Editing Temporomandibular joint dysfunction (section)

===Devices===
[[File:Knirschschiene-acht-Jahre.jpg|thumbnail|A lower, full coverage occlusal splint after 8 years in use]]
[[File:Aufbissschiene.jpg|thumbnail|An upper, full coverage occlusal splint]]
[[Occlusal splint]]s (also termed bite plates or intra-oral appliances) are often used by dentists to treat TMD. They are usually made of [[acrylate polymer|acrylic]] and can be hard or soft. They can be designed to fit onto the upper teeth or the lower teeth. They may cover all the teeth in one arch (full coverage splint) or only some (partial coverage splint). Splints are also termed according to their intended mechanism, such as the anterior positioning splint or the stabilization splint.<ref name="Wassell 2008" /> Although occlusal splints are generally considered a reversible treatment,<ref name="Hupp 2008" /> sometimes partial coverage splints lead to pathologic tooth migration (changes in the position of teeth). Normally splints are only worn during sleep, and therefore probably do nothing for people who engage in parafunctional activities during wakefulness rather than during sleep. There is slightly more evidence for the use of occlusal splints in sleep bruxism than in TMD. A splint can also have a diagnostic role if it demonstrates excessive occlusal wear after a period of wearing it each night. This may confirm the presence of sleep bruxism if it was in doubt. Soft splints are occasionally reported to worsen discomfort related to TMD.<ref name="Wassell 2008" /> Specific types of occlusal splint are discussed below.

A stabilization splint is a hard acrylic splint that forces the teeth to meet in an "ideal" relationship for the muscles of mastication and the TMJs. It is claimed that this technique reduces abnormal muscular activity and promotes "neuromuscular balance". A stabilization splint is only intended to be used for about 2–3 months.<ref name="Al-Ani 2004" /> It is more complicated to construct than other types of splint since a [[Articulator|face bow]] record is required and significantly more skill on the part of the [[dental technician]]. This kind of splint should be properly fitted to avoid exacerbating the problem and used for brief periods of time. The use of the splint should be discontinued if it is painful or increases existing pain.<ref name=TMJA/> A systematic review of all the scientific studies investigating the efficacy of stabilization splints concluded the following:

{{blockquote|"On the basis of our analysis we conclude that the literature seems to suggest that there is insufficient evidence either for or against the use of stabilization splint therapy over other active interventions for the treatment of TMD. However, there is weak evidence to suggest that the use of stabilization splints for the treatment of TMD may be beneficial for reducing pain severity, at rest and on palpation, when compared to no treatment".<ref name="Al-Ani 2004" />}}

Partial coverage splints are recommended by some experts, but they have the potential to cause unwanted tooth movements, which can occasionally be severe. The mechanism of this tooth movement is that the splint effectively holds some teeth out of contact and puts all the force of the bite onto the teeth which the splint covers. This can cause the covered teeth to be intruded, and those that are not covered to over-erupted. I.e. a partial coverage splint can act as a [[Dahl appliance]]. Examples of partial coverage splints include the NTI-TSS ("nociceptive trigeminal inhibitor tension suppression system"), which covers the upper front teeth only. Due to the risks involved with long term use, some discourage the use of any type of partial coverage splint.<ref name="Wassell 2008" />

An anterior positioning splint is a splint that designed to promote an anteriorly displaced disc. It is rarely used.<ref name="Wassell 2008" /> A 2010 review of all the scientific studies carried out to investigate the use of occlusal splints in TMD concluded:

{{blockquote|"Hard stabilization appliances, when adjusted properly, have good evidence of modest efficacy in the treatment of TMD pain compared to non-occluding appliances and no treatment. Other types of appliances, including soft stabilization appliances, anterior positioning appliances, and anterior bite appliances, have some [[Randomized controlled trial|RCT]] evidence of efficacy in reducing TMD pain. However, the potential for adverse events with these appliances is higher and suggests the need for close monitoring in their use."<ref>{{cite journal | vauthors = Fricton J, Look JO, Wright E, Alencar FG, Chen H, Lang M, Ouyang W, Velly AM | display-authors = 6 | title = Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders | journal = Journal of Orofacial Pain | volume = 24 | issue = 3 | pages = 237–54 | year = 2010 | pmid = 20664825 }}</ref> }}

Ear canal inserts are also available, but no published peer-reviewed clinical trials have shown them to be useful.