on th e m echanism s o f pain
transmission and the blocking o f those mecha­
nisms. T he first of these theories was the gate
control theory advanced by Melzack and Wall.14
According to this theory, stimulation o f the
large, peripheral A-delta nerve fibers closes a
spinal gate and prevents painful stimuli carried
on the small C-fibers from gaining access to the
ascending transmission system. T his is the so-
called “rubbing it better” effect.
An alternative explanation offered for the
effectiveness o f TENS was that the stimulation
caused a release o f endorphins, which attached
to opiate receptors and blocked the transm is­
sion o f noxious stim ulation.15 Research showed
soon after that this was not the final answer as to
why the analgesic effects of TEN S occurred. In
some cases, these effects could be reversed by
injection o f naloxone,16 but in o th er cases the
analgesic effects could not be reversed o r could
be reversed only partially. This suggested that
o th er ways existed with which pain transmission
was blocked.17
F urther study1819 indicated that serotonin,
dopam ine, and n o repinephrine have im portant
roles in the effects o f stim ulation-produced
analgesia and that an increase in serotonin has a
direct relationship with th e analgesic effect
produced by TENS.
When using electrical cu rren t for analgesia in
teeth, Fields and o th ers20 believed th at the
analgesic effect was a resu lt o f an electro­
coagulation o f odontoblasts in the dentinal
tubules u n d e r the site o f the drilling. In his
study o f the same subject, Reid21 showed that
there was no significant dam age to odontoblasts
at 60 /j-A or less and that the analgesic effect was
caused by what he called anodal blocking o f
nerve fibers within the tooth.
Applications
Myofascial pain dysfunction syndrome
T h e so-called myofascial p ain dysfunction
(MPD) syndrom e is th ought to be a combination
o f occlusal disharm onies and an underlying
psychic tension. O ne theory is that the pain
associated with this syndrom e is caused by
spasms in the mastication muscles. T reatm ent
generally has consisted o f reducing the occlusal
d is h a r m o n ie s a n d re lie v in g th e m u scle
spasms.22
TEN S has been used in several ways to treat
MPD. In 1977, Markovich3 reported the use o f
TEN S to reduce muscle spasms in patients with
MPD. He originally used a high-voltage elec-
trogalvanic instrum ent th at activated the mus-
JADA, Vol. 113, October 1986 ■ 649
REVIEW ARTICLES
cle. Electrodes were placed either on the skin or
in the m outh o f the patient, and current was
applied for 3 to 15 minutes, usually the latter.
Markovich stated that this m ethod resulted in
considerable relief o f pain to the patient. T he
follow-up treatm ent consisted o f analgesics and
m uscle-relaxant tranquilizer. Markovich also
encouraged patients to visit a psychiatrist for
treatm ent o f possible underlying psychological
problems that he believed could be contributing
factors in causing MPD.
Markovich3 later used another type o f TENS
unit, which he said acted as a central inhibitor of
pain, to restore the balance o f the neurom uscu­
lar system. A fter use o f this technique, he re­
ferred the patients to dentists fo r occlusal ad­
justm ents or splint therapy. Markovich also re­
ferred patients for psychodynamic evaluation
and therapy.
Block and Laskin23 did a study on the effec­
tiveness o f TEN S in the treatm ent o f MPD
using a control group for comparison. T he
treatm ent group participated in six to 12 ses­
sions o f 30 m inutes each, twice a week. T he
control group participated in the same num ber
o f sessions, but no electrical cu rren t was used.
Both groups showed a range from complete
relief to no relief. T h e researchers concluded
that the TEN S treatm ents were somewhat ef­
fective.
A high-frequency, low-amperage TENS unit
has been used to treat MPD (S. Liss, personal
comm unication, Pain Suppression Labs, 1983).
T h e electrodes were placed over the painful
muscles to stimulate them for 3 to 30 minutes.
T his unit was believed to block the pain and
increase blood flow to the area. In the study o f
20 patients, 16 experienced complete pain re­
lief, two experienced significant pain relief, and
two experienced little or no pain relief.
W essberg and others24 treated MPD by using
a TEN S unit to generate a relaxed, muscularly
o riented, occlusal position o f the mandible. At
the first appointm ent, they placed the elec­
trodes over the sigmoid notch and applied cu r­
re n t fo r a m inim um o f 45 m inutes at the
threshold level (the level o f electrical cu rren t at
which the patient first could feel any sensation).
