***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The authors compared the efficacy of bilateral balanced and canine guidance ( occlusal ) splints in the treatment of temporom and ibular joint ( TMJ ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind , controlled r and omized clinical trial . METHODS The authors r and omly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint : bilateral balanced , canine guidance and nonoccluding . The authors followed the groups for six months using analysis of a visual analog scale ( VAS ) , palpation of the TMJ and masticatory muscles , m and ibular movements and joint sounds . They used repeated analysis of variance and a chi(2 ) test to test the hypothesis . RESULTS The type of guidance used did not influence the pain reduction , yet both occlusal splints were superior to the nonoccluding splint , on the basis of the VAS . Despite similar outcomes in relation to opening , left lateral and protrusive movements , TMJ and muscle pain on palpation , subjects who used the occlusal splints had improved clinical outcomes . The frequency of joint noises decreased over time , with no significant differences among groups . Subjects in the groups using the occlusal splints reported more comfort . CONCLUSION The type of lateral guidance did not influence the subjects ' improvement . All of the subjects had a general improvement on the VAS , though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group Masticatory myofascial pain ( MFP ) condition is a musculoskeletal disorder that compromises the functional capacities of the masticatory system . As such , the incorporation of an intensive chewing test as a discriminatory exercise for the diagnosis of this condition and evaluation of treatment success has considerable potential . Various splint design s have been used successfully , which have posed a question of whether the therapeutic effect of the splint is a placebo or has some other curative properties . The purpose of this study was to evaluate the efficacy of the stabilization appliance to reduce signs and symptoms in MFP patients and to compare the pain experience during the chewing test between two groups of patients , with and without splints . Myofascial pain patients ( n = 37 ) who reported exacerbation of pain in function participated in the study . Patients perfomed a 9-min chewing test , followed by 9-min rest and marked their pain intensity on a visual analogue scale every 3 min . Of the 37 patients , 21 received a stabilization flat occlusal splint for night use and 16 were equally monitored clinical ly without a splint .  At the end of 8 weeks , a second clinical examination and chewing test were performed . Student 's t-test was used to analyse differences between study groups . Analysis of variance and covariance ( ancova ) with repeated measures was applied to analyse the effect of treatment . Level of pain at baseline prior to the chewing test ( P0 ) was introduced as a co-variant . At baseline both groups showed relatively high scores of pain intensity and did not show any significant differences among the collected variables . At the end of the experiment , the splint group had a statistically significant reduction in pain intensity , in mean muscle sensitivity to palpation and in the pain experience during the chewing test compared with no change in the controls . A stabilization splint has a therapeutic value beyond its placebo effects . Thus , it should be an integral part of the treatment modalities in MFP disorder patients . An intensive chewing test is an effective tool to evaluate the treatment modality efficacy in MFP patients AIMS To compare the short-term efficacy of treatment with a stabilization appliance compared with that of a non-occlusal , control appliance in patients with temporom and ibular disorders ( TMD ) of mainly myogenous origin . METHODS A r and omized , controlled trial was performed with 60 patients suffering from myofascial pain . Patients were r and omly assigned to a treatment or a control group . The treatment group was treated by means of a stabilization appliance and the control group by means of a non-occlusal appliance . Symptoms and signs were registered before and after 10 weeks of treatment . RESULTS Improvement of overall subjective symptoms was reported in both groups , but significantly more often in the treatment group than in the control group ( P = .000 ) . The prevalence of daily or constant pain showed a significant reduction in the treatment group ( P = .028 ) compared with the control group . There was a significant decrease in the number of tender masticatory muscles in the treatment group ( P = .018 ) compared with the control group . CONCLUSION The results of this short-term evaluation suggest that the stabilization appliance is more effective in alleviating symptoms and signs in patients with TMD of mainly myogenous origin than a control , non-occlusal appliance . The stabilization appliance can therefore be recommended for the therapy of these patients Background Pain affecting the face or mouth and