BACKGROUND:

Sleep bruxism is an oral activity characterized by involuntary teeth grinding or clenching during sleep. Several forms of treatment have been proposed for this disorder, including behavioural, dental and pharmacological strategies.

OBJECTIVES:

To evaluate the effectiveness and safety of pharmacological therapy for the treatment of sleep bruxism compared with other drugs, no treatment or placebo.

SEARCH METHODS:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2014), MEDLINE (1966 to August 2014), EMBASE (1980 to August 2013) and LILACS (1982 to August 2014). We identified additional reports from the reference lists of retrieved reports and from reviews on treatment of sleep bruxism. We applied no language restrictions.

SELECTION CRITERIA:

We selected randomized controlled trials (RCTs) or quasi-RCTs that compared drugs with other drugs, no treatment or placebo in people with sleep bruxism.

DATA COLLECTION AND ANALYSIS:

Review authors carried out data extraction and quality assessment of the included trials independently and in duplicate. We discussed discrepancies until we reached consensus. We consulted a third review author in cases of persistent disagreement. We contacted authors of primary studies when necessary.

MAIN RESULTS:

We identified 18 potentially relevant RCTs, but only seven met the inclusion criteria. All studies had a small number of participants, ranging from seven to 16 people per study and had a cross-over design. Three studies were of low risk of bias, while four were of uncertain risk. Amitriptyline (three studies), bromocriptine (one study), clonidine (one study), propranolol (one study), levodopa (Prolopa®) (one study) and tryptophan (one study) were compared with placebo. Studies evaluating bromocriptine, clonidine, propranolol and levodopa reported our primary outcome of indices of bruxism motor activity.
Results were imprecise and consistent with benefit, no difference or harm. These were the specific findings for each of the drugs according to specific outcomes: 1. Amitriptyline versus placebo for masseteric electromyography (EMG) activity per minute: standardized mean difference (SMD) -0.28 (95% confidence interval (CI) -0.91 to 0.34; P value = 0.37), 2. bromocriptine versus placebo for bruxism episodes per hour: mean difference (MD) 0.60 (95% CI -2.93 to 4.13), bruxism bursts per hour: MD -2.00 (95% CI -53.47 to 49.47), bruxism bursts per episode: MD 0.50 (95% CI -1.85 to 2.85) or number of episodes with grinding noise: MD 2.40 (95% CI -24.00 to 28.80), 3. clonidine versus placebo for number of bruxism episodes per hour: MD -2.41 (95% CI -4.84 to 0.02), 4. propranolol versus placebo for the number of bruxism episodes per hour: MD 1.16 (95% CI -1.89 to 4.21), 5. L-tryptophan versus placebo for masseteric EMG activity per second: SMD 0.08 (95% CI -0.90 to 1.06) and 6. levodopa versus placebo for bruxism episodes per hour of sleep: MD -1.47 (95% CI -3.64 to 0.70), for bruxism bursts per episode: MD 0.06 (95% CI -2.47 to 2.59).
We combined several secondary outcomes (sleep duration, masseteric EMG activity per minute and pain intensity) in a meta-analysis for comparison of amitriptyline with placebo. The results for most comparisons were uncertain because of statistical imprecision. One study reported that clonidine reduced rapid eye movement (REM) sleep stage and increased the second stage of sleep. However, results for other sleep-related outcomes with clonidine were uncertain. Adverse effects were frequent in people who took amitriptyline (5/10 had drowsiness, difficulty awakening in the morning, insomnia or xerostomia compared with 0/10 in the placebo group), as well as in people who received propranolol (7/16 had moderate-to-severe xerostomia compare with 2/16 in the placebo group). Clonidine was associated with prolonged morning hypotension in three of 16 participants. The use of preventive medication avoided any adverse effects in people treated with levodopa and bromocriptine.

AUTHORS' CONCLUSIONS:

There was insufficient evidence on the effectiveness of pharmacotherapy for the treatment of sleep bruxism. This systematic review points to the need for more, well-designed, RCTs with larger sample sizes and adequate methods of allocation, outcome assessment and duration of follow-up. Ideally, parallel RCTs should be used in future studies to avoid the bias associated with cross-over studies. There is a need to standardize the outcomes of RCTs on treatments for sleep bruxism.

AIMS:

Botulinum toxin, the most potent biological toxin, has been shown to be effective for a variety of disorders in several medical conditions, when used both therapeutically and cosmetically. In recent years, there has been