The most common treatment for temporomandibular disorders is a splint − or, as one dentist put it, "Everybody needs magic plastic." If you are being recommended to get a splint - you should know all about them before you agree to the treatment.
Definition: An occlusal (refers to the position of the teeth or “bite”) splint is a removable dental appliance that covers several or all of the upper or lower teeth.
Types: There are several distinct types of occlusal splints.
Materials Used: Occlusal splints are typically constructed of hard acrylic resin. The resilient or soft type is less durable, more difficult to adjust and harder to keep clean. In some patients, it may encourage clenching and grinding, and therefore, increase the symptoms.
Beyond the basic information, what do you need to know in order to decide if a splint is right for you?
Occlusal splints are among the most popular non-surgical means by which dentists treat pain in the jaw muscles and TMJ. However, studies to evaluate the effectiveness of splint therapy have produced inconsistent results. Here's a summary of current research.
A 2010 Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders found "stabilization appliances, when adjusted properly, have good evidence of modest efficacy in the treatment of TMD pain compared to non-occluding appliances and no treatment. Other types of appliances, including soft stabilization appliances, anterior positioning appliances, and anterior bite appliances, have some randomized controlled trial (RCT) evidence of efficacy in reducing TMD pain. [However, the potential for adverse events with these appliances is higher and suggests the need for close monitoring in their use.]"
A 2009 Cochrane Database of Systematic Review study concluded "There is insufficient evidence either for or against the use of stabilisation splint therapy for the treatment of temporomandibular pain dysfunction syndrome. This review suggests the need for further, well conducted randomized controlled trials (RCTs) that pay attention to method of allocation, outcome assessment, large sample size, and enough duration of follow up. A standardisation of the outcomes of the treatment of PDS should be established in the RCTs ."
Because studies so far have shown inconsistent results at best, you should be especially wary of having a repositioning splint. Because the effects of the use of this type of splint are permanent, prolonged use (over six weeks) raises the risk of changes in the bite, long-term damage to the joint, and increased pain, requiring further treatment and possibly including surgery.
In summary, it is wise to be informed and educate yourself before you agree to any recommended treatment.
Your dentist may make you agree to a range of other “services” as a condition for providing the splint. These other services may include various modes of massage/physical therapy, injections, braces and/or crowns. These are all added costs. Some dentists require that you sign a contract for splints and/or a whole treatment “package” before they will make and fit your splint.
After your initial consultation, the dentist will make an impression of your teeth. After the splint is made, the dentist will fit and readjust it. You will be expected to wear it at the recommended times (all day, only at night, both) and to come in for follow-up appointments to check on your bite and have the splint readjusted, if necessary. Your dentist will advise you how to care for the splint.
Since splints can cost up to thousands of dollars, including initial examination and fitting. You should expect to pay for follow-up visits. Insurance often does not cover this treatment, so be sure to check with your insurance carrier in advance.
Over-the-counter splints are occlusal splints that are sold in stores. They are made of a type of plastic that softens when warmed, and you can then mold the splint to fit over your teeth. Such splints should never be used because it is not possible to obtain an exact fit, and therefore, they can cause permanent changes in the bite by moving the teeth.
These mouth guards are used by people engaged in contact sports to protect the teeth from injury and are not designed for use in patients with TMJ problems.
The Aqualizer® is a soft plastic bite appliance filled with water, the use of which is based on the idea that jaw muscle pain is caused by an unbalanced bite. By containing a liquid, the Aqualizer® is supposed to automatically rebalance the bite because the fluid level can vary depending on the degree of tooth contact. The problem with this appliance is that it is based on a false premise - that myofacial pain can be caused by the manner in which the teeth touch each other rather than by what the patient may be doing with their teeth. Rather than working by "rebalancing the bite,"the appliance works because the patient senses that biting against the fragile plastic will cause it to break, and therefore, it may cause them to stop clenching and grinding.
An article by Dr. Christian Stohler, Dean at
Thanks to our volunteer, Laurie, who researched the current literature for this article. It was reviewed for accuracy by Dr. Daniel Laskin, the TMJA's clinical consultant.
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