ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Occlusal Splint Therapy in Combination With Masseter and Temporalis Muscle Massage Significantly Improves TMD Muscle Pain
Clinical Question For a patient with TMD muscle pain, will massaging the masseter and temporalis muscles improve the patient’s symptoms in comparison to splint therapy alone?
Clinical Bottom Line For patients with TMD muscle pain, a combination of splint therapy and massage of the masseter and temporalis muscles will significantly improve the patient’s symptoms as opposed providing either of these treatments alone.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26733760Gomez/201578 women diagnosed with sleep bruxism between the ages of 18 and 40. Randomized Controlled Trial
Key resultsThis clinical trial randomly allocated 100 women into one of four groups consisting of massage therapy, occlusal splint therapy, a combination of massage therapy and occlusal splint therapy, and a control group. The massage group received three thirty-minute sessions weekly for four consecutive weeks and the occlusal splint therapy group underwent treatment for four weeks. Moreover, the combined group received both treatments, while the no treatment control group was only seen twice during the four week interval. Post-treatment evaluations were performed on all groups and outcome measures consisted of TMD pain assessment and 8 medical subscales that included physical functioning, role physical, bodily pain, general health state, vitality, role social, role emotional, and mental health. Post-treatment evaluations revealed that the combination group had statistically significantly more improvement than the other groups (p< 0.05) with a reduction in their overall pain score from a 7.7 to a 3.6 on the numeric pain rating scale (NRS).
Evidence Search ("occlusal splints"[MeSH Terms] OR ("occlusal"[All Fields] AND "splints"[All Fields]) OR "occlusal splints"[All Fields] OR ("occlusal"[All Fields] AND "splint"[All Fields]) OR "occlusal splint"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]) AND ("massage"[MeSH Terms] OR "massage"[All Fields] OR ("massage"[All Fields] AND "therapy"[All Fields]) OR "massage therapy"[All Fields])
Comments on
The Evidence
Validity: The strengths of this study included a randomized, controlled, blinded, clinical trial with the evaluators and researchers being blinded to the subject’s group allocation. Furthermore, the inclusion criteria were appropriate which included a sleep bruxism diagnosis, self-reported awake bruxism, and a minimum pain intensity score of a 3 on a 11-point NRS scale. In addition, the exclusion criteria were also appropriate which included having missing teeth; use of an orthodontic appliance; history of systemic or joint disease; use of an analgesic anti-inflammatory or muscle relaxant medication; and undergoing physical therapy. A weakness to this study was the high number of dropouts. The investigators randomized 100 subjects into 4 groups and 22 dropped out, primarily in the massage only, splint only, and control groups. Perspective: Overall, the studies deemed adequate but a larger sample size would possibly have been more beneficial.
Applicability For patients with TMD pain from sleep bruxism, this study suggests it would be better to provide them with a splint and recommend they massage the masseter and temporalis muscles than only providing either of these treatments alone.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Occlusal Splint Therapy, TMD pain, Massage therapy
ID# 3027
Date of submission: 04/26/2016spacer
E-mail thomass4@livemail.uthscsa.edu
Author Soumya Thomas
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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