Title	Relief Of TMD Pain In Patients Diagnosed With PTSD: Modifications Of Traditional Occlusal Appliances
Clinical Question	In a patient diagnosed with post-traumatic stress disorder who reports of night time clenching activity during during PTSD nightmares, and has found no relief via psychiatric/psychologic means, what is the best dental treatment?
Clinical Bottom Line	Severe nocturnal tooth clenching activity is commonly observed with nightmares related to PTSD, and serves as a primary contributing factor for their TMD symptoms. A non-pharmaceutical approach for managing the TMD symptoms among these patients is to provide a maxillary acrylic appliance worn at night. If this traditional appliance does not adequately resolve the symptoms, the addition of an opposing mandibular soft appliance may provide additional benefit.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 15119679 Wright/2004 1 patient diagnosed with PTSD reporting of tooth pain Case Study Key results A maxillary acrylic appliance provided some relief, while addition of a subsequent soft occlusal appliance opposing on the mandibular provided additional relief.
Evidence Search	"Stress Disorders, Post-Traumatic"[Mesh] AND "Bruxism"[Mesh]
Comments on The Evidence	This was a case report covering the diagnosis, treatment, and management of a patient diagnosed with PTSD reporting bilateral tooth pain and night time clenching activity. There was no evidence of competing interest. As with all case reports, it is deficient in control groups, however, it offers insight to a potential solution for patients presenting with similar symptoms. More research is needed to assess alternative and best methods of treatment.
Applicability	PTSD patients often present much different than the average TMD patient. This case represents successful dental pain management in the complex PTSD presenting patient. Correct diagnosis and management of tooth pain in PTSD patients is critical in successful dental treatment.
Specialty	(General Dentistry) (Behavioral Science)
Keywords	PTSD, Bruxism, Tooth Pain, Appliance
ID#	2212
Date of submission	04/26/2012
E-mail	Moers@uthscsa.edu
Author	Emily L. Moers
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Edward F. Wright, DDS, MS
Faculty mentor 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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available