Controlled Assessment of the Efficacy of Occlusal Stabilization Splints on Sleep Bruxism

Aims: To assess the efficacy of occlusal stabilization splints in the management of sleep bruxism (SB) in a double-blind, parallel, controlled, randomized clinical trial. Methods: Twenty-one partic-ipants were randomly assigned to an occlusal splint group (n = 11; mean age = 34.2 ± 13.1 years) or a palatal splint (ie, an acrylic palatal coverage) group (n = 10; mean age = 34.9 ± 11.2 years). Two polysomnographic recordings that included bilateral masseter electromyographic activity were made: one prior to treatment, the other after a treatment period of 4 weeks. The number of bruxism episodes per hour of sleep (Epi/h), the number of bursts per hour (Bur/h), and the bruxism time index (ie, the percentage of total sleep time spent bruxing) were established as outcome variables at a 10% maximum voluntary contraction threshold level. A general linear model was used to test both the effects between splint groups and within the treatment phase as well as their interaction for each outcome variable. Results: Neither occlusal stabilization splints nor palatal splints had an influence on the SB outcome variables or on the sleep variables measured on a group level. In individual cases, variable outcomes were found: Some patients had an increase (33% to 48% of the cases), while others showed no change (33% to 48%) or a decrease (19% to 29%) in SB outcome variables. Conclusion: The absence of significant group effects of splints in the management of SB indicates that caution is required when splints are indicated, apart from their role in the protection against dental wear. The application of splints should therefore be considered at the individual patient level.

bruxism; occlusal stabilization splint; polysomnography; randomized clinical trial; sleep

1. American Sleep Disorders Association (ASDA). Parasomnias. In: Thorpy MJ (ed). International Classification of Sleep Disorders: Diagnostic and Coding Manual. Rochester: ASDA, 1990:142–185.

2. Kato T, Thie NMR, Huynh N, Miyawaki S, Lavigne GJ. Topical review: Sleep bruxism and the role of peripheral sensory influences. J Orofac Pain 2003;17:191–213.

3. Lavigne GJ, Montplaisir JY. Restless legs syndrome and sleep bruxism: Prevalence and association among Canadians. Sleep 1994;17:739–743.

4. Laberge L, Tremblay RE, Vitaro F, Montplaisir JY. Development of parasomnias from childhood to early adolescence. Pediatrics 2000;106:67–74.

5. Lobbezoo F, Naeije M. Bruxism is mainly regulated cen-trally, not peripherally. J Oral Rehabil 2001;28:1085–1091.

6. Lobbezoo F, Montplaisir JY, Lavigne GJ. Bruxism: A factor associated with temporomandibular disorders and orofacial pain. J Back Musculoskeletal Rehabil 1996;6:165–176.

7. Lavigne GJ, Manzini C. Sleep bruxism and concomitant motor activity. In: Kryger M, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine, ed 3. Philadelphia: Saunders, 2000:773–785.

8. Marbach JJ, Raphael KG, Janal MN, Hirschkorn-Roth R. Reliability of clinician judgements of bruxism. J Oral Rehabil 2003;30:113–118.

9. Kato T, Thie NMR, Montplaisir JY, Lavigne GJ. Bruxism and orofacial movements during sleep. Dent Clin North Am 2001;45:657–684.

10. The glossary of prosthodontic terms. J Prosthet Dent 1999;81:44–110.

11. Clark GT, Beemsterboer PL, Solberg WK, Rugh JD. Nocturnal electromyographic evaluation of myofascial pain dysfunction in patients undergoing occlusal splint therapy. J Am Dent Assoc 1979;99:607–611.

12. Rugh JD, Harlan J. Nocturnal bruxism and temporo-mandibular disorders. Adv Neurol 1988;49:329–341.

13. Holmgren K, Sheikholeslam A, Riise C, Kopp S. The effects of an occlusal splint on the electromyographic activities of the temporal and masseter muscles during maximal clenching in patients with a habit of nocturnal bruxism and signs and symptoms of craniomandibular disorders. J Oral Rehabil 1990;17:447–459.

14. Lobbezoo F, Lavigne GJ. Do bruxism and temporo-mandibular disorders have a cause-and-effect relationship?J Orofac Pain 1997;11:15–23.

15. Lobbezoo F, van der Zaag J, Visscher CM, Naeije M. Oral kinesiology. A new postgraduate programme in the Netherlands. J Oral Rehabil 2004;31:192–198.

16. Dao TTT, Lavigne GJ. Oral splints: The crutches for tem-poromandibular disorders and bruxism? Crit Rev Oral Biol Med 1998;9:345–361.

17. Lavigne GJ, Rompré PH, Poirier G, Huard H, Kato T, Montplaisir JY. Rhythmic masticatory muscle activity during sleep in humans. J Dent Res 2001;80:443–448.

18. Lobbezoo F, Naeije M. A reliability study of clinical tooth wear measurements. J Prosthet Dent 2001;86:597–602.

19. Dworkin SF, LeResche L. Research Diagnostic Criteria for Temporomandibular Disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6:301–355.

20. Spilker B. Guide to Clinical Trials. New York: Raven Press, 1991.

21. Rechtschaffen A, Kales A. A Manual of Standardized Terminology: Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles: UCLA Brain Information Service/ Brain Research Institute, 1968.

22. American Sleep Disorders Association. Arousals scoring rules and examples: A preliminary report from sleep disorders atlas task force of the American Sleep Disorders Association. Sleep 1992;15:173–184.

