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The Journal of Headache and Pain 2015Pain related to temporomandibular disorders (TMD) is a common problem in modern societies. The aim of the article is to present the concepts of TMD pain clinical... (Review)
Review
BACKGROUND
Pain related to temporomandibular disorders (TMD) is a common problem in modern societies. The aim of the article is to present the concepts of TMD pain clinical management.
METHODS
A survey was performed using the PubMed, SCOPUS and CINAHL databases for documents published between 1994 and 2014. The following search keywords were selected using MeSH terms of the National Library of Medicine in combination: TMD pain, TMD, TMJ, TMJ disorders, occlusal splint, TMD physiotherapy, TMJ rheumatoid disorders and TMJ surgery. Original articles and review papers which presented the clinical relevance and practical validity regarding the possibility of application in TMD management have been included. Authors have excluded articles without outstanding practical aspect and evidence-based background. A first selection was carried out by reviewing titles and abstracts of all articles found according to the criteria. After that the full texts of potentially suitable articles were assessed. In line with these criteria, among 11467 results the writers have included 66 papers.
RESULTS
The most commonly reported conservative treatments are massage therapy and individually fabricated occlusal splints. In addition to massage, other popular methods include manual therapy and taping, warming/cooling of aching joints, and light and laser therapy. Drugs are also commonly used. In the most severe cases of the temporomandibular joint degeneration, surgical restoration of the joint is sometimes applied.
CONCLUSIONS
The authors concluded that conservative treatment including counselling, exercises, occlusal splint therapy, massage, manual therapy and others should be considered as a first choice therapy for TMD pain because of their low risk of side effects. In the case of severe acute pain or chronic pain resulting from serious disorders, inflammation and/or degeneration pharmacotherapy, minimally invasive and invasive procedures should be considered.
Topics: Chronic Pain; Exercise Therapy; Facial Pain; Humans; Massage; Occlusal Splints; Pain Management; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 26644030
DOI: 10.1186/s10194-015-0586-5 -
The Saudi Dental Journal Jan 2023Occlusal splints are routinely used in dental offices to diagnose and treat abnormalities of the masticatory system. There are different occlusal splints, each of which...
BACKGROUND
Occlusal splints are routinely used in dental offices to diagnose and treat abnormalities of the masticatory system. There are different occlusal splints, each of which can address various conditions. They may treat individuals with temporomandibular disorders (TMDs) and bruxism or be used for occlusal stabilization and dentition wear reduction.
METHODS
The literature in the National Library of Medicine's Medline Database was reviewed using the Mesh terms 'occlusal splints' AND 'Temporomandibular Disorders.
CONCLUSION
Occlusal splints can treat a wide variety of TMDs. They can treat bruxism, headaches, postural imbalances related to TMDs, and decreased vertical dimension of occlusion (VDO). However, there is no clear evidence that occlusal splints are superior to physiotherapy in treating TMDs. In the long-term follow-up, they were equally effective as other therapies.
PubMed: 36817028
DOI: 10.1016/j.sdentj.2022.12.013 -
Lung Apr 2021Obstructive sleep apnea syndrome (OSAS) is a common and underdiagnosed medical condition characterized by recurrent sleep-dependent pauses and reductions in airflow.... (Review)
Review
Obstructive sleep apnea syndrome (OSAS) is a common and underdiagnosed medical condition characterized by recurrent sleep-dependent pauses and reductions in airflow. While a narrow, collapsible oropharynx plays a central role in the pathophysiology of OSAS, there are other equally important nonanatomic factors including sleep-stage dependent muscle tone, arousal threshold, and loop gain that drive obstructive apneas and hypopneas. Through mechanisms of intermittent hypoxemia, arousal-related sleep fragmentation, and intrathoracic pressure changes, OSAS impacts multiple organ systems. Risk factors for OSAS include obesity, male sex, age, specific craniofacial features, and ethnicity. The prevalence of OSAS is rising due to increasing obesity rates and improved sensitivity in the tools used for diagnosis. Validated questionnaires have an important but limited role in the identification of patients that would benefit from formal testing for OSA. While an in-laboratory polysomnography remains the gold standard for diagnosis, the widespread availability and accuracy of home sleep apnea testing modalities increase access and ease of OSAS diagnosis for many patients. In adults, the most common treatment involves the application of positive airway pressure (PAP), but compliance continues to be a challenge. Alternative treatments including mandibular advancement device, hypoglossal nerve stimulator, positional therapies, and surgical options coupled with weight loss and exercise offer possibilities of an individualized personal approach to OSAS. Treatment of symptomatic patients with OSAS has been found to be beneficial with regard to sleep-related quality of life, sleepiness, and motor vehicle accidents. The benefit of treating asymptomatic OSA patients, particularly with regard to cardiovascular outcomes, is controversial and more data are needed.
