Oral splints for temporomandibular disorder or bruxism: a systematic review.,British Dental Journal

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Oral splints for temporomandibular disorder or bruxism: a systematic review.
British Dental Journal ( IF 2.0 ) Pub Date : 2020-02-01 , DOI: 10.1038/s41415-020-1250-2
Philip Riley ₁ , Anne-Marie Glenny ₁ , Helen V Worthington ₁ , Elisabet Jacobsen ₂ , Clare Robertson ₃ , Justin Durham ₄ , Stephen Davies ₅ , Helen Petersen ₅ , Dwayne Boyers ₂

Affiliation

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 from inception 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 of 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 subtypes 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, 1,076 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.

中文翻译：

颞下颌疾病或磨牙症的口腔夹板：系统评价。

目的评估口腔夹板对TMD或磨牙症患者的主要结局：疼痛（TMD）和牙齿磨耗（轻度磨牙）的临床效果。数据来源自成立至2018年10月1日，检索了MEDLINE和EMBASE等四个数据库。选择和提取比较所有类型的TMD或磨牙症患者的夹板与无/最低治疗的随机对照试验是合格的。使用标准的Cochrane审查方法。使用随机效应模型对TMD患者的主要疼痛结局标准化均值（SMD）。数据合成纳入了37项试验，使用GRADE评估得出的证据不确定性极低。当将所有TMD亚型归为一个整体TMD组时，没有证据表明夹板可减轻疼痛：SMD（长达3个月）-0.18（95％CI -0.42至0.06）; 13项试验，1,076名参与者。没有证据表明使用夹板可以改善任何其他结局。没有证据表明夹板会产生不良事件，但是关于该结局的报道很差。没有试验测量磨牙症患者的牙齿磨损。使用和报告的诊断标准，夹板类型和结局指标差异很大。基于这些因素的敏感性分析并未表明疼痛减轻。结论极低的确定性证据并未显示夹板作为一组病症可减轻TMD的疼痛。没有足够的证据来确定夹板是否减少磨牙症患者的牙齿磨损。没有证据表明使用夹板可以改善任何其他结局。没有证据表明夹板会产生不良事件，但是关于该结局的报道很差。没有试验测量磨牙症患者的牙齿磨损。使用和报告的诊断标准，夹板类型和结局指标差异很大。基于这些因素的敏感性分析并未表明疼痛减轻。结论极低的确定性证据并未显示夹板作为一组病症可减轻TMD的疼痛。没有足够的证据来确定夹板是否减少磨牙症患者的牙齿磨损。没有证据表明使用夹板可以改善任何其他结局。没有证据表明夹板会产生不良事件，但是关于该结局的报道很差。没有试验测量磨牙症患者的牙齿磨损。使用和报告的诊断标准，夹板类型和结局指标差异很大。基于这些因素的敏感性分析并未表明疼痛减轻。结论极低的确定性证据并未显示夹板作为一组病症可减轻TMD的疼痛。没有足够的证据来确定夹板是否减少磨牙症患者的牙齿磨损。没有试验测量磨牙症患者的牙齿磨损。使用和报告的诊断标准，夹板类型和结局指标差异很大。基于这些因素的敏感性分析并未表明疼痛减轻。结论极低的确定性证据并未显示夹板作为一组病症可减轻TMD的疼痛。没有足够的证据来确定夹板是否减少磨牙症患者的牙齿磨损。没有试验测量磨牙症患者的牙齿磨损。使用和报告的诊断标准，夹板类型和结局指标差异很大。基于这些因素的敏感性分析并未表明疼痛减轻。结论极低的确定性证据并未显示夹板作为一组病症可减轻TMD的疼痛。没有足够的证据来确定夹板是否减少磨牙症患者的牙齿磨损。

更新日期：2020-02-14

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