D uring the second appointm ent, the TENS
treatm ent was applied the same as it was during
the first appointm ent. T h en a direct intraoral
occlusal record was done as determ ined by
T EN S at a stim ulation level one increm ent
above the threshold level. These records were
evaluated, and the patients received either oc­
clusal adjustm ent o r an occlusal splint. At sub­
sequent appointm ents, they used the TENS
therapy to do necessary adjustm ents to the den ­
tition o r to the splint until a stable position was
achieved. O f the 21 patients included in the
study, 20 had positive and one had a negative
im mediate response to therapy. O ne year after
treatm ent, 18 o f the patients had positive and
three o f the patients had negative responses to
therapy.
Gold and others25 conducted a study o f 40
patients with MPD. T hey apportioned h alf into
a treatm en t g ro u p and h a lf into a control
group. Electrodes were placed over the masse-
650 ■ JADA, Vol. 113, October 1986
ter and tem poralis muscles on the involved side.
In the treatm ent group, the patient set the unit
to the highest tolerable level. T h e control group
was told that TEN S worked best at subsensory
levels, and the unit was not turned on. T he
results o f the study indicated that treatm ent
with TENS was no better than treatm ent with­
out TENS—both had a high (60% to 70%) ini­
tial success rate.
Treatment of facial neuralgias
O ’Neil26 reported on the use o f TEN S in the
treatm ent o f 12 cases o f trigem inal neuralgia
and 12 cases o f atypical facial neuralgia. TENS
he method known as TENS has a definite but, at this time,
limited use in dentistry.
was used as an adjunctive treatm ent to therapy
with d ru g s such as carbam azepine. O ’Neil
placed the negative electrode in a preauricular
position overlying th e te m p o ro m an d ib u lar
jo in t and the facial nerve. T he positive elec­
trode was placed over the infraorbital foram en
or the mental foram en depending on w hether
the second division o f the fifth cranial nerve or
the third division o f the Fifth cranial nerve a p ­
peared to be involved. T reatm ents were given
for 20-m inute periods at weekly intervals.
O ’Neil26 reported an overall success rate of
58%. T h e success rate decreased to 42% after 6
months. More success was seen in the patients
with trigem inal neuralgia (ten o f 12) than was
seen in the patients with atypical facial pain
(four of 12). In his discussion, O ’Neil adm itted
to difficulties in interpreting the results because
o f a lack o f controls but stated that the treat­
m ent sessions seemed to be appreciated by most
o f the patients and produced results m ore fa­
vorable than would have been expected had
TEN S not been used.
Sedation
Shane and Kessler27 used TENS for sedation
d u rin g dental procedures. They used simul­
taneous high-frequency (3,200 to 8,000 Hz) and
low-frequency (5 to 40 Hz) alternating electric
cu rren t o f low milliam perage (2 to 29 mA)
through the brain. They stated that the advan­
tage o f this technique would be that the patient
could leave the dental ofFice immediately after
the current was switched o ff w ithout the re ­
sidual effects o f sedative drugs.
T h e m ethod used by the authors was to place
one electrode over each closed eyelid and an
opposite electrode over the occiput. T he mil­
liam perage was started at zero and gradually
increased until the desired effect was obtained.
This generally took 15 to 40 minutes. Increas­
ing the milliamperage at a faster rate caused the
patient to experience a severe, burning sensa­
tion. Electrosedation did not relieve pain or
mem ory o f pain, so the authors found it neces­
sary to use short-acting barbiturates to induce a
general anesthesia when rapidly increasing the
milliamperage and adm inistering the local an ­
esthetic.
A total of 12 patients received electrosedation
and only five experienced complete relaxation.
I'he patients’ reactions ranged from pleading
not to have the current turned o ff to stating that
receiving the current was one o f the most mis­
erable experiences o f his o r her life. This study
was discontinued as a result o f the severe reac­
tions o f many o f the patients; however, the au­
thors believed that this treatm ent held pos­
sibilities and deserved fu rth er study.
Cavity preparation
T he area that lias received the most attention in
the use of TENS in dentistry is cavity p rep ara­
tion. As with all the procedures dentists per­
form , one of the greatest concerns in cavity
preparation is that the pulpal tissue not be dam ­
aged perm anently. Dogon and others28 pub­
lished a study designed to determ ine the pulpal
response to an air-driven turbine handpiece
containing an electromagnetic coil delivering
100 mV versus the pulpal response to a conven­
tional air-driven turbine handpiece. They de­
tected no histological differences in the pulpal
response o f the two groups and stated that pre­
liminary results showed no histological differ­
ences in pulpal responses with handpieces that
delivered 200 and 400 mV.