lasting longer than three months ( “ chronic orofacial pain ” , COFP ) is relatively common in the UK . This study aims to describe and model current care pathways for COFP patients , identify areas where current pathways could be modified , and model whether these changes would improve outcomes for patients and use re sources more efficiently . Methods / Design The study takes a prospect i ve operations research approach . A cohort of primary and secondary care COFP patients ( n = 240 ) will be recruited at differing stages of their care in order to follow and analyse their journey through care . The cohort will be followed for two years with data collected at baseline 6 , 12 , 18 , and 24 months on : 1 ) experiences of the care pathway and its impacts ; 2 ) quality of life ; 3 ) pain ; 4 ) use of health services and costs incurred ; 5 ) illness perceptions .  Qualitative in-depth interviews will be used to collect data on patient experiences from a purposive sub- sample of the total cohort ( n = 30 ) at baseline , 12 and 24 months . Four separate appraisal groups ( public , patient , clincian , service manager/commissioning ) will then be given data from the pathway analysis and asked to determine their priority areas for change . The proposals from appraisal groups will inform an economic modelling exercise . Findings from the economic modelling will be presented as incremental costs , Quality Adjusted Life Years ( QALYs ) , and the incremental cost per QALY gained . At the end of the modelling a series of recommendations for service change will be available for implementation or further trial if necessary . Discussion The recent white paper on health and the report from the NHS Forum identified chronic conditions as priority areas and whilst technology can improve outcomes , so can simple , appropriate and well-defined clinical care pathways . Underst and ing the opportunity cost related to care pathways benefits the wider NHS . This research develops a method to help design efficient systems built around one condition ( COFP ) , but the principles should be applicable to a wide range of other chronic and long-term conditions Abstract Objective . The aim of this study was to analyze dentist ’s clinical decision-making related to treatment need for temporom and ibular disorders ( TMD ) in an adult population . Material s and methods . The study population comprised 779 r and omly selected 35 , 50 , 65 and 75 year old individuals living in the county of Västerbotten , Sweden . The participants filled out a question naire and were examined clinical ly according to a structured protocol . The four examiners ( two men , two women ) were experienced dentists and were calibrated before the start of the study . After examination they individually assessed the need of treatment owing to TMD . Results . In total , 15 % of the study population was considered to have a treatment need owing to TMD . The highest estimate was noted for 35 and 50 years old women and the lowest for 65 and 75 years old men . Overall , 21 % of the women and 8 % of the men were considered to have a treatment need owing to TMD , with statistically significant differences between men and women for the 35 and 50 years old groups . Inter-individual variations in dentists ’ decisions were observed . In a multivariate analysis , female gender , signs and symptoms of TMD pain , signs and symptoms of TMD dysfunction and smoking were associated with estimated treatment need . Conclusions . The prevalence of estimated treatment need owing to TMD was fairly high , but the dentists ’ clinical decision-making process showed large inter-individual variability . The observation calls for further research on the factors affecting the decision-making process in care providers BACKGROUND Temporom and ibular pain has multiple etiologies and a range of therapeutic options . In this pilot study , the authors assessed the feasibility of conducting a larger trial to evaluate chiropractic treatment of temporom and ibular disorders ( TMDs ) . METHODS The authors assigned 80 participants r and omly into one of the following four groups , all of which included a comprehensive self-care program : reversible interocclusal splint therapy ( RIST ) , Activator Method Chiropractic Technique ( AMCT ) ( Activator Methods International , Phoenix ) , sham AMCT and self-care only . They made assessment s at baseline and at month 2 and month 6 , including use of the Research Diagnostic Criteria for Temporom and ibular Disorders . RESULTS The authors screened 721 potential participants and enrolled 80 people ; 52 participants completed the six-month assessment . The adjusted mean change in current pain over six months , as assessed on the 11-point numerical rating scale , was 2.0 ( 95 percent confidence interval , 1.1 - 3.0 ) for RIST , 1.7 ( 0.9 - 2.5 ) for self-care only , 1.5 ( 0.7 - 2.4 ) for AMCT and 1.6 ( 0.7 - 2.5 ) for sham AMCT . The authors also assessed bothersomeness and functionality . CONCLUSIONS The authors found the study design and methodology to be manageable . They gained