Intraoral appliances for temporomandibular disorders: what we know and what we need to know

Abstract

Oral appliances (OAs) have been a part of the clinical protocols used by many dentists over the past 100 years for treating patients with temporomandibular disorders (TMDs). However, in a field filled with many conceptual and clinical controversies, these devices remain near the top of the list of controversial topics. There are multiple designs proposed for making OAs, and there are disagreements about when and how they should be utilized. There are also theoretical arguments about what they are intended to do therapeutically. However, the most significant point of contention is whether OAs should be regarded as a first phase of TMD treatment, to be followed by a second phase of major dental procedures to realign the condylar position as well as the occlusal relationships. Alternatively, within the past 50 years many researchers have established an evidence base supporting a more conservative application of OAs in which they are an orthotic modality intended to produce relief from pain and improvement in jaw function—after which they may be removed or used to respond to symptomatic flareups. This paper discusses what we currently know, and what more we need to know, in order to deal with this confusing topic in the best interest of managing various categories of TMD patients. It concludes with a proposal for future research directions which may help to clarify some of these issues.