T asm an29 conducted a study to m easure the
changes in im pedance o f tissue between two
electrodes im planted in the maxillary canine of
a cat and to determ ine the effect that direct
currents had on tooth structure histologically.
He reported that clinically significant blocking
o f pain could be produced with a direct cu rren t
o f 60 fiA and that this level o f cu rren t did not
induce irreversible changes in the dentin or
pulp.
Brooks and others,30 in the first clinical study
o f the use of TENS for cavity preparation, re­
ported the subjective and objective pain re­
sponses noticed during cavity preparation in 76
adult males. T h e device used was a magnetic
field set close to the patient’s face and a h and­
piece with a built-in wire coil. T he coil rotated in
the magnetic field and produced a cu rren t of
approximately 5 /aA and .06 V. T h e circuit was

completed by an electrode held in the patient’s
hand. They reported that this technique pro­
duced a decrease in sensitivity.
Ehrlich31 reported a clinical study o f a Rus­
sian electrical device called the Sin Dolar. The
negative electrode from this device was at­
tached to the patient’s ear and the positive elec­
trode was attached to the drill. T he handpiece
was insulated with a rubber tube to prevent the
operator from grounding the current. The
maximum output o f this device was 22.5 V and
60 /¿A. Normally, a current o f 5 to 20 (iA was
used. For 100 patients ranging in age from 13 to
60 years, the author stated that there were
mixed results. He believed that although the Sin
Dolar was no panacea, it did have a place as one
more tool to enable a dentist to practice painless
dentistry.
Bradley and others32 conducted a study on
the use o f a modified air-turbine handpiece.
Their handpiece contained the magnet and the
coil within the head o f the handpiece that made
a miniature electrical generator producing an
electrical impulse o f 0.6 V. They did a single­
blind study and found that most patients in the
active group experienced no pain or slight pain
and that most patients in the control group ex­
perienced minimal pain to moderate pain.
Bradley and others believed that with the use o f
this device, preparation could be completed for
many patients without local anesthetics.
Laster and Pressm an33 rep orted using
another Russian-made electroanesthetic device,
the Eloz-1, electric tooth freezer. The Eloz-1
delivered a maximum current o f 18 V and 50
fiA . As with the Sin Dolar, the positive electrode
was attached to the earlobe. Although the in­
structions stated that this device should be used
with a direct-drive handpiece, the study was
done with an air-turbine handpiece to deter­
mine whether the current would cross the air
gap in the turbine effectively. The authors re­
ported that the Eloz-1 reduced pain during
those procedures that normally elicit high levels
o f pain and seemed to be o f little, if any, benefit
during those procedures that normally elicit
low levels o f pain. They also found that discus­
sion o f the nature o f the electroanesthetic de­
vice with patients before its use had a negative
influence on its effectiveness.
Horiuche and others34 reported on what they
called an improved method for applying elec­
troanesthesia in cavity preparation. T hey
used a 0.8-mm stainless steel wire as the positive
electrode and placed it on dentin within 3 mm
o f the tip o f the bur. The negative electrode was
held by the patient in his or her hand. The
patients varied the electric current to gain the
optimum level. The currents used ranged from
0.1 to 1.5 fj.A, and the maximum voltage was 45
V. Horiuche and others stated a success rate o f
63%. They believed that their method was
superior to other methods in that it allowed the
use o f maximum current and did not allow for
fluctuation in the current as a result o f the
change in speed o f rotation o f the turbine-pro-
duced electrical current used in some other sys­
tems.
Savage35 reported an improved version o f an
electroanalgesic device. He increased the volt­
age o f the unit from 9 to 18 V and increased the
maximum amperage from 50 to 65 ¡j.A. He also
added a battery tester and a reverse polarity
switch. Savage believed that the best results
were in the range of 40 to 60 /iA and that if
analgesia was improperly established or lost
during cavity preparation, the reversal o f the
polarity reestablished analgesia. In 22 patients
tested, only one did not receive a satisfactory
level o f analgesia. Thermal tests o f the treated
teeth gave positive responses and no clinical
evidence existed o f irreversible pulpal damage
to any o f the teeth.
