Oral splints for temporomandibular disorder or bruxism: a systematic review

Abstract

This systematic review comprehensively summarised the best available evidence from randomised controlled trials on the effects of oral splints for temporomandibular disorders (TMD) and bruxism.There is no evidence to support the use of oral splints for either condition based on the results found.For TMD patients, sensitivity analyses were conducted to explore the effects of differences in: 1) diagnostic criteria; 2) splint types; and 3) outcome measures used and reported. There were no differences in the results based on these factors. AbstractObjectives To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism).Data sources Four databases including MEDLINE and EMBASE were searched from inception until 1 October 2018. Data selection and extractionRandomised controlled trials comparing all types of splints versus no/minimal treatment for patients with TMD or bruxism were eligible. Standard Cochrane review methods were used. Standardised mean differences (SMD) were pooled for the primary outcome of pain, using random effects models in TMD patients. Data synthesisThirty-seven trials were included and the evidence identified was of very low certainty using GRADE assessments. When all subtypes of TMD were pooled into one global TMD group, there was no evidence that splints reduced pain: SMD (up to 3 months) -0.18 (95% CI -0.42 to 0.06); 13 trials, 1,076 participants. There was no evidence that any other outcomes improved when using splints. There was no evidence of adverse events associated with splints, but reporting was poor regarding this outcome. No trials measured tooth wear in patients with bruxism. There was a large variation in diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these factors did not indicate a reduction in pain. ConclusionsThe very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions. There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism.

The efficacy of occlusal splints in the treatment of bruxism: A systematic review

“…Previous reviews such as the 2007 systematic review by the Cochrane Collaboration [2] found insufficient evidence to affirm the use of occlusal splints in bruxism therapy. A recent systematic review published during editing of the present review had similar findings and did not find evidence to support splint use for temporomandibular disorders or bruxism [3].…”

Bruxism: Best Evidence Consensus Statement

“…Riley et al 59 in an SR on the use of OD for TMD or bruxism concluded that “the body of evidence that this conclusion is based on is of very low certainty. The studies included in this review differed in three important factors: (1) diagnoses, (2) splint type, and (3) outcome measurement/reporting.…”

Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management

“…The use of occlusal splint therapy has been shown to reduce pain intensity and increase maximal mouth opening [ 48 ]. However, whether the effect of an occlusal splint is due to the placebo effect has been questioned, and that the evidence of its efficacy remains to be low [ 49 , 50 ]. A systematic review in 2018 by Alkhutari et al has suggested that the use of occlusal splint may improve patient-centred treatment outcomes, which may be more than merely a placebo effect [ 51 ].…”