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Contents lists available at ScienceDirect

Journal of Prosthodontic Research

journal homepage: www.elsevier.com/locate/jpor

Technical procedure

A newly developed ultraminiature wearable electromyogram

system useful for analyses of masseteric activity during the
whole day
Taihiko Yamaguchia,* , Saki Mikamib , Miku Saitoa , Kazuki Okadac , Akihito Gotoudab
a
Department of Crown and Bridge Prosthodontics, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
b
Department of Temporomandibular Disorder, Center for Advanced Oral Medicine, Hokkaido University Hospital, Sapporo, Japan
c
Satake Dental Clinic, Kitami, Japan

A R T I C L E I N F O A B S T R A C T

Article history: Purpose: We describe the characteristics of a new data-logger-type ultraminiature electromyogram
Received 24 February 2017 (EMG) system (FLA-500-SD) and methods used for recording and we show its potential in clinical
Received in revised form 3 April 2017 applications by presenting an example of a clinical case.
Accepted 29 April 2017
Method: FLA contains electrodes, an amplifier, 12-bit analog-to-digital (A/D) converter at a sampling
Available online xxx
frequency of 1 kHz, 16-bit CPU, a 3.7-V coin-shaped lithium battery, and a micro SD card. The size of FLA is
37.0  23.5  8.6 mm, and its weight is 6 g (9 g with a battery inserted). The device is wearable and
Keywords:
patients can attach the device and operate it by themselves in daily life. Data recorded in the micro SD
Electromyogram
Wearable
card are transferred to a personal computer and analyzed.
Active electrodes Although the device is ultraminiature and wearable, it has the capacity for recording a precise and clear
Sleep bruxism masseteric surface electromyogram that is not inferior to that recorded by conventional stationary-type
Awake bruxism EMG recording systems.
Conclusions: To our knowledge, the device is the smallest and lightest device with capacity for the longest
consecutive measuring time as a data-logger-type electromyograph with built-in electrodes and
memory. The device is useful for analyses of masseteric activity during the whole day. In the future, it is
expected that applications of the device will expanded to observation, evaluation and diagnosis of normal
or abnormal gnathic functions, e.g., assessment of sleep and awake bruxism and observation of the
chewing state in daily life.
© 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

1. Introduction
Bruxism is a repetitive jaw-muscle activity characterized by
clenching or grinding of the teeth and/or by bracing or thrusting of
the mandible [1]. Bruxism is a possible risk factor of various
ailments and disorders in the stomatognathic system [2,3].
Assessment, treatment and management of bruxism are important
in dentistry [4,5]. Assessment of sleep bruxism (SB) in ordinary
clinical practice has been based on clinical findings such as teeth
wear and interviews about tooth-grinding noise. However, an
interview about teeth grinding noise is not necessarily objective,
* Corresponding author at: Department of Crown and Bridge Prosthodontics,
Graduate School of Dental Medicine, Hokkaido University, Kita 13 Nishi 7, Kita-ku,
Sapporo 060-8586, Japan. Fax: +81 11 706 4276.
E-mail address: taihiko@den.hokudai.ac.jp (T. Yamaguchi).
and the validity of clinical findings such as tooth wear for making a
definite diagnosis of SB has not been proven [6]. Polysomnography
with simultaneous audio-visual recording (PSG-AV) is currently
the gold standard for assessment of SB [7]. It was suggested that
‘possible’ sleep or awake bruxism should be based on self-report,
by means of questionnaires and/or the anamnestic part of a clinical
examination. ‘Probable’ sleep or awake bruxism should be based
on self-report plus the inspection part of a clinical examination.
‘Definite’ sleep bruxism should be based on self-report, a clinical
examination, and a polysomnographic recording, preferably along
with audio/video recordings [1]. However, PSG-AV has not become
a routine clinical examination for diagnosis of SB due to its
complexity, high cost, and burden and inconvenience for the
patient. Bruxism has two distinct circadian manifestations: it can
occur during sleep (indicated as sleep bruxism) or during
wakefulness (indicated as awake bruxism) [1]. The necessity of
a method for adequate assessment of awake bruxism has been

