Stabilisation splint therapy for temporomandibular pain dysfunction syndrome

Al-Ani MZ, Davies SJ, Gray RJM, Sloan P, Glenny A-M

Published Online:

January 21, 2009

Not enough evidence about whether stabilisation splints can reduce pain caused by painful temporomandibular (jaw) disorders.
Pain dysfunction syndrome (PDS) is the most common TMD (temporomandibular disorder, from the joint between the lower jaw and base of the skull). PDS is also called facial arthromyalgia, myofacial pain dysfunction syndrome and craniomandibular dysfunction. One option is a splint (a type of bite plate) at night when people otherwise may grind their teeth more. The stabilisation splint (SS) is one type, also known as the Tanner appliance, the Fox appliance, the Michigan splint or the centric relation appliance. The review found there is not enough evidence from trials to show whether or not stabilisation splints can reduce PDS.

Abstract (click to read)

Background:

Pain dysfunction syndrome (PDS) is the most common temporomandibular disorder (TMD). There are many synonyms for this condition including facial arthromyalgia, TMJ dysfunction syndrome, myofacial pain dysfunction syndrome, craniomandibular dysfunction and myofacial pain dysfunction. The aetiology of PDS is multifactorial and many different therapies have been advocated.

Objectives:

To establish the effectiveness of stabilisation splint therapy in reducing symptoms in patients with pain dysfunction syndrome.

Search strategy:

Electronic databases (including the Cochrane Oral Health Group's Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2003, Issue 2); MEDLINE (1966 to June 2001); EMBASE (1966 to June 2001)) were searched. Handsearching of relevant journals was undertaken and reference lists of included studies screened. Experts in the field were contacted to identify unpublished articles. There was no language restriction.

Selection criteria:

Randomised or quasi-randomised controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other active intervention.

Data collection and analysis:

Data extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third review author consulted. The author of the primary study was contacted where necessary. The studies were grouped according to treatment type and duration of follow up.

Main results:

Twenty potentially relevant RCTs were identified. Eight trials were excluded leaving 12 RCTs for analysis. Stabilisation splint therapy was compared to: acupuncture, bite plates, biofeedback/stress management, visual feedback, relaxation, jaw exercises, non-occluding appliance and minimal/no treatment.

There was no evidence of a statistically significant difference in the effectiveness of stabilisation splint therapy (SS) in reducing symptoms in patients with pain dysfunction syndrome compared with other active treatments. There is weak evidence to suggest that the use of SS for the treatment of PDS may be beneficial for reducing pain severity, at rest and on palpation, when compared to no treatment.

Authors' conclusions:

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 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 .

This record should be cited as:

Al-Ani MZ, Davies SJ, Gray RJM, Sloan P, Glenny A-M. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002778. DOI: 10.1002/14651858.CD002778.pub2

Assessed as up to date:

November 4, 2003

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Oral pain

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Stabilisation splint therapy for temporomandibular pain dysfunction syndrome

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