Other researchers (Curcio, F., and Bergeger,
R., unpublished findings, 1983) took a new ap­
proach to the use of TENS in cavity prepara­
tions. Instead o f having the electric current run
through the tooth, they placed contacts on the
web o f the hand, on the mastoid area, and in-
traorally in the mucobuccal fold adjacent to the
operative site. The patient had control o f the
unit and increased the current as needed. The
unit used produced a maximum o f 4 /¿A. The
patients used in this study all had a history of
discomfort during cavity preparation with the
use o f local anesthetics. The researchers re­
ported a 79.1% success rate.
Relief of acute orofacial pain
Hansson and Ekblom36 reported on the use of
high-frequency (100 Hz) and low-frequency (2
Hz) TENS versus placebo TENS in patients ex­
periencing acute pain as a result o f pulpal in­
flammation, apical periodontitis, or extraction.
The electrodes were placed on the skin over the
painful area for 30 minutes. A monopolar
square wave pulse was used. The stimulation
intensity was two to three times the perception
threshold for high-frequency TENS and three
to five times the perception threshold for low-
frequency TENS. The control group was told
that they might not experience the stimulation
and a TENS unit without batteries was used.
O f the 42 patients in the test group, 16 pa­
tients experienced pain relief o f greater than
50%, and seven experienced increased pain.
Essentially no differences were found between
patients receiving high-frequency TENS and
patients receiving low-frequency TENS. O f the
patients reporting relief, 80% experienced a
reduction in pain within 5 minutes after the
onset o f stimulation. O f the patients reporting
more than 50% relief, 38% experienced a
gradual return o f pain starting within 5 minutes
after stimulation ended. In the control group,
two o f 20 patients experienced more than 50%
relief and four experienced increased pain. Of
the 23 patients who had used analgesics such as
acetylsalicylic acid or paracetamol, 12 reported
greater relief from TENS.
Discussion
The use o f TENS in dentistry has received
only limited attention, and much o f the
study done has been carried out on an
Black : USE OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION ■ 651
REVIEW ARTICLES
empirical basis. Undoubtedly, a placebo
effect occurs when a patient sees the elec­
trical devices and is told what the devices
are expected to accom plish.37 In the
treatment of MPD syndrome, treatment
with TENS is aimed at relieving spasms in
the muscles o f mastication. Two schools of
thought reinforce this treatment. First, the
treatment is thought to block nerve im­
pulses and increase the blood flow to the
muscles o f mastication to relieve spasms
and pain. Second, the treatment is thought
to relax the muscles and to generate a
muscularly oriented occlusal position to
which the teeth can be equilibrated or to
which splints can be fabricated. The mus­
cularly oriented occlusal position places
the condyles and the teeth anteriorly and
inferiorly with respect to those intercuspal
relationships found in otherwise normal
people.38
In treating MPD with reversible proce­
dures such as medications, oral appli­
ances, biofeedback, relaxation training,
mock equilibration, psychological counsel­
ing, and TENS, Greene and Laskin39
found that each o f these methods pro­
duced lessened pain in 70% to 80% o f the
patients.
Enough research has not been done on
the use o f TENS in the treatment o f facial
n e u r a lg ia s or sed a tio n to m ake an
adequate evaluation.
Most research and clinical studies have
dealt with the use o f TENS in cavity prep­
aration. Most methods have run the elec­
trical current through the tooth structure,
although a recent study placing the elec­
trode on the mucosa showed promise. Al­
though no device or method has been
completely successful, all methods seem to
show a higher success rate than would be
expected considering the placebo effect. A
large variation exists between the voltage
and a m p era g e u sed ; h o w ev e r, the
analgesic effect appears to depend on the
amperage used and not on the voltage
used. Little, if any, consideration was
given to the frequency o f the impulses or
to the wave form. Frequency varied widely
in the studies, from 4 Hz26 to 1 MHz (Cof­
fey, G., unpublished findings, 1979), and
there seemed to be no reason for using a
particular frequency or combination of
frequencies other than to state that other
researchers had used that particular fre­
quency.26 The frequency and wave form
often are a function o f a particular ma­
chine and offer the user little or no room
for variation.