http://dx.doi.org/10.1016/j.jpor.2017.04.001
1883-1958/© 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: T. Yamaguchi, et al., A newly developed ultraminiature wearable electromyogram system useful for analyses
of masseteric activity during the whole day, J Prosthodont Res (2017), http://dx.doi.org/10.1016/j.jpor.2017.04.001
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pointed out. For a grading of ‘definite’ awake bruxism, self-report,
clinical examination and an electromyographic recording are
needed [1]. Thus a reliable and convenient method for assessment
using a wearable device is needed.
The development of small integrated circuits (ICs) and small
lithium batteries due to technological advancements has enabled
miniature electromyogram (EMG) devices to be manufactured [8–
11]. In cooperation with Harada Electronic Industry Ltd., Japan, we
have developed an ultraminiature telemetric-type bruxism mea-
surement system, BMS-601 (BMS), in which electrodes and an
amplifier are directly connected [8]. Although the measurement
sensitivity of BMS was very high [12], some linear-spike artifact
signals that were thought to be arising from a communication error
in the telemetric process were sometimes observed [13]. In
addition, the telemetric system needed a receiver unit, which
was inconvenient to wear or carry during the day. We therefore
developed a data-logger-type EMG measurement system with
built-in electrodes and memory [10]. This device was not telemetric
and did not need a receiver unit. However, it was impossible for
patients to handle the power on/off switch, change the battery and
retrieve recorded data from the device by themselves in their home.
In the next step with the cooperation of Furusawa Lab
Appliance Co., Japan, we developed another data-logger-type
ultraminiature EMG system (FLA-500-SD) for clinical use. In this
article, we describe the characteristics of the latest data-logger-
type ultraminiature EMG system and the method for recording
using the device and we show its potential for clinical application
by presenting an example of a clinical case.
2. Materials and methods
2.1. Structure of the device
FLA contains electrodes, an amplifier, 12-bit analog-to-digital
(A/D) converter at a sampling frequency of 1 kHz, 16-bit CPU, a 3.7-
V coin-shaped lithium battery, and a micro SD card. The size of FLA
is 37.0  23.5  8.6 mm, and its weight is 6 g (9 g with a battery
inserted) (Figs. 1 and 2). The surface sizes of the bipolar measuring
electrodes are 6 mm in diameter, and the distance between the
centers of the electrodes is 24 mm. A reference electrode with the
same size as that of the electrodes is positioned at the middle
position between the two measuring electrodes. Gain of the
amplifier is 256 times.
2.2. Measuring procedure
2.2.1. Preparation for recording
After charging, a lithium battery is inserted into the body of FLA.
A micro SD card is inserted into a slot in the body of FLA. The switch
of FLA is turned on and blinking of a small LED lamp indicates the
start of recording.
2.2.2. Attaching FLA
The skin surface is cleaned with alcohol gauze, and then the
device is attached to the skin surface with dedicated double-sided
adhesive tape (Fig. 3A). During nocturnal use, stronger fixation by
adhesive tape over the body of device is recommended. If patients
need some camouflage for daytime use, the device can be covered
with gauze as if it is covering a wound on the face (Fig. 3B).
2.2.3. Recording data
Prior to recording data during the targeted period, recording
data during some calibration movements such as maximum
clenching, tapping, swallowing and coughing is performed. Then
patients start their usual daily lifetime activity without restraint.
The device should be removed before faces washing and taking a
Please cite this article in press as: T. Yamaguchi, et al., A newly developed ultraminiature wearable electromyogram system useful for analyses
of masseteric activity during the whole day, J Prosthodont Res (2017), http://dx.doi.org/10.1016/j.jpor.2017.04.001
D F H
G
b F
Fig. 1. Components of FLA-500-SD.
a: Coin-shaped lithium battery, b: micro SD card, c: measuring electrode, d:
reference electrode, e: double-sided adhesive tape.
bath. When the recording has finished, the device is removed and
the power switch is turned off. The micro SD card is transferred
from the body of FLA to a personal computer.
2.3. Data analyses
Data can be recorded in raw binary format at a sampling
frequency of 1 kHz for 24 consecutive hours. The data can be
converted to text (comma-separated values: CSV) data or EDF
(European Data Format) data file. Owing to the capacity for
conversion of the data format, the data obtained by FLA can be
analyzed by various software programs.
EDF is a format for exchange and storage of multichannel
biological and physical signals, e.g., polysomnographic data. The
format is simple and flexible, and the volume of data is reduced and
much easier to use than text format when handling a large volume
data. Therefore, various kinds of commercial software and
software made by the user can be flexibly used.
3. Difference from conventional methods
For conventional EMG measurement, skin preparation, i.e.,
scrubbing skin with a substance such as abrasive gel, and
intermediation of a paste or gel pad that is electrically conductive
between an electrode and the underlying skin are needed because
high contact resistance between an electrode and the underlying
skin causes a poor signal-to-noise ratio (S/N ratio). Recently, active
electrodes, in which a preamplifier is embedded and connected to a
measuring electrode, have been used for EMG measurement. The
structure of an active electrode provides higher impedance of the
measuring electrodes, i.e., close to skin impedance, and reduces
contact resistance between the measuring electrodes and the
underlying skin. Since active electrode structure is used in the
new EMG device, recording can be performed with the electrodes in
direct contact with the underlying skin without using conductive
paste or a gel pad. The process of abrading skin can also be omitted.
Patients can handle the power on/off switch, change the battery and
retrieve recorded data (micro SD card) by themselves at home. To our
knowledge, the device is the smallest and lightest device with the
capacity for the longest consecutive measuring time as a data-logger-
type electromyograph with built-in electrodes and memory.
4. Effect of performance
The following performance was approved by the ethical
committee of Hokkaido University Hospital (No. 010-0303), and
informed consent was obtained from the patient.
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PP
D
G
PP PP F

