Stabilisation splint therapy for temporomandibular pain dysfunction syndrome

 

Abstract

Background

Pain dysfunction syndrome (PDS) is the most common temporomandibular disorder (TMD). There are many synonyms for this condition including facial arthromyalgia, TMJ dysfunction syndrome, myofacial pain dysfunction syndrome, craniomandibular dysfunction and myofacial pain dysfunction. The aetiology of PDS is multifactorial and many different therapies have been advocated.

Objectives

To establish the effectiveness of stabilisation splint therapy in reducing symptoms in patients with pain dysfunction syndrome.

Search methods

Electronic databases (including the Cochrane Oral Health Group's Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2003, Issue 2); MEDLINE (1966 to June 2001); EMBASE (1966 to June 2001)) were searched. Handsearching of relevant journals was undertaken and reference lists of included studies screened. Experts in the field were contacted to identify unpublished articles. There was no language restriction.

Selection criteria

Randomised or quasi-randomised controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other active intervention.

Data collection and analysis

Data extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third review author consulted. The author of the primary study was contacted where necessary. The studies were grouped according to treatment type and duration of follow up.

Main results

Twenty potentially relevant RCTs were identified. Eight trials were excluded leaving 12 RCTs for analysis. Stabilisation splint therapy was compared to: acupuncture, bite plates, biofeedback/stress management, visual feedback, relaxation, jaw exercises, non-occluding appliance and minimal/no treatment.

There was no evidence of a statistically significant difference in the effectiveness of stabilisation splint therapy (SS) in reducing symptoms in patients with pain dysfunction syndrome compared with other active treatments. There is weak evidence to suggest that the use of SS for the treatment of PDS may be beneficial for reducing pain severity, at rest and on palpation, when compared to no treatment.

Authors' conclusions

There is insufficient evidence either for or against the use of stabilisation splint therapy for the treatment of temporomandibular pain dysfunction syndrome. This review suggests the need for further, well conducted RCTs that pay attention to method of allocation, outcome assessment, large sample size, and enough duration of follow up. A standardisation of the outcomes of the treatment of PDS should be established in the RCTs .

 

Plain language summary

Stabilisation splint therapy for temporomandibular pain dysfunction syndrome

Not enough evidence about whether stabilisation splints can reduce pain caused by painful temporomandibular (jaw) disorders.
Pain dysfunction syndrome (PDS) is the most common TMD (temporomandibular disorder, from the joint between the lower jaw and base of the skull). PDS is also called facial arthromyalgia, myofacial pain dysfunction syndrome and craniomandibular dysfunction. One option is a splint (a type of bite plate) at night when people otherwise may grind their teeth more. The stabilisation splint (SS) is one type, also known as the Tanner appliance, the Fox appliance, the Michigan splint or the centric relation appliance. The review found there is not enough evidence from trials to show whether or not stabilisation splints can reduce PDS.

 

摘要

背景

顳顎關節疼痛障礙症狀之穩固性咬合板治療

疼痛障礙症候群(pain dysfunction syndrome)是最常見的顳顎關節障礙(temporomandibular disorder, TMD)。此症候群亦稱為如:顏面關節肌肉發炎、顳顎關節障礙症狀、肌筋膜疼痛機能障礙症候群、口顎障礙和肌筋膜疼痛障礙。顎肌症候群的病原學是具多發性因素且已有多種不同的方式可供治療。

目標

評估以穩固性咬合板治療疼痛障礙症候群的療效。

搜尋策略

搜尋電子資料庫(包含Cochrane Oral Health Group's Trials Register;(CENTRAL); The Cochrane Library Issue 2, 2003; MEDLINE (1966 – 2001.06); EMBASE (1966 – 2001.06))。手動搜尋相關期刊與篩選出的研究中所列的參考文獻。並諮詢該領域的專家以確認未出版的文獻。沒有語言的限制。

選擇標準

隨機或半隨機對照試驗(RCTs)，咬合板治療同時需與無治療、其他咬合裝置或其他任何積極性介入治療進行比較。

資料收集與分析

互不影響的擷取被納入的試驗資料數據並製成一式兩份。擷取資料的同時評估該試驗的效度。當有歧見時會經過討論與諮詢第三檢閱者。當有必要時會聯絡該原始試驗的作者。依據治療種類和追蹤期將所納入的試驗分組。

主要結論

證得20例潛在相關RCTs。排除8件試驗，分析剩餘的12例試驗。穩固性咬合板治療與針灸、咬合導板、生理回饋/壓力管理、視覺回饋、放鬆、顎運動、非咬合裝置和極輕度治療/無治療，進行比較。在減緩疼痛障礙症候群患者的症狀方面，沒有足夠的統計顯著差異證明穩固性咬合板治療比其他積極性治療有效。僅有一個微弱的證明顯示：使用穩固性咬合板治療疼痛障礙症候群，可能有降低靜態或觸診時疼痛嚴重度的效果(與無治療相比)。

作者結論

沒有足夠的證據支持或反對使用穩固性咬合板治療顳顎關節疼痛障礙症候群。此篇文獻回顧建議需要引入更完善的隨機對照試驗：注意方法配置、結果評估、大樣本數和足夠的追蹤期。在這些隨機對照試驗中，疼痛障礙症候群治療成效的評估方法應該標準化。

翻譯人

本摘要由臺灣大學附設醫院王東美翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有足夠證據證明穩固性咬合板能減少顳顎關節障礙所造成的疼痛。疼痛障礙症候群(PDS)是最常見的顳顎關節障礙(TMD)(顳顎關節，從下顎關節到顱底)。PDS又稱為顏面關節肌肉痛、顏面肌疼痛障礙症候群、顱顎關節障礙症。 對於會夜間磨牙的患者而言，治療選擇之一為咬合板(某一類型咬導板)。穩固形咬合板為此類咬合板其中的一型，也稱為Tanner appliance、Fox appliance、Michigan splint或centric relation appliance。此篇文獻回顧發現沒有足夠的試驗能證實穩固性咬合板是否能減少疼痛障礙症後群。