TENS offered relief to some patients
with orofacial pain and may be more effec­
tive than are mild analgesics. The pain
REVIEW ARTICLES

relief appears to be more than a placebo treatment o f orofacial pain because the pain in man. Science 155:108-109, 1967.
effect. The effects o f TENS, however, patient must be in a setting where the 14. Melzack, R., and Wall, P. Pain mechanisms: a
seem to be short-lived. new theory. Science 150:971-979, 1965.
equipment is available; the benefits ap­
15. Snyder, S. Opiate receptors in the brain. N Engl
pear to be short-lived; and TENS has been J Med 296:266-271, 1977.
Conclusions shown only to give better results than mild 16. Adams, J. Naloxone reversal o f analgesia pro­
analgesics for just half the patients. If the duced by brain stimulation in the hum an. Pain 2:161-
166, 1976.
TENS has a definite but, at this time, lim­ patient needs definitive treatment for 17. Abram, S.; Reynolds, A., and Cusich, J. Failure
ited use in dentistry. There is a place for its acute orofacial pain, local anesthesia is o f naloxone to reverse analgesia from transcutaneous
use in treatment o f MPD. Whether the more effective. TENS might be a useful electrical stimulation in patients with chronic pain.
effectiveness o f TENS is from a placebo adjunct in situations in which local anes­ Anesth Analg 60:81-84, 1981.
18. Mazer, D. Central nervous system mechanism
effect or from more physiologically based thesia is contraindicated or less than effec­ o f analgesia. Pain 2:379-404, 1976.
reasons is subject to debate. In reality, tive such as during the incision and drain­ 19. Buckett, W. Pharmacological studies on stimu­
there probably is a component o f both at age o f an area of acute infection. lation produced analgesia in mice. E ur J Pharmacol
work. Treatment o f MPD with TENS re­ A significant amount o f research has 69:281-290, 1981.
lieves the pain in a significant number of been conducted on the use o f TENS, but 20. Fields, R.; Savara, B.; and Tacke, R. Effects of
electroanesthesia. O ral S urg 34:694, 1972.
patients and, therefore, is a useful adjunct only a limited amount o f research has been 21. Reid, N. Mechanism o f action o f dental electro­
to more conventional treatments. It ap­ conducted on the use of TENS in den­ anaesthesia. N ature 247:150-151, 1974.
pears to be useful in relaxing the muscles tistry. No consensus has been reached as to 22. Ramfjord, S., and Ash, M. Occlusion. Philadel­
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tran scu tan eo u s nerve stim ulation (TENS) in the
Because of the questionable centric rela­ control is important in dentistry, these fac­ tre a tm e n t o f u n ilateral MPD syndrom e. AADR
tion achieved with a muscularly oriented tors need further research to give optimal Abstracts, no. 999, 1980.
approach when using TEN S for the results with the use o f TENS. 24. Wessberg, G., and others. Transcutaneous elec­
foregoing purpose, the technique should trical stimulation as an adjunct in the m anagem ent of
--------------------- J ! « A ---------------------- myofascial pain-dysfunction syndrom e. J Prosthet
be used with caution. TENS units should Dent 45:307-314, 1981.
be available as a treatment modality where Inform ation about the m anufacturers o f the prod­ 25. Gold, N.; Greene, C.; and Laskin, D. TENS
large numbers o f patients with MPD are ucts m entioned in this article may be available from the therapy for treatm en t o f MPD syndrom e. AADR
treated. author. N either the author no r the American Denta! Abstracts, no. 676, 1983.
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directly to the tooth have been in limited appraisal. In Gelb, H., ed. Clinical m anagem ent of 1970.
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applications and would not require addi­ tation with TENS. Presented at the Conference on
Pain Control, W alter Reed Arm y Medical Center, 34. Horiuche, H., and others. Anodal electrotonus
tional equipment. The dentist should have W ashington, DC, 1977. using a separate electrode to suppress pain during
methods o f pain control for cavity prepa­ 6. Kellaway, P. T h e p art played by electric fish in cavity preparation in labiocervical cavities. Bull Tokyo
ration other than local anesthesia. There the early history o f bioelectricity and electrotherapy. Med Dent Univ 25:101-103, 1978.
are patients for whom TENS would be of Bull Hist Med 20:112-137, 1946. 35. Savage, M. Clinical use o f d en tal electro ­
7. Walsh, J. O f the electric property o f the torpedo. analgesia. Br Dent J 152:242-244, 1982.
value. Control of pain in cavity prepara­ Philos T rans R Soc Lon [Biol] 63:461-480, 1773. 36. Hansson, P., and Ekblom, A. Transcutaneous
tion by the use of TENS should be consid­ 8. Cavendish, H. An account o f some attem pts to electrical nerve stimulation (TENS) as com pared to
ered in the treatment o f patients with imitate the effects o f the torpedo fish by electricity. placebo TENS for the relief o f acute oro-facial pain.
hemophilia who might otherwise have to Philos T rans R Soc Lon [Biol] 66:196-225, 1776. Pain 15:157-165, 1983.