Fig. 2. Structure of FLA-500-SD.

a: Slot for micro SD card, b: LED lamp, c: power on/off switch, d: cover of battery storage space.

A %
Fig. 3. FLA-500-SD attached to the skin surface with double-sided adhesive tape (A) and covered with a piece of gauze for camouflage (B).

1mV
D E F G
)/$

1s

1mV
F(0*

1s

Fig. 4. An example data of comparison in masseteric EMG activities between FLA and a conventional EMG recording system.
FLA was attached on the right side while electrodes of the conventional EMG recording system were attached on the left side. EMG signals were high-pass-filtered at 20 Hz.
Stable base lines during resting and distinct bursts that originated from the examined movements of maximum voluntary clenching and tapping were observed in the EMG
recorded by FLA as well as that recorded by a conventional stationary-type EMG recording system.
a: Resting, b: maximum voluntary clenching, c: light tapping, d: hard tapping.
cEMG: conventional stationary-type EMG recording system

masseter muscle. Simultaneously, masseteric EMG signals on the left

4.1. An example data of comparison between FLA and a conventional
EMG recorder
Masseteric EMG signals of a 45-year-old female outpatient with
suspected bruxism were recorded by FLA attached on the right side
side were recorded using a conventional EMG recorder in a polygraph
system. After skin cleaning only using alcohol gauze as mentioned
above, FLA was attached with double-sided adhesive tape without
using electrically conductive paste or a gel pad. FlexComp Infiniti
(Thought Technology Co., Canada) was used as a conventional

Please cite this article in press as: T. Yamaguchi, et al., A newly developed ultraminiature wearable electromyogram system useful for analyses
of masseteric activity during the whole day, J Prosthodont Res (2017), http://dx.doi.org/10.1016/j.jpor.2017.04.001
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Fig. 5. An example data of comparison in masseteric EMG activities during gum chewing between FLA and a conventional EMG recording system.
FLA was attached on the right side while electrodes of the conventional EMG recording system were attached on the left side. EMG signals were high-pass-filtered at 20 Hz.
cEMG: conventional stationary-type EMG recording system.

