A review of the NTI-tss device in the effectiveness of treating bruxism

The NTI-tss - Nocieceptive Trigeminal Inhibition - Tension Suppression System is a device that fits over the 2 front top incisors to prevent them from touching the lower teeth, thereby decreasing muscle tension.

Although this device has been marketed since the early 1990s there is to date very little clinical evidence of its effectiveness.

In 2008, Stapelmann H & Turp J conducted a qualitative systematic review of the literature. Although they found 68 relevant publications only 5 randomised controlled trials (RTC) concentrated on TMJ disorders and bruxism.

The original manufacturers of this device claim the splint can be used in the prophylactic and treatment of migraine and migraine-associated tension-type headache but as an aside can be used to prevent bruxism and TMJ disorders.

The 5 RCT trials ranged from poor to high methodological quality but all had very small sample sizes. One study had a larger sample of 94 migraine patients and it was upon the results of this particular paper that the US Federal Drug Administration approved the marketing of the device for individuals with migraine and migraine-associated headaches, bruxism and TMJ disorders.

However, other studies found little or no effect, whilst others found no difference between the NTI device and a standard occlusal splint.

According to published reports the prevalence and severity of adverse events seems minimal. However, there has been some concern as to possible adverse effects of the device. Information from an approved FDA database reveals that the size of the device is less than recommended by the Consumer Products Safety Commission Guidelines and as such could be a choking hazard. Another hazard reported with bite shifting and TMJ disc slipping to the extent that the front teeth are no longer able to touch.

In conclusion, the NTI-tss device may be of benefit to some patients, but with the paucity of clinical data as to its effectiveness both short- and long-term, a cautious approach to its use is recommended.

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