Treatment for TMJ disorder can vary from simple self-care techniques to complex surgical procedures. One of the first stops in TMJ disorder treatment for most patients is splint therapy.
You are probably familiar with what a splint is, as they are widely used for sports and some medical conditions such as sleep apnea. Other words for splints are “mouth guard,” “bite plate,” “bite appliance,” “mouthpiece,” “orthotic,” “nightguard,” and/or “occlusal appliance.”
Splints are made of plastic, and can be hard or soft. They can cover all of the teeth, or a select few teeth, and can be worn on the bottom or top teeth depending on what the particular splint is for and the preferences of the dentist.
Types of Splints:
- Stabilization splints: usually worn to prevent clenching and/or bruxism, these are flat and cover all of the teeth. Can be made out of soft or hard materials.
- Repositioning splints: said to “realign the condyles,” “capture the disc.” These splints attempt to pull the mandible (lower jaw) forward. They are usually worn 24 hours a day. Some specific names of repositioning splints: MORA (mandibular repositioning appliance), anterior bite planes, Witzig, Gelb, anterior repositioning splint.
How Do Splints Work?
There are a couple theories on why splint therapy may help relieve jaw pain in some TMJ disorder patients:
- They allow the muscles & ligaments to relax, therefore ridding the facial muscles of the tension and tightness that bruxism, clenching, or other jaw problems may cause.
- If the patient grinds their teeth (bruxes), splints may protect them from more wear of the teeth, preventing pain, sensitivity, and jagged edges.
- If a patients bite (occlusion: the way teeth fit together) is off or not right for his or her jaw joints, a splint may adjust the bite into what many dentists feel is a more optimum position, which then allows for the muscles to rest.
What is “Phase II Treatment”?
After wearing the splint 24 hours a day for months or years, a patient may choose to have what many dentists call “Phase 2” therapy because their teeth or bite changed to accommodate the position the appliance put the jaw into. If the patient discontinues wearing the splint at any time, the symptoms could come back and his or her teeth would not be aligned the same way as they were before. The symptoms, if changed, could also go back to their “before splint” state.
Phase II therapy can include treatments such as:
- Dental work such as veneers, crowns, and bridges.
- Grinding and/or reshaping of the teeth
- Please note that ALL phase two treatments are IRREVERSIBLE (meaning they are permanent even if they do not work).
Since many splints can change the bite and the teeth-jaw relationship, it is advised that patients exercise caution when beginning treatment, and seek a second (or third) independent opinion before consenting to irreversible treatments like these.
Even though they have been used for a long time in TMJ disorder treatment, unfortunately, splints have not been researched extensively.There is very little scientific data on splint therapy’s benefit over other treatments or effectiveness in relieving jaw pain and other TMJ symptoms.
Regardless of the splint type, they must be constantly adjusted in order to help. The most important thing with splints is that they are made correctly or they will not work at all. Unfortunately, there is not a consensus among dentists on the best way to fabricate splints. Until there is more research, splint therapy, as well as other TMJ disorder treatments, will be at best trial and error.
Some patients do not experience relief of pain and other symptoms with splint therapy alone, or at all. Other patients experience MORE, or WORSE pain. We ran a poll, asking patients if splint therapy had helped their pain. The results were mixed: 47% said that it did NOT help, 12% hadn’t tried splints yet, and 42% received help from splints. A more detailed analysis is available on our blog.
When splint therapy is unsuccessful, patients may consider other treatments, such as:
- Physical Therapy
- Trigger Point Injections
- Massage Therapy
- Alternative Therapies
It is important to consider conservative, reversible therapy with any TMJ disorder treatment. It has been suggested by literature that approximately half of patients either feel much better or have complete resolution of all symptoms in weeks or monthswithout significant treatment. Many patients do not require more than self care techniques.
Physicians and patients often agree that splints are most effective in combination with other treatments such as physical therapy, medications, stress management, behavioral modification and pain management to name a few.
More research is needed to establish the effectiveness of splint therapy, but until then, it is wise to ask many questions before beginning this treatment.