AN OBJECTIVE ASSESSMENT ON DENTAL OCCLUSAL APPLIANCE MANAGEMENT OF SLEEP BRUXISM: A LITERATURE REVIEW.

Abstract

Purpose The aim of this article is to review the available literature on objective electromyography (EMG) assessment on treatment effectiveness with various occlusal splints (OS) on sleep bruxism (SB). Materials and Methods The dental literature was searched from 1966 - 2008 in Ovid Medline, Pre-Medline, Embase and all EBM Reviews: Cochrane Database of Systematic Reviews; ACP Journal Club; Database of Abstracts of Reviews of Effects; Cochrane Central Register of Controlled Trials, and Pre- Medline. Studies conducted on human subjects with abstracts written in the English language were included. Articles not pertaining to the topic were excluded. Selected articles were graded according to levels of evidence based upon guidelines provided by Journal of Evidence Based Dental Practice (2002). Results The literature on electromyography assessment of treatment effectiveness with oral appliances worn during sleep on bruxers was scarce. Twelve articles satisfied the inclusion criteria out of the 104 found, and included 6 randomised controlled trials (RCTs) and 6 cohort studies. A total of 187 subjects were involved, predominantly female. Studies showed high methodology heterogeneity and splint treatment duration was generally short-term. The splint designs tested include maxillary stabilising splint (MSS), MSS with canine guidance or molar guidance, thermoplastic vacuum formed soft splint (SS), palatal placebo ‘splint’ (PS), mandibular advancement splint (MAS), nociceptive trigeminal inhibitory splint (NTIS) and splint design according to Jeanmonod prescription (JS). Conclusion Large heterogeneity exists in study methodology. There is moderate evidence that MSS could significantly reduce SB activity in most patients in the short-term. This effect appears to be immediate. However when the splint was discontinued, SB immediately returned to pretreatment levels in most subjects. Long-term splint therapy should be investigated. There is little or no evidence to support the use of other splint designs over the MSS in terms of clinical effectiveness, comfort and lack of long term complications. Objective changes in SB activity do not always correlate to subjective changes in clinical signs or symptoms of SB. Increased bruxism is found in some patients with occlusal splint therapy. As this effect is currently unpredictable, patient interview as well as clinical splint monitoring should be employed by all treating physicians.