Topics: Adult; Continuous Positive Airway Pressure; Humans; Occlusal Splints; Polysomnography; Sleep Apnea, Obstructive; Symptom Assessment
PubMed: 33713177
DOI: 10.1007/s00408-021-00426-w -
International Journal of Oral and... Sep 2022Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be... (Review)
Review
Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.
Topics: Arthrocentesis; Humans; Occlusal Splints; Systematic Reviews as Topic; Temporomandibular Joint Disorders
PubMed: 35339331
DOI: 10.1016/j.ijom.2021.11.009 -
British Dental Journal Sep 2018Bruxism is characterised by clenching or grinding of the teeth due to contraction of the masseter, temporalis and other jaw muscles. Bruxism may lead to masticatory... (Review)
Review
Bruxism is characterised by clenching or grinding of the teeth due to contraction of the masseter, temporalis and other jaw muscles. Bruxism may lead to masticatory muscle hypertrophy, tooth surface loss, fracture of restorations or teeth, hypersensitive or painful teeth and loss of periodontal support. Sleep bruxism has previously been viewed as a dysfunctional movement or pathological condition, whereas it is now accepted as a centrally controlled condition with various systemic risk factors. It has been postulated that sleep bruxism may have a protective role during sleep, for example in relation to airway maintenance or in stimulating saliva flow. A diagnosis of sleep bruxism may be made via patient report and clinical interview, clinical examination, intraoral appliances or recording of muscle activity. Bruxism in itself does not require treatment: management is only indicated where problems arise as a result of bruxism. Oral appliances primarily aim to protect the dentition from damage caused by clenching/grinding, although they may reduce muscle activity. Irreversible occlusal adjustments have no basis in evidence in the management of bruxism. Behavioural strategies include biofeedback, relaxation and improvement of sleep hygiene. Administration of botulinum toxin (Botox) to the masticatory muscles appears to reduce the frequency of bruxism, but concerns have been raised regarding possible adverse effects. Dentists should be aware of the potential aetiology, pathophysiology and management strategies of sleep bruxism.
Topics: Biofeedback, Psychology; Electromyography; Humans; Medical History Taking; Occlusal Splints; Polysomnography; Risk Factors; Sleep Apnea, Obstructive; Sleep Bruxism; Temporomandibular Joint Disorders
PubMed: 30237554
DOI: 10.1038/sj.bdj.2018.757 -
Journal of Dentistry May 2021Bruxism is a commonly reported oral parafunctional activity characterised by excessive tooth grinding or clenching outside normal functional activity. The present... (Review)
Review
OBJECTIVES
Bruxism is a commonly reported oral parafunctional activity characterised by excessive tooth grinding or clenching outside normal functional activity. The present systematic review aims to examine the available literature to determine the effectiveness of occlusal splints in the treatment of bruxism compared to no treatment and alternative treatment modalities.
DATA
Data extraction was undertaken in conjunction with quality of evidence assessment.
SOURCES
A literature search of the following databases was undertaken: MEDLINE via OVID, Pubmed (Medline), Cochrane Oral Health Group's Trials, The Cochrane Central Register of Controlled Trials and EMBASE.
STUDY SELECTION
Randomised Controlled Trials (RCT) and quasi-RCTs which met the inclusion criteria were selected for analysis. These included studies comparing occlusal splints to no treatment or other interventions.
RESULTS
Twenty-two studies were identified for review with fourteen meeting the inclusion criteria. Only a small number of studies were available in each comparison (one or two for some) all of which had a medium to high risk of bias.
