The Occlusal Splint Fit Notes Template
An occlusal splint fit notes template captures the splint issue visit — confirmation of TMD diagnosis from assessment, splint type selected with rationale (stabilisation / Michigan / soft — no evidence superiority), fit assessment with extension and occlusal contacts in ICP and excursions, adjustments made, wear instructions and storage, review interval, and baseline outcome measures (pain score, MCO) for comparison at review — meeting RCS England FDS TMD Guideline (2024) and BSOS standards.
Supplying a soft bite guard without a documented TMD diagnosis OR documented temporary/palliative intent is the dominant indemnity issue in occlusal therapy. Below is the template UK clinicians paste into their PMS for every splint fit.
Download the free Occlusal Splint Fit template — plain text, GDC/FGDP(UK)-aligned.
Why this occlusal splint fit template wins
- Diagnosis confirmation from assessment — defends against "splint without diagnosis" indemnity issue.
- Splint type rationale documented — defends against subsequent challenge of choice.
- Conservative trial outcome recorded before progressing to splint — RCS 2024 compliance.
- Baseline outcome measures (pain CPI, MCO) — enables objective review.
- Wear instructions specifically include "nightly not continuous" — prevents over-wearing complications.
Compliance: the medico-legal angle
- RCS England FDS TMD Guideline (2024) — conservative trial first, splint for failed/persistent cases.
- BSOS guidance on occlusal therapy.
- GDC Principle 4 — splint provision must be diagnostically justified.
- Montgomery — splint is occlusal therapy with potential for irreversible changes; patient must understand the indication and alternatives.
Common mistakes UK dentists make
- Splint provided without confirmed TMD diagnosis — biggest indemnity gap.
- No conservative trial before splint — RCS 2024 non-compliance.
- No baseline pain or MCO recorded — no objective outcome at review.
- No wear instructions given (or not documented) — patient may over-wear or under-wear, both problematic.
- Generic "occlusal splint" with no type / arch / rationale — undefendable.
Frequently asked questions
Hard or soft splint?
RCS 2024: no clear evidence of superiority between types. Hard (Michigan-style) provides robust occlusal stabilisation, full coverage, durable. Soft (EVA) — short-term palliative, less durable, may shift occlusion if over-worn. Most clinicians choose hard for long-term bruxism + TMD; soft for short-term acute management. Document the rationale.
Upper or lower splint?
Either acceptable. Upper: patient comfort during sleep, more posterior coverage easier. Lower: less impact on tongue space, sometimes preferred by patients. No clinical superiority. Patient preference + clinical accessibility drives the choice.
Why nightly not 24/7?
Continuous wear (>16h/day) can cause occlusal changes (intrusion of contacting teeth, supraeruption of non-contacting teeth). Nightly wear targets sleep bruxism without these risks. Day wear should be intermittent (stress periods, brief), not continuous.
How long should patient wear the splint?
Variable. Acute TMD episode: 6-12 weeks then re-assess for tapering. Chronic bruxism: long-term nightly wear to protect teeth. Document review at 4-6 weeks initial, then annual fitness checks if continuing.
What if symptoms don't improve?
At 4-6 week review: if no improvement in pain or MCO, reconsider diagnosis, conservative measures, refer to specialist. Splints help most but not all TMD. Document the review and decision.
Should I be adjusting the splint at follow-up?
Initial occlusal settlement often requires 2-week adjustment appointment. Subsequent annual fitness check. Major adjustments would suggest the splint is no longer optimal — assess fit, wear patterns on splint, occlusal contacts.