9. Francis, J. Extracting teeth by galvanism. Dent 37. Schwitzgebel, R., and T raugott, M. Initial note
undergo transfusion or be given fresh
Rep 1:65-69, 1858. on the placebo effect of machines. Behav Sci 13:267-
plasma containing factor VIII to receive 10. Garratt, A. Galvanism for counteracting pain in 273,1968.
deep nerve blocks. TENS also would be the extraction o f teeth. Boston Med Surg J 59:32-34, 38. C a rr a n z a , F .A ., e d . G lic k m a n ’s clin ical
useful in the treatment o f patients who are 1859. periodontology, ed 5. Philadelphia, W. B. Saunders
allergic to local anesthetics and for pa­ 11. College o f Dentists o f London. Electricity as an Co, 1979, p 950.
anaesthetic agent in dental surgery. Lancet 1:594-595. 39. G reene, C.S., and Laskin, D.M. Long-term
tients for whom local anesthetics seem to 12. Kane, K. A history o f local electrical analgesia. e v a lu a tio n o f tr e a tm e n t f o r m y o fascial p a in -
be less than effective. Pain 1:125-140, 1975. dysfunction syndrome: a comparative analysis. JADA
TENS is o f questionable benefit in the 13. Wall, P., and Sweet, W. T em porary abolition of 107(2):235-238, 1983.

652 ■ JADA, Vol. 113, October 1986


The A m erican Dental A ssociation seeks to
prom ote the art and science of dentistry and
encourage the health of the public. In serving
these objectives, the ADA com m unicates regu­
larly w ith the m em bers of the dental profes­
sion, w ith professional persons in allied fields,
and w ith the public. The ADA welcomes ad­
vertising in its publications because it believes
th a t a d v e rtisin g c o n stitu te s a n im p o rtan t
m eans of keeping the dentist informed of new
and better products and services for the prac­
tice of dentistry. Such advertising should be at­
tractive, factual, dignified, and calculated to
provide useful product and service informa­
tion.
The ADA recognizes that the dentist does
not rely exclusively upon advertisem ents in
ADA publications as sources of information.
P r a c t it io n e r s re f e r to A c c e p te d D e n ta l
T herapeutics, D entist’s Desk Reference, spe­
cialty journals, and other authoritative sources
of dental product inform ation. The inform a­
tion derived from these diverse sources su p ­
plem ents the den tist’s own experience.
The appearance of advertising in ADA pub­
lications is not an ADA guarantee or endorse­
m ent of the product or the claim s made for the
p roduct by the m anufacturer. The fact that an
advertisem ent for a product, service, or com ­
pany has appeared in an ADA publication shall
not be referred to in collateral advertising.
As a m atter of policy, the ADA will sell ad­
vertising space in its publications w hen the
buyer believes purchase of such space is a
sound expenditure and w hen th e inclusion of
advertising m aterial does not interfere w ith the
purpose of the publication.
These standards apply to all publications of
the A m erican Dental A ssociation in w hich ad­
vertising space is sold, nam ely The Journal of
the A m erican Dental A ssociation, ADA News,
D ental Abstracts, Special Care in Dentistry,
and the Daily Bulletin.
I. General Eligibility Requirements
1. Products or services eligible for advertis­
ing in ADA publications shall be germane
to and effective and useful in the practice
of dentistry.
2. In ad d itio n to the requirem ents stated
654 ■ JADA, October 1986
Advertising Standards
above, products and services that are of­
fered by responsible advertisers and that
are of interest to dentists and their families
or the dental profession as a w hole, are eli­
gible for advertising in the ADA News.
3. Pharm aceutical products for w hich ap­
proval of a New Drug A pplication by the
Food and Drug A dm inistration is a pre­
requisite for m arketing w ill not be eligible
for advertising u n til such approval has
been obtained.
