Oral splints for temporomandibular disorder or bruxism: a systematic review

Philip Riley*, Anne-Marie Glenn, Helen V. Worthington, Elisabet Jacobsen, Clare Robertson, Justin Durham, Stephen Davies, Helen Petersen, Dwayne Boyers

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objectives: To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism).

Data sources: Four databases including MEDLINE and EMBASE were searched until 1 October 2018.

Data selection and extraction: Randomised controlled trials comparing all types of splints versus no/minimal treatment for patients with TMD or bruxism were eligible. Standard Cochrane review methods were used. Standardised mean differences (SMD) were pooled for the primary outcome pain, using random effects models in TMD patients.

Data synthesis: Thirty-seven trials were included and the evidence identified was of very low certainty using GRADE assessments. When all sub-types of TMD were pooled into one global TMD group, there was no evidence that splints reduced pain: SMD (up to 3 months) -0.18 (95% CI -0.42 to 0.06); 13 trials, 1076 participants. There was no evidence that any other outcomes improved when using splints. There was no evidence of adverse events associated with splints, but reporting was poor regarding this outcome.

No trials measured tooth wear in patients with bruxism.

There was a large variation in diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these factors did not indicate a reduction in pain.

Conclusions: The very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions. There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism.
Original languageEnglish
JournalBritish Dental Journal
Publication statusAccepted/In press - 19 Nov 2019

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Bruxism
Temporomandibular Joint Disorders
Splints
Tooth Wear
Pain
Information Storage and Retrieval
MEDLINE
Randomized Controlled Trials
Outcome Assessment (Health Care)
Databases

Cite this

Riley, P., Glenn, A-M., Worthington, H. V., Jacobsen, E., Robertson, C., Durham, J., ... Boyers, D. (Accepted/In press). Oral splints for temporomandibular disorder or bruxism: a systematic review. British Dental Journal.

Oral splints for temporomandibular disorder or bruxism : a systematic review. / Riley, Philip; Glenn, Anne-Marie; Worthington, Helen V.; Jacobsen, Elisabet; Robertson, Clare; Durham, Justin; Davies, Stephen; Petersen, Helen; Boyers, Dwayne.

In: British Dental Journal, 19.11.2019.

Research output: Contribution to journalArticle

Riley P, Glenn A-M, Worthington HV, Jacobsen E, Robertson C, Durham J et al. Oral splints for temporomandibular disorder or bruxism: a systematic review. British Dental Journal. 2019 Nov 19.
Riley, Philip ; Glenn, Anne-Marie ; Worthington, Helen V. ; Jacobsen, Elisabet ; Robertson, Clare ; Durham, Justin ; Davies, Stephen ; Petersen, Helen ; Boyers, Dwayne. / Oral splints for temporomandibular disorder or bruxism : a systematic review. In: British Dental Journal. 2019.
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abstract = "Objectives: To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism).Data sources: Four databases including MEDLINE and EMBASE were searched until 1 October 2018.Data selection and extraction: Randomised controlled trials comparing all types of splints versus no/minimal treatment for patients with TMD or bruxism were eligible. Standard Cochrane review methods were used. Standardised mean differences (SMD) were pooled for the primary outcome pain, using random effects models in TMD patients.Data synthesis: Thirty-seven trials were included and the evidence identified was of very low certainty using GRADE assessments. When all sub-types of TMD were pooled into one global TMD group, there was no evidence that splints reduced pain: SMD (up to 3 months) -0.18 (95{\%} CI -0.42 to 0.06); 13 trials, 1076 participants. There was no evidence that any other outcomes improved when using splints. There was no evidence of adverse events associated with splints, but reporting was poor regarding this outcome.No trials measured tooth wear in patients with bruxism.There was a large variation in diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these factors did not indicate a reduction in pain.Conclusions: The very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions. There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism.",
author = "Philip Riley and Anne-Marie Glenn and Worthington, {Helen V.} and Elisabet Jacobsen and Clare Robertson and Justin Durham and Stephen Davies and Helen Petersen and Dwayne Boyers",
note = "Funded by: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (Project number: 16/146/06). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.",
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AU - Robertson, Clare

AU - Durham, Justin

AU - Davies, Stephen

AU - Petersen, Helen

AU - Boyers, Dwayne

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N2 - Objectives: To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism).Data sources: Four databases including MEDLINE and EMBASE were searched until 1 October 2018.Data selection and extraction: Randomised controlled trials comparing all types of splints versus no/minimal treatment for patients with TMD or bruxism were eligible. Standard Cochrane review methods were used. Standardised mean differences (SMD) were pooled for the primary outcome pain, using random effects models in TMD patients.Data synthesis: Thirty-seven trials were included and the evidence identified was of very low certainty using GRADE assessments. When all sub-types of TMD were pooled into one global TMD group, there was no evidence that splints reduced pain: SMD (up to 3 months) -0.18 (95% CI -0.42 to 0.06); 13 trials, 1076 participants. There was no evidence that any other outcomes improved when using splints. There was no evidence of adverse events associated with splints, but reporting was poor regarding this outcome.No trials measured tooth wear in patients with bruxism.There was a large variation in diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these factors did not indicate a reduction in pain.Conclusions: The very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions. There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism.

AB - Objectives: To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism).Data sources: Four databases including MEDLINE and EMBASE were searched until 1 October 2018.Data selection and extraction: Randomised controlled trials comparing all types of splints versus no/minimal treatment for patients with TMD or bruxism were eligible. Standard Cochrane review methods were used. Standardised mean differences (SMD) were pooled for the primary outcome pain, using random effects models in TMD patients.Data synthesis: Thirty-seven trials were included and the evidence identified was of very low certainty using GRADE assessments. When all sub-types of TMD were pooled into one global TMD group, there was no evidence that splints reduced pain: SMD (up to 3 months) -0.18 (95% CI -0.42 to 0.06); 13 trials, 1076 participants. There was no evidence that any other outcomes improved when using splints. There was no evidence of adverse events associated with splints, but reporting was poor regarding this outcome.No trials measured tooth wear in patients with bruxism.There was a large variation in diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these factors did not indicate a reduction in pain.Conclusions: The very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions. There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism.

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