CONCLUSIONS
There is insufficient evidence to determine whether occlusal splint therapy for the treatment of bruxism provides a benefit over no treatment, other oral appliances, TENS, behavioural or pharmacological therapy. Furthermore, there is a lack of studies in each comparison with many suffering from a high risk of bias. There is a need for further research in this area and improvement in trial quality.
CLINICAL SIGNIFICANCE STATEMENT
This systematic review aimed to determine the effectiveness of occlusal splints in the treatment of bruxism. It found there was insufficient evidence to recommend occlusal splint therapy over no treatment or other treatment modalities. This is relevant to dental clinicians who may provide such appliances and cautions them in treatment provision.
Topics: Bruxism; Humans; Occlusal Splints; Splints
PubMed: 33652054
DOI: 10.1016/j.jdent.2021.103621 -
Annals of Palliative Medicine Jun 2021This systematic review of the literature was to compare the effects of exercise therapy and occlusal splint therapy on pain and mobility in individuals with painful... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review of the literature was to compare the effects of exercise therapy and occlusal splint therapy on pain and mobility in individuals with painful temporomandibular disorders (TMD).
METHODS
PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched for English publications from database root to March 1, 2020. Search terms were [("temporomandibular joint disorders" or "temporomandibular disorders" or "craniomandibular disorders" or "orofacial pain" or "myofascial pain" or "myofascial pain" or "facial pain") AND (exercise or "physical therapy modalities" or physiotherapy or "exercise therapy") AND ("splints" or "occlusal splints" or "stabilization splint" or "occlusal appliance" or "occlusal splint therapy")]. We included randomized controlled trials that evaluated the effects of therapeutic exercise therapy and occlusal splint therapy, and were published in English. Trial quality was assessed with the Physiotherapy Evidence Database scale.
RESULTS
Six studies were included (498 patients: 251 occlusal splint therapy, 247 therapeutic exercise). The results revealed that exercise therapy was not superior to occlusal splint therapy for pain reduction in patients with painful TMD (P=0.08; weighted standardized mean difference -0.29; 95% CI, -0.62 to 0.04). The effectiveness of occlusal splint therapy and exercise therapy was found to be equivalent in the maximum mouth-opening range (P=0.51; weighted standardized mean difference 0.12; 95% CI, -0.24 to 0.48), right laterotrusion (P=0.99; weighted standardized mean difference -0.00; 95% CI, -0.31 to 0.31), left laterotrusion (P=0.32; weighted standardized mean difference 0.16; 95% CI, -0.16 to 0.48), and protrusion (P=0.77; weighted standardized mean difference 0.06; 95% CI, -0.32 to 0.43) for painful TMD patients.
CONCLUSIONS
Given the limitations of the study, the small number of studies included in the sub-analysis for pain relief and the maximum mouth-opening range, and the small overall standardized mean difference for pain relief and mandibular movement observed, no high-quality evidence was found to distinguish the clinical effectiveness between occlusal splint therapy and exercise therapy for painful TMD patients. It appears that more randomized controlled trials comparing the effects of exercise therapy and occlusal splint therapy need to be implemented.
Topics: Exercise Therapy; Humans; Occlusal Splints; Pain; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 33977737
DOI: 10.21037/apm-21-451 -
Clinical and Experimental Dental... Apr 2019The aim of this study was to investigate the effects of the use of an occlusal splint on postural balance considering the occlusal splint as a device for treating... (Randomized Controlled Trial)
Randomized Controlled Trial
The aim of this study was to investigate the effects of the use of an occlusal splint on postural balance considering the occlusal splint as a device for treating temporomandibular joint disorder. A randomized, controlled, prospective clinical trial was conducted. The research group consisted of 49 patients (36 as test group and 13 as control group) between 18 and 75 years old, both genders, diagnosed as temporomandibular disorder by Research Diagnostic Criteria/Temporomandibular Disorders questionnaire and magnetic resonance imaging of the temporomandibular joints. Test group was treated with orientations for physiotherapeutic exercises and occlusal splint, whereas control group received orientation for physiotherapeutic exercises only. Postural equilibrium was evaluated by means of a force plate. After 12 weeks, the groups were re-evaluated. Patients from both groups presented a significant increase in antero-posterior speed with eyes closed, test group ( < 0.001) and control group ( = 0.046). Only patients of the test group presented a significant increase in antero-posterior speed with eyes opened ( = 0.023). We concluded that the use of occlusal splint affected the postural balance.