4. A dvertisem ents for dental materials, in­
strum ents, equipm ent, and therapeutic
products th at are not involved in ADA
Council program s (see Section III) w ill be
review ed by the Office of the Editor to de­
term ine advertising eligibility.
5. Com plete scientific and technical data,
w hether published or unpublished, con­
cerning the p ro d u ct’s safety, operation,
and usefulness may be required. Samples
of the product should not be subm itted.
The ADA reserves the right to decline ad­
vertising for any product that is involved
in litigation w ith a governm ent agency
w ith respect to claims m ade in m arketing
of the product and for any technique or
product th at is the subject of an unfavor­
able or cautionary report by an agency of
the A m erican Dental Association.
6. The advertisem ent may cite, in footnotes,
references from dental and other scientific
literature provided the reference is tru th ­
fully cited and is a fair representation of
the body of literature supporting the claim
made.
7. The advertisem ent m ay include the use of
a com petitor’s nam e and the description of
a com parable p roduct or service, in clu d ­
ing price, if the com parison is m ade in a
m anner that is not false or m isleading.
8. “Institutional-type” advertising germ ane
to the practice of dentistry and public ser­
vice messages of interest to dentists are el­
igible for app earan ce in ADA p u b lica­
tions.
9. D isp la y a d v e rtis in g w ith re s p e c t to
em ploym ent, purchase of practices, par­
ticipation or any other contractual rela­
tionship w ith any dental care delivery
I
mode or system shall not be accepted for
publication. Such opportunities may be
advertised in the classified section of ADA
publications w ithout any illustrations or
graphics.
10. A lcoholic beverages and tobacco products
are not eligible for advertising.
11. Food Products. Special purpose foods and
n u tritio n a l su p p le m e n ts (for exam ple,
foods for low -sugar diets, postoperative
diets, and other therapeutic diets) are eli­
gible w hen th eir uses are supported by ac­
ceptable data.
12. Books. Books related to the practice of den ­
tistry w ill be considered eligible for adver­
tising. In addition, books of interest to den ­
tists and their fam ilies as consum ers will
be eligible for advertising in the ADA
News.
13. E ducational Courses. An advertisem ent
for an educational course w ill be eligible if
the course is conducted by or u n d er the
auspices of the ADA, one of its constituent
or com ponent dental societies, a national
certifying board or national society for one
of the specialty areas of dental practice
recognized by th e ADA, an accredited
dental or m edical school, or any organiza­
tion specifically referred to in the Bylaws
o f the A m erican Dental Association. The
ADA reserves the right to decline advertis­
ing for any course that involves the teach­
ing or use of a p roduct or technique that is
the subject of an unfavorable or cautionary
report by an agency of the American Den­
tal Association.
The advertisement must state which of
the aforementioned organizations is as­
sociated with the course, and, if applica­
ble, the number and type of continuing
education credits granted on completion
of the course.
The eligibility of an advertisement for a
course conducted by or under the auspices
of an organization other than the afore­
mentioned will be reviewed by the Office
of the Editor to determine eligibility.
Acceptance of advertisem ents for
courses and educational materials di­
rected to the income of a dentist or to the
of the American Dental Association
comm ercial aspects of a dental practice
w ill be reviewed by the Office of the Editor
for attractiveness, accuracy, and dignity to
determ ine eligibility.
14. M iscellaneous P roducts a n d Services.
Products and services not in the foregoing
classifications may be eligible for advertis­
ing if they satisfy the standards governing
eligibility for advertising in ADA publica­
tions.
II. Guidelines for Advertising Copy
1. The advertiser and th e product or service
being offered should be clearly identified
in the advertisem ent. In the case of drug
advertisem ents, the full generic nam e of
each active ingredient shall appear.
2. A rtw ork, format, and layout should be
such as to avoid confusion w ith editorial
content of the publication. The w ord “ad ­
vertisem ent” may be required.
3. U nw arranted disparagem ents or u nfair
com parisons of a com petitor’s products or
services w ill not be allowed.
4. A dvertisem ents w ill not be acceptable if
they conflict w ith the ADA Principles o f
Ethics and Code of Professional C onduct
or its Constitution and Bylaws.
5. It is the responsibility of the advertiser to
com ply w ith the laws and regulations ap­
plicable to m arketing and sale of the m an­
ufacturer’s products. A cceptance of adver­
tising in ADA publications should not be
construed as a guarantee that the manufac­
turer has com plied w ith such laws and
regulations.
6. A dvertisem ents should not be deceptive
or m isleading.
7. A dvertisem ents w ill not be accepted if
they appear to violate the ADA Principles
o f Ethics and Code of Professional Con­
duct or its C onstitution and Bylaws, or if
they are indecent or offensive in either text
or artwork, or contain attacks of a per­
sonal, racial, or religious nature.
8. A dvertisem ents in the ADA News that
offer the reader inform ation concerning
investm ent opportunities m ust avoid ref­
erence to a specific security issue.
III. Participants in Scientific Council
Acceptance and Certification Programs
H undreds of major m anufacturers participate
in ADA scientific program s of the Council on
Dental Therapeutics and the Council on Dental
M aterials, Instrum ents, and Equipm ent. Coun­
cil seals and statem ents lend additional credi­
b ility to the advertising messages by assuring
the dentist that the product is safe, effective,
and truthfully advertised.
A dvertisem ents in ADA publications that
carry ADA Council statem ents of Acceptance,
Provisional A cceptance, or Certification have
u n d e rg o n e th o ro u g h e v a lu a tio n an d have
earned the recognition and d istinction that
these Council statem ents signify. The Ameri­
can D ental A ssociation advocates m anufac­
turer participation in ADA scientific programs
and urges the dentist to look for Council seals
or statem ents in advertising literature when
planning the purchase of dental products.
Products that have been entered into an ADA
C ouncil program m u st satisfy th e official
guidelines of the applicable scientific Council,
in addition to the standards governing eligibil­
ity for advertising in ADA publications.
GENERAI COUNCIL PROGRAM GUIDELINES
FOR ADVERTISING
1. The advertisem ent shall be acceptable
w hen the m anufacturer of a Certified, Pro­
v isio n a lly C ertified, P ro v isio n ally A c­
ceptable, or A cceptable product has sub­
stantiated all advertising claims to the ap­
propriate Council.
2. The advertisem ent may feature an au ­
thorized statem ent w ith reference to an
evaluation program of the Council if the
statem ent is approved by the appropriate
Council.
3. The advertisem ent may include the seal of
A cceptance, Certification, or Provisional
A cceptance if the product has been clas­
sified as such, if all advertising claims
have been substantiated to the Council,
and if use of the seal has been authorized
by the appropriate Council.
A dditional inform ation on the evaluation pro­
gram s of the Council on Dental Therapeutics
and the Council on Dental M aterials, Instru­
m ents, and E quipm ent is available in the texts
A ccepted Dental Therapeutics and D entist’s
Desk Reference and by contacting th e Office of
the Editor or the appropriate Council office.
IV. Time Requirements
A lthough the ADA cannot guarantee adher­
ence in all cases to a fixed tim e schedule, every
effort w ill be made to expedite com pletion of
ADA c o n sid e ra tio n in th e fo llo w ing tim e
intervals:
A dvertisem ents for C urrently Eligible Prod­
ucts. From the tim e copy and, if necessary,
su p p o rtiv e data are received, five w orking
days should be allow ed for ADA considera­
tion.
A dvertisem ents for New Products. From the
tim e copy and supportive data are received, ten
w orking days should be allow ed for ADA con­
sideration.
A d vertisem en ts fo r Products in Council Pro­
grams. From the tim e copy and, if necessary,
supportive data are received, 15 w orking days
should be allow ed for ADA Council considera­
tion.
A d v ertisem en ts fo r P roducts N e w ly A p ­
proved b y Councils or A d vertisem ents w ith
New A dvertising Claims. From the tim e copy
and supportive data are received, 30 days
should be allow ed for Council consideration.
Participants in ADA Council program s are
strongly urged to subm it all advertising copy
in rough form at least 30 days prior to the pub­
lication’s closing date. A ny changes can then
be made at a m inim um of tim e and expense.
In those cases in w hich ADA consideration
cannot be com pleted prior to the expiration of
the foregoing tim e intervals, the advertiser or
the agency w ill be so inform ed.
As a m atter of policy, the ADA w ill periodi­
cally review its advertising standards w ith the
objective of keeping pace w ith changes that
may occur in the dental ind u stry and in the
profession. It is hoped that this practice of con­
tinuous review and réévaluation w ill im prove
an d ensure the relevancy, tim eliness, and ap ­
propriateness of the advertising content of
ADA publications.
JADA, October 1986 ■ 655