substantial knowledge to aid in conducting a larger study . AMCT , RIST and self-care should be evaluated in a future comparative effectiveness study . PRACTICAL IMPLICATION S This pilot study was a necessary step to prepare for a larger study that will provide clinicians with information that should be helpful when discussing treatment options for patients with TMD The aim of this study was to compare the effectiveness of three treatment methods for unilateral temporom and ibular joint ( TMJ ) disc displacement without reduction ( DDwoR ) . One hundred and twenty patients with unilateral TMJ DDwoR were assigned r and omly to one of three treatment groups ( 40 patients in each ) : group 1 received arthrocentesis , group 2 received stabilization splint therapy following arthrocentesis , and group 3 received splint therapy only . The groups were compared in terms of pain ( visual analogue scale ) , joint function ( maximum mouth opening and laterotrusive movements ) , disability and psychological status ( vali date d question naire ) , and success rates . These were recorded before treatment and during follow-up after treatment ( 1 , 3 , and 6 months ) . The between-group and within-group differences in the data were analyzed statistically . The baseline characteristics were similar in all groups ( P>0.05 ) . Significant improvements were noted in all parameters compared to baseline values in all groups ( all P<0.01 ) . Groups 1 and 2 showed comparable outcomes that were superior to those of group 3 .  Arthrocentesis reduces pain and functional impairment more rapidly and effectively than splint therapy . Simultaneous splint application has no additional effect on the effectiveness of arthrocentesis for the treatment of unilateral PURPOSE The aim of the present study was to investigate the effects of massage therapy on the masticatory muscles and occlusal splint usage on quality of life and pain in individuals with sleep bruxism . METHOD A r and omized , controlled , blinded , clinical trial was conducted involving 78 volunteers aged 18 to 40 years with sleep bruxism .  Quality of life and pain assessment s were performed . RESULTS Significant differences ( p < 0.05 ) were found on the physical functioning , general health state , vitality , role emotional and mental health subscales . A large effect size was found for all treatment protocol s with regard to pain . The largest effect was found in the combined treatment group . CONCLUSIONS The findings of the present study reveal that the occlusal splint usage alone led to improvements in components of quality of life among individuals with sleep bruxism . Moreover , both treatments ( occlusal splint usage and massage therapy on the masticatory muscles ) led to a reduction in pain Purpose : To determine the efficacy of hard , liquid , and soft splints in the management of myofascial pain dysfunction syndrome .  Material s and Methods : In this r and omized clinical trial , 45 patients with myofascial pain were diagnosed and were r and omly assigned into three groups of 15 patients each . Group 1 - subjects were given hard splint , Group 2 - soft splint , and Group 3 - liquid oral splint for 3 months . Subjective pain analysis using Modified Symptom Severity Index ( Mod-SSI ) and objective pain analysis muscle palpation was performed at 7 days , 1 month , 2 months , and 3 months after splint insertion . The changes in mean pain value by both methods , in all three groups , were analyzed with Tukey test and Kruskal-Wallis H-test , respectively ( P < 0.05 ) . Results : Both Mod-SSI and palpation scores showed statistically significant reduction in pain for all three groups at the end of 3 months . However , the hard splints proved to be very effective in a shorter period of time , followed by liquid splints and finally soft splints . Conclusion : The result of this study advocates the use of any one of the three types of the occlusal splints in the therapeutic management of myofascial pain due to temporom and ibular disorders The evidence supporting the use of stabilisation splints in the treatment of temporom and ibular disorders ( TMD ) is scarce and a need for well-controlled studies exists . The aim of this r and omised , controlled trial study was to assess the efficacy of stabilisation splint treatment on TMD . The sample consisted of 80 consecutive referred patients who were r and omly assigned to the splint group ( n = 39 ) and the control group ( n = 41 
    Output:
    
There was no evidence that other outcomes , including temporom and ibular joint noises , decreased mouth-opening , and quality of life , improved when using splints  .
Adverse events were generally not reported , but seemed infrequent when reported .
Sensitivity analyses based on these limitations did not indicate a reduction in pain .
CONCLUSIONS The very low- quality evidence identified did not demonstrate that splints reduced pain in temporom and ibular disorders as a group of conditions .
There is insufficient evidence to determine whether or not splints reduce tooth wear in patients with bruxism .