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Title Treatment of TMD Pain With Occlusal Splint vs. Physical Therapies
Clinical Question For a patient with TMD pain, does an occlusal splint reduce pain in a higher percentage of patients than does physical therapy and/or stress exercises?
Clinical Bottom Line Both methods of treatment reduce pain in patients with TMD, but there is inconclusive evidence as to which treatment is definitively better for all patients.
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) 21959663Madani/ 201160 patients with acute pain and dysfunctionRCT
Key resultsOcclusal splints and physical therapy are both effective methods of TMD treatment, but occlusal splints is the best treatment for reduction of pain and joint sounds.
#2) 17138397Friction/ 2006168 trialsMeta-Analysis
Key resultsOcclusal splints are more effective short term, but in the long term, physical therapy that modifies habits and behaviors may be more effective.
#3) 16275687Al-Ani/ 200512 RCTSystematic Review of RCT
Key resultsOcclusal splints are effective in reducing pain, but there is not enough evidence to support this over other forms of treatment.
Evidence Search "Temporomandibular Joint Disorders"[Mesh] AND "Occlusal Splints"[Mesh]"Temporomandibular Joint Disorders"[Mesh] AND "Occlusal Splints"[Mesh] AND Meta-Analysis[ptyp]("Temporomandibular Joint Disorders"[Mesh]) AND "Occlusal Splints"[Mesh] AND (systematic[sb])
Comments on
The Evidence
The Madani evidence was an RCT with similar starting groups. There was over 80% completion rate, the groups were given one of three different treatments. There was adequate follow up, and the study was not double blind. Recall bias could be present. The Friction evidence was a meta-analysis of RCTs. All studies were evaluated for relevancy and validity. 5% of the studies met the gold standard quality of a well designed RCT. The Al-Ani evidence was a systematic review of RCTs. Comprehensive search for relevancy and validity of studies was performed. Of the 20 trials, 12 were deemed relevant and valid.
Applicability Occlusal splint treatment and physical therapy are both effective treatment methods for patients with temporomandibular disorders. There is not conclusive evidence on which treatment is definitively better. This may need to be chosen on a case by case basis, or by therapies that combine multiple forms of treatment.
Specialty/Discipline (General Dentistry)
Keywords Temporomandibular Disorders, Occlusal splint
ID# 2252
Date of submission: 04/12/2012spacer
E-mail clarkel@livemail.uthscsa.edu
Author Laura Jo Clarke
Co-author(s) e-mail
Faculty mentor/Co-author Robert A. Kaminski, DDS, MS
Faculty mentor/Co-author e-mail kaminskir@uthscsa.edu
Basic Science Rationale
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None available
Comments and Evidence-Based Updates on the CAT
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by Danielle Hill, Ola Ukaoma (San Antonio, Texas) on 11/28/2017
A PubMed performed November 2017 yielded two pieces of evidence, both of which do not provide a conclusive answer to this issue. Rather, they display conflicting results. Gomer’s 2015 (PMID 26733760) random control trial (RCT) included 78 volunteers with sleep bruxism. Results showed that occlusal splint and massage therapy led to improvement of TMD pain, but the combined treatment group displayed superior effect. The Nagata 2015 (PMID 26174571) study evaluated 181 TMD patients in two groups (non-splint multi-modal therapy and non-splint multi-modal therapy with splint) and concluded TMD pain decreased for all three parameters measured but no significant difference between combined and individual therapy.

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