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Does long-term use of occlusal appliance have an impact on sleep structure?


Man Sleeping In BedThis summary is based on the article published in the Journal of Oral Rehabilitation: Long-term use of occlusal appliance has impact on sleep structure (November 2014)

T. Sjoholm, T. Kauko, P. Kemppainen, and E. Rauhala





  • The occlusal appliance (OA) is commonly referred to as a splint, night guard, bite-plane, interocclusal appliance, stabilization splint. Occlusal appliances have several uses, but mostly, they are used to treat temporomandibular disorders (TMD) and sleep bruxism1.
  • The exact mechanism of OA therapy is not known. There is some controversy about the OAs impact on oral symptoms in different studies, and the methodology is not consistent2, 3. In spite of frequent nocturnal use of OAs, there are a small number of studies investigating the OA’s impact on sleep and sleep structure4.
  • Accordingly, there are not enough data on long-term effects of OA during sleep, although most clinicians are treating their patients for several months or years with an OA.

Purpose of the Study

  • The study investigated the effects of an OA on sleep and to evaluate the changes in the masseter EMG activity using direct online recordings after 8 weeks use of OA.
  • The working hypothesis was that the OA would decrease nocturnal masticatory muscle activity. It was also hypothesized that the OA would have no impact on sleep stages.

Key Findings

  • The OA did not decrease nocturnal masticatory activity when compared to baseline night activity.
  • OA does not have significant feedback inhibition on masseter muscle motor activity during sleep. However, OA may increase slow wave sleep.


  1. Okeson JP. Management of temporomandibular disorders and occlusion. 7th ed. Mosby: Elsevier Science Health Science Division; 2012.
  2. Okkerse W, Brebels A, De Deyn PP, Nagels G, De Deyn B, Van Bogaert PP, et al. Influence of a bite-plane according to Jeanmonod, on bruxism activity during sleep. J Oral Rehabil. 2002;29: 980–985.
  3. Forssell H, Kalso E, Koskela P, Vehmanen R, Puukka P, Alanen P. Occlusal treatments in temporomandibular disorders: a qualitative systematic review of randomized controlled trials. Pain. 1999;83:549–560.
  4. Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Washington (DC): National Institute of Health; 1968.


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