The National Institutes of Health Brochure on TMJ Disorders states that stabilization splints are the most widely used treatments for TMJ disorders, however studies of their effectiveness in providing pain relief has been inconclusive. Stabilization splints are also often recommended to prevent bruxism.
Charles S. Greene, D.D.S., Clinical Professor, Department of Orthodontics, UIC College of Dentistry, Chicago, IL wrote the article below for our August 2013 issue of TMJ News Bites. Recently another article was published relating to this topic. We are re-posting Dr. Greene's article along with the new information.
Maria Nikolopoulou, DDS, MSc/Jari Ahlberg, DDS, PhD/Corine M. Visscher, PT, PhD/Hans L. Hamburger, MD, PhD/Machiel Naeije, PhD/Frank Lobbezoo, DDS, PhD Journal of Orofacial Pain 2013; 27: (3) 199-205
This article deals with the question of whether the stabilization splint, which is commonly used for treating TMDs and bruxism, may pose a risk of worsening obstructive sleep apnea in patients with that condition. While a few earlier studies have touched on this matter, this is the first study to use quantitative measures to answer the question. All subjects had 3 recordings done in a sleep laboratory while wearing a splint and 3 recordings without it. Also, it is the first one to use a randomized format in which each patient is his own control; half of the patients wore a splint first and then slept without it, while the other half followed the opposite protocol.
The result was that there was a change in just one of the two variables studied. The variable affected, called AHI, which stands for Apnea-Hypopnea Index is a measure of obstructed airflow during sleep. If the index is higher than 5 events per hour and is accompanied by excessive daytime sleepiness, it qualifies for a diagnosis of obstructive sleep apnea. The second measure is called the Epworth Sleepiness Scale, which is a more subjective assessment of sleep disturbance.
In this study, the Epworth Sleepiness Scale was not different between the two conditions of wearing or not wearing a stabilization splint, but there was some difference in the AHI scores. While this difference was relatively small, it was in the negative direction of worse scores while wearing a splint. The researchers commented that this may not be clinically significant in the short run, and there is no long-term data. However, they caution dentists who want to make a stabilization splint for their patients to at least inquire about whether obstructive sleep apnea is a condition they may have.
Ramesh Balasubramaniam, BDSc, MS; Gary D. Klasser, DMD; Peter A. Cistulli, MD, PhD; Gilles J. Lavigne, DDS, PhD.
Journal of Dental Sleep Medicine Vol.1, No.1, 2014.
The following statements are taken directly from this article:
"...It appears that when patients with sleep bruxism and/or painful TMD complain about insomnia, snoring, and/or cessation of breathing during sleep, sleepiness of unidentified causes, or uncontrolled blood pressure, it is prudent to screen for the presence of sleep disordered breathing [SDB]. Such is done in collaboration with sleep medicine specialists using either sleep laboratory or home recording system with electromyography analysis of masseter/temporal muscle activity..."
"Dentists need to be aware that current standard maxillary oral appliances (occlusal splints) to protect teeth from attrition may not be appropriate treatment in the presence of sleep disordered breathing. That is, in some cases, occlusal splints [also known as stabilization appliances] may aggravate underlying sleep disordered breathing. Also, in some cases, mandibular advancement appliances may initiate or aggravate preexisting painful TMD in patients with sleep disordered breathing. Further prospective studies looking at the relationship between sleep bruxism and sleep disordered breathing, and painful TMD and sleep disordered breathing are warranted before it may be translated into clinical guidelines and standards of practice."
This study raises the paradoxical problem that both types of splints may pose a problem for some patient subgroups. The bruxism patient who has SDB may have a negative effect from wearing a stabilization appliance, while patients who have both TMD and SDB may have a negative effect on their pain symptoms from wearing a mandibular advancement appliance. Dentists treating these patient populations need to carefully weigh all these factors when deciding what kind of appliances to use for each patient--or whether to recommend an appliance at all.