ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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 (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15119679Wright/20041 patient diagnosed with PTSD reporting of tooth painCase Study
Key resultsA 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/Discipline (General Dentistry)
Keywords PTSD, Bruxism, Tooth Pain, Appliance
ID# 2212
Date of submission: 04/26/2012spacer
E-mail Moers@uthscsa.edu
Author Emily L. Moers
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
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Comments on the CAT
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