Topics: Adolescent; Adult; Aged; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Occlusal Splints; Physical Therapy Modalities; Postural Balance; Sensation Disorders; Single-Blind Method; Temporomandibular Joint Disorders; Young Adult
PubMed: 31049212
DOI: 10.1002/cre2.136 -
Nigerian Journal of Clinical Practice Mar 2021Bruxism is a parafunctional habit, usually performed in sleep, by rhythmic and involuntary teeth being squeezed or squeaked. The most common methods of treatment are the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Bruxism is a parafunctional habit, usually performed in sleep, by rhythmic and involuntary teeth being squeezed or squeaked. The most common methods of treatment are the use of occlusal splints.
AIMS
The aim of this study was to compare the efficacy of occlusal splinting with botulinum toxin administration in the treatment of TMJ pain.
SUBJECTS AND METHODS
For this purpose, 40 patients with bruxism were divided into two groups and one group was treated with occlusal splint and the other group received masseter muscle botulinum toxin injection. Then, the participants in both groups were evaluated in terms of pain, functional movement, and maximum bite force change at 2 weeks, 6 weeks, 3 months, and 6 months. Mann-Whitney U test was used to examine the differences between two independent groups. While Friedman test was used for differences between dependent groups, the Wilcoxon test was used for the differences between two repetitive measurements. Chi-square test was used to examine the relationship between categorical variables. Results: When pain was evaluated, both methods were effective in pain reduction, botulinum toxin injection was found to be less effective in reducing pain but no difference was found between the two methods. The maximum bite force decreased in the 2 and 6 weeks and increased in the 3 and 6 months in patients receiving botulinum toxin. In patients using occlusal splints, there was no change until the 3 month and an increase was seen in the 6 month. In this study, it was observed that low dose BTX-A and occlusal splint use were effective in eliminating bruxism-related pain but not superior to each other.
CONCLUSIONS
According to these results, low dose botulinum toxin can be considered as an alternative treatment in patients who cannot use occlusal splint for various reasons.
Topics: Bruxism; Humans; Pain; Prospective Studies; Temporomandibular Joint; Temporomandibular Joint Dysfunction Syndrome
PubMed: 33723117
DOI: 10.4103/njcp.njcp_251_20 -
Sleep Medicine Reviews Dec 2021Obstructive Sleep Apnea (OSA) is often treated with Mandibular Advancement Devices (MADs). It is unclear whether particular design features are superior to others in... (Meta-Analysis)
Meta-Analysis Review
Obstructive Sleep Apnea (OSA) is often treated with Mandibular Advancement Devices (MADs). It is unclear whether particular design features are superior to others in terms of OSA alleviation. In order to facilitate clinical decision-making, this systematic review summarizes the objective and subjective outcomes of different available MAD designs. Studies comparing different MAD designs in OSA treatment were searched. After screening 1887 titles and abstracts, 20 original RCTs and six cohort studies were included. 14 articles were systematically reviewed in a meta-analysis. The decrease in AHI was significantly different between some of the MAD designs. The clinical relevance of the observed differences was however limited. Monoblock appliances performed more favorable, compared to bilateral thrust (effect size:-0.37; CI:-1.81 to 0.07). Midline traction appliances performed more favorable, compared to other designs. Custom appliances performed more favorable, compared to thermoplastic appliances (effect size:0.86; CI:-0.62 to 2.35). Furthermore, there were no clinically relevant differences between MAD designs in reduction of ESS, compliance, preference, side effects, and cost effectiveness. With respect to the included trials, presently there is not one superior custom MAD design in OSA treatment regarding the effect on AHI reduction, ESS improvement, compliance, preference, side effects, cost effectiveness, and other disease-related outcomes. We confirm custom MAD designs perform superior to thermoplastic MAD designs.
Topics: Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 34662769
DOI: 10.1016/j.smrv.2021.101557