23. Lavigne GJ, Rompré PH, Montplaisir JY. Sleep bruxism: Validity of clinical research diagnostic criteria in a controlled polysomnographic study. J Dent Res 1996;75:546–552.

24. Lavigne GJ, Guitard F, Rompré PH, Montplaisir JY. Variability in sleep bruxism activity over time. J Sleep Res 2001;10:237–244.

25. Rasmussen C, Nielsen KD, Arima T, et al. An automatic system for selective and standardized sleep deprivation [abstract]. J Sleep Res 1998;7:221.

26. van der Zaag J, Lobbezoo F, Wicks DJ, Hamburger HL, Naeije M. Self-reported jaw pain on mouth opening is associated with a reduced bruxism time index. J Oral Rehabil (in press).

27. Kydd WL, Daly C. Duration of nocturnal tooth contacts during bruxing. J Prosthet Dent 1985;53:717–721.

28. Holmgren K, Sheikholeslam A, Riise C. Effect of a fullarch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders. J Prosthet Dent 1993;69:293–297.

29. Okkerse W, Brebels A, de Deyn PP, et al. Influence of a biteplane according to Jeanmonod, on bruxism activity during sleep. J Oral Rehabil 2002;29:980–985.

30. Forssell H, Kalso E. Application of principles of evidence-based medicine to occlusal treatment for temporo-mandibular disorders: Are there lessons to be learned? J Orofac Pain 2004;18:9–22.

31. Carskadon MA, Dement WC. Normal human sleep: An overview. In: Kryger M, Roth T, Dement WC (eds). Principles and Practice of Sleep Medicine, ed 2. Philadelphia: Saunders, 1994:16–25.

32. Reding GR, Zepelin H, Robinson JE Jr, Zimmerman SO. Nocturnal teeth-grinding: All-night psychophysiologic studies. J Dent Res 1968;47:786–797.

33. Sjöholm T, Lehtinen I, Helenius H. Masseter muscle activ-ity in diagnosed sleep bruxists compared with non-symptomatic controls. J Sleep Res 1995;4:48–55.

34. Lobbezoo F, Soucy JP, Montplaisir JY, Lavigne GJ. Striatal D2 receptor binding in sleep bruxism: A controlled study with iodine-123-iodobanzamide and single photon emission computed tomography. J Dent Res 1996;75:1804–1810.

35. Gallo LM, Lavigne GJ, Rompré PH, Palla S. Reliability of scoring EMG orofacial events: Polysomnography compared to ambulatory recordings. J Sleep Res 1997;6:259–263.

36. Khan F, Young WG, Daley TJ. Dental erosion and bruxism. A tooth wear analysis from south east Queensland. Aust Dent J 1998;43:117–127.

37. Ahlberg J, Rantala M, Savolainen A, et al. Reported bruxism and stress experience. Community Dent Oral Epidemiol 2002;30:405–408.

38. Raphael KG, Marbach JJ, Klausner JJ, Teaford MF, Fischoff DK. Is bruxism severity a predictor of oral splint efficacy in patients with myofascial face pain? J Oral Rehabil 2003;30:17–29.

39. Le Bon O, Staner L, Hoffmann G, et al. The first-night effect may last more than one night. J Psychiatr Res 2001;35:165–172.

40. Okeson JP, Philips BA, Berry DTR, Cook Y, Paesani D, Galante J. Nocturnal bruxing events in healthy geriatric subjects. J Oral Rehabil 1990;17:411–418.

41. Velly-Miquel AM, Montplaisir JY, Rompré PH, Lund JP, Lavigne GJ. Bruxism and other orofacial movements during sleep. J Craniomand Dis 1992;6:71–81.

42. Ikeda T, Nishigawa K, Kondo K, Takeuchi H, Clark GT. Criteria for the detection of sleep-associated bruxism in humans. J Orofac Pain 1996;10:270–282.

43. Gallo LM, Lavigne GJ, Rompré PH, Palla S. Optimization of threshold values for automated analysis of EMG recordings [abstract]. J Dent Res 2002;81(Special Issue A):316.

44. van Selms MKA, Lobbezoo F, Wicks DJ, Hamburger HL, Naeije M. Craniomandibular pain, oral parafunctions, and psychological stress in a longitudinal case study. J Oral Rehabil (in press).

45. Solberg WK, Clark GT, Rugh JD. Nocturnal electromyo-graphic evaluation of bruxism patients undergoing short-term splint therapy. J Oral Rehabil 1975;2:215–223.

46. Sheikholeslam A, Holmgren K, Riise C. A clinical and electromyographic study of the long-term effects of an occlusal splint on the temporal and masseter muscles in patients with functional disorders and nocturnal bruxism. J Oral Rehabil 1986;13:137–145.

47. Hiyama S, Ono T, Ishiwata Y, Kato Y, Kuroda T. First night effect of an interocclusal appliance on nocturnal masticatory muscle activity. J Oral Rehabil 2003;30:139–145.

48. Jacob RF, Carr AB. Hierarchy of research design used to categorize the “strength of evidence” in answering clinical dental questions. J Prosthet Dent 2000;83:137–152.

49. Sjöholm T, Lehtinen I, Polo O. The effect of mouth guard on masseter muscle activity during sleep [abstract]. J Sleep Res 2002;11(suppl 1):209.