I am concerned about the conclusions from the August JADA study by Dr. Edmond Truelove and colleagues, "The Efficacy of Traditional, Low-Cost and Nonsplint Therapies for Temporomandibular Disorder: A Randomized Controlled Trial" (
JADA 2006;137[8]:1099–107
).
Like many other studies, this one appears to be designed to support [the authors’] hypothesis and apparent prejudice toward the behavioral sciences (and against splints).
For example, patients with successful splint therapy were not included, the hard splint group was assigned patients with more baseline TMD symptoms, and a much larger percentage of the no-splint group did not complete the study. The actual data show that the hard splint group did better than the no-splint group in almost all follow-up assessments—especially in arthralgia, which was conveniently downplayed.
The hard splint did better, despite the fact that it was not made in centric relation, was apparently never adjusted and was only made on the upper arch (there are absolute indications for both arches). The fact that no occlusal changes were noted speaks volumes in itself.
I applaud the conservative concepts of the study, and any TMD treatment should include detailed emphasis on "self-care" and behavioral modification. But a properly adjusted splint can also serve as a diagnostic aid, a therapeutic aid, a retainer to prevent tooth movement and a periodontal aid for mobile teeth. It can reduce parafunction, protect against occlusal wear, prevent tooth fractures and protect long-term esthetics. It also can provide time for patient ownership of the problem, and time for relationship development. All this is critical prior to any major restorative dentistry, and for better dentistry in general.
