ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Hard Versus Soft Occlusal Splints
Clinical Question In patients with masticatory muscle pain, are hard occlusal splints more effective at reducing symptoms than soft occlusal splints?
Clinical Bottom Line Based on the currently best available evidence it appears that most patients with masticatory muscle pain are helped by the incorporation of a stabilization splint. A stabilization splint does not appear to yield a better clinical outcome than a soft splint, a non-occluding palatal splint, physical therapy, or body acupuncture. However, there remains a need for more randomized controlled trials with high power in this area, as it seems that the improvement in symptoms is caused by specific effects of the splints. (See Comments on the CAT below)
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) 15179561Turp/200411 of 13 publications with participants seeking care for orofacial pain, and remaining 2 of 13 publications with participants recruited by local print media, ranging from n = 26 to n = 168Systematic Review
Key resultsThe systematic review did not include a confidence level or p-value. However, the results show that the intervention did not exceed the comparison, but rather that soft and hard occlusal splints help patients with masticatory muscle pain fairly equally.
Evidence Search Limits: Randomized Controlled Trial, Systematic Reviews Meta-Analysis, Search "Occlusal Splints"[Mesh] Search "Masticatory Muscles"[Mesh]
Comments on
The Evidence
The systematic review included randomized controlled trials (RCTs). The groups were not similar at the start due to trials with different pre-treatment pain levels depending on whether participants were referred by a dentist or by media. Since the number of participants was small, one of the studies did not have greater than a 90% completion rate due to participant dropout. The groups were not treated the same, as some appliances were worn nearly 24 hours a day, while others were worn only at night. There isn’t information on adequate follow-up. The study was not double-blind (and it should be noted that it is controversial whether that is possible in comparing active and placebo appliances). There isn’t information on adequate compliance. Recall bias is unlikely. There are no competing interests.
Applicability The subjects in the systematic review are representative of potential future patients, where occlusal appliance treatment is feasible.
Specialty/Discipline (General Dentistry)
Keywords temporomandibular joint disorders, myofascial pain, masticatory muscle pain, soft occlusal splint, soft appliance, hard occlusal splint, stabilization splint
ID# 577
Date of submission: 04/01/2010spacer
E-mail LinK3@livemail.uthscsa.edu
Author Karen Lin
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?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Omar El-Kweifi, Matthew Hannan, Monica Momin (San Antonio, Texas) on 01/07/2013
A PubMed search on Hard Versus Soft occlusal Splints was performed on January 2013. A more recent publication by Alpaslan, 2008, PMID # 18356022, showed no difference between the use of soft and hard occlusal splints. In addition, it showed arthrocentesis alone to be more efficient treatment for TMD patients with masticatory muscle pain.
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