R W Wassell1, N Adams, P J Kelly. 1. Department of Restorative Dentistry, The School of Dental Sciences, Framlington Place, Newcastle upon Tyne NE2 4BW. r.w.wassell@ncl.ac.uk
Abstract
INTRODUCTION: Little is known about how effective general dental practitioners (GDPs) are in treating temporomandibular disorders (TMD). The overall aim of this study was to compare the lower stabilising splint (SS) with a non-occluding control (CS) for the management of TMD in general dental practice. METHOD: A total of 93 TMD patients attending 11 GDPs were randomly allocated to SS or CS. Diagnosis was according to International Headache Society Criteria. Outcome criteria included pain visual analogue scale (VAS), number of tender muscles, aggregate joint tenderness, inter-incisal opening, TMJ clicks and headaches. Splints were fitted one week after baseline and patients were followed-up every three weeks to three months; those not responding to CS after six weeks (< 50% VAS reduction) were crossed over to SS for a further three months. RESULTS: Documentation was returned from nine GDPs for 72 patients (38 for SS, 34 for CS). At six weeks, mean improvements were noted for all outcome criteria, but less so for clicking. There were no significant differences between splints [chi(2)]. Seventeen CS patients had < 50% VAS reduction and were provided with SS in the cross-over group. CS patients with >50% VAS reduction were significantly younger than CS patients who crossed-over (ANOVA, p=0.009) and had significantly less diagnoses of TMJ clicking (chi(2), p<0.05). At the conclusion of the trial 16 patients were referred for specialist management: 11 non-responders (< 50% VAS reduction), one of whom needed occlusal adjustment and five responders also needing occlusal adjustment. CONCLUSIONS: At six weeks SS gave similar relief to CS for all outcome criteria. Patients who crossed-over from CS to SS were more likely to be older and have clicking TMJs. At the end of treatment nine of 11 non-responders to SS had a diagnosis of disc displacement with reduction. However, 80% TMD patients were managed effectively by GDPs using splints for periods of up to five months.
RCT Entities:
INTRODUCTION: Little is known about how effective general dental practitioners (GDPs) are in treating temporomandibular disorders (TMD). The overall aim of this study was to compare the lower stabilising splint (SS) with a non-occluding control (CS) for the management of TMD in general dental practice. METHOD: A total of 93 TMDpatients attending 11 GDPs were randomly allocated to SS or CS. Diagnosis was according to International Headache Society Criteria. Outcome criteria included pain visual analogue scale (VAS), number of tender muscles, aggregate joint tenderness, inter-incisal opening, TMJ clicks and headaches. Splints were fitted one week after baseline and patients were followed-up every three weeks to three months; those not responding to CS after six weeks (< 50% VAS reduction) were crossed over to SS for a further three months. RESULTS: Documentation was returned from nine GDPs for 72 patients (38 for SS, 34 for CS). At six weeks, mean improvements were noted for all outcome criteria, but less so for clicking. There were no significant differences between splints [chi(2)]. Seventeen CSpatients had < 50% VAS reduction and were provided with SS in the cross-over group. CSpatients with >50% VAS reduction were significantly younger than CSpatients who crossed-over (ANOVA, p=0.009) and had significantly less diagnoses of TMJ clicking (chi(2), p<0.05). At the conclusion of the trial 16 patients were referred for specialist management: 11 non-responders (< 50% VAS reduction), one of whom needed occlusal adjustment and five responders also needing occlusal adjustment. CONCLUSIONS: At six weeks SS gave similar relief to CS for all outcome criteria. Patients who crossed-over from CS to SS were more likely to be older and have clicking TMJs. At the end of treatment nine of 11 non-responders to SS had a diagnosis of disc displacement with reduction. However, 80% TMDpatients were managed effectively by GDPs using splints for periods of up to five months.
Authors: Philip Riley; Anne-Marie Glenny; Helen V Worthington; Elisabet Jacobsen; Clare Robertson; Justin Durham; Stephen Davies; Helen Petersen; Dwayne Boyers Journal: Health Technol Assess Date: 2020-02 Impact factor: 4.014
Authors: Ana M Velly; Eric L Schiffman; D Brad Rindal; Joana Cunha-Cruz; Gregg H Gilbert; Maryann Lehmann; Allan Horowitz; James Fricton Journal: J Am Dent Assoc Date: 2013-01 Impact factor: 3.634
Authors: Ljuben Guguvcevski; Nikola Gigovski; Aneta Mijoska; Katerina Zlatanovska; Ana Arsova-Gigovska Journal: Open Access Maced J Med Sci Date: 2017-10-25