Interocclusal appliances--indications and clinical routines in general dental practice in Sweden

The aim of this study was to analyse what kind of interocclusal appliances that are used in general dental practice in Sweden, the indications for such treatment, to what extent a clinical status is recorded before treatment, as well as the routines for evaluation of treatment results. The study was a retrospective analysis of patient records from 320 adult patients who had been treated by general dental practitioners in the Public Dental Service in Sweden. For comparison a group of 88 consecutive patients who had received interocclusal appliance therapy at a specialist clinic was used. The most common indication for treatment with hard acrylic stabilisation appliances, as well as with soft appliances, was occlusal wear due to tooth grinding. The second most common indication for treatment with hard acrylic stabilisation appliances was pain from masticatory muscles, while the second most common indication for soft appliances was tension-type headache. Treatment with soft appliances was more often combined with other treatment modalities compared to treatment with hard acrylic stabilisation appliances. Large variations were found between the 3 general dental clinics and the specialist clinic in respect of treatment indications, combinations with other treatment modalities, recording of clinical findings, follow-ups and evaluation of treatment results. General conclusion should, however, be made with caution due to the risk of selection bias. From the results of this study it is obvious that treatment with soft appliances is common in general dental practice in Sweden, despite the lack of scientific support for their efficacy, as well as effectiveness, compared to hard acrylic stabilisation appliances. There is an obvious need for investigations of the decision-making processes among dentists when performing treatment with interocclusal appliances, as well as for randomised controlled studies concerning efficacy and effectiveness of soft appliances.