stationary-type EMG recorder. Gain of amplifier was 500 times. Data
were A/D converted at a sampling frequency 2048 Hz. Bipolar surface
electrodes with diameters of 10 mm and an interval distance of
20 mm (DUO-TRODE, Myotronics-Noromed, Inc., Kent. WA, USA)
were used. A reference electrode with the same size as that of the
measuring electrode is positioned in a triangle with the measuring
electrodes with an interval of 20 mm. Surface skin was prepared in a
conventional manner, i.e., scrubbing the skin with a skin preparation
gel (SkinPure, NIHONKOHDEN CO., Japan), and electrically conduc-
tive electrode gel (Spectra 360, Parker Laboratories Inc. New Jersey,
USA) was used. The movements examined were tapping, maximum
clenching and gum-chewing.
Figs. 4 and 5 show the recorded data. Data from both recorders
were high-pass-filtered at 20 Hz. Stable base lines during resting
and distinct bursts that originated from the examined movements
of maximum clenching, tapping and gum-chewing were observed
in the EMG recorded by FLA as well as that recorded by the
conventional EMG recording system.
4.2. An example of recording by using FLA during the day and when
sleeping
Fig. 6 shows masseteric EMG signals of the same patient with
suspected bruxism recorded by using FLA during the day and when
sleeping. Consecutive data for 23 h and 52 min from the morning to
the next morning were recorded by the patient’s own preparation
and operation. The total recording time included lunch time
(55 min), eating between meals (5 min), dinner time (22 min),
breakfast time (13 min), afternoon napping time (1 h and 35 min),
sleep time at night (8 h and 54 min) and awake time other than
meal time (11 h and 48 min).
Among the bursts recorded during sleep, phasic bursts (lasting
0.25–2.0 s) and tonic bursts (longer than 2.0 s) were observed.
Some bursts were found in a typical pattern of rhythmic
masticatory muscle activity (RMMA) [14,15] defined as three or
more consecutive bursts of EMG activity (Fig. 6). Some bursts with
low amplitude but considerably long duration were also be
observed (Fig. 6). When bursts with an amplitude larger than 20%
of MVC (maximum voluntary contraction, i.e., maximum voluntary
clenching) and a duration longer than 0.25 s from the record during
sleep time were selected, the number of bursts was 11.4 per hour. In
our previous study using BMS, mean  SD of the number of bursts
with an amplitude larger than 20% of MVC and duration longer
than 0.25 s was 6.7  6.1 per hour for normal controls without sleep
bruxism [16]. The data obtained from our patient were judged to be
in the normal range.
As for daytime data, our previous study showed that mean  SD
number of burst was 195.6  131.7 per hour when EMG bursts of
more than three times the baseline amplitude and longer than
0.08 s were selected from EMG recordings in young healthy adults
during awake time other than mealtimes [10]. The number of
bursts during the day in our patient selected at the same threshold
as that in the previous study [10] was 174.9 per hour, which is less
than the mean for young healthy adults.
In the example of recording using FLA, it was shown that the
baseline was not significantly disturbed and that stable signals
with a relatively good S/N ratio were provided during the whole
measurement time.

Please cite this article in press as: T. Yamaguchi, et al., A newly developed ultraminiature wearable electromyogram system useful for analyses
of masseteric activity during the whole day, J Prosthodont Res (2017), http://dx.doi.org/10.1016/j.jpor.2017.04.001
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Fig. 6. Masseteric EMG signals of a patient with suspected bruxism during the day and when sleeping recorded by using FLA.
Consecutive data for 23 h and 52 min from the morning to the next morning are shown.
The total recording time included lunch time (55 min), eating between meals (5 min), dinner time (22 min), breakfast time (13 min), afternoon napping time (1 h and 35 min),
sleep time at night (8 h and 54 min) and awake time other than meal times (11 h and 48 min).
a: Maximum voluntary clenching, b: mastication during breakfast, c: bursts with low amplitude but considerably long duration, d: rhythmic masticatory muscle activity
(RMMA) during sleep, e: RMMA including a tonic burst.

5. Conclusion References

We introduced a newly developed ultraminiature wearable
electromyogram system useful for analyses of masseteric activity
during the whole day. Although the device is ultraminiature and
wearable, it can record a precise and clear masseteric surface
electromyogram. In addition, patients can attach the device and
operate it by themselves in daily life. In the future, it is expected
that applications of the device will expanded to observation,
evaluation and diagnosis of normal or abnormal gnathic functions,
e.g., assessment of sleep and awake bruxism and observation of the
chewing state in daily life. Possible applications to examination of
body muscles as well as masticatory muscles are also expected in
the fields of rehabilitation medicine and sports medicine.
Author contribution
All authors made substantial contributions to this study.
[10] Watanabe K, Yamaguchi T, Gotouda A, Okada K, Mikami S, Hishikawa R.
Acknowledgments
This study was supported in part by a Grant-in-Aid for Scientific
[11] Deregibus A, Castroflorio T, Bargellini A, Debernardi C. Reliability of a portable
Research from the Japan Society for the Promotion of Science (No.
24390427).
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Please cite this article in press as: T. Yamaguchi, et al., A newly developed ultraminiature wearable electromyogram system useful for analyses
of masseteric activity during the whole day, J Prosthodont Res (2017), http://dx.doi.org/10.1016/j.jpor.2017.04.001
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Please cite this article in press as: T. Yamaguchi, et al., A newly developed ultraminiature wearable electromyogram system useful for analyses
of masseteric activity during the whole day, J Prosthodont Res (2017), http://dx.doi.org/10.1016/j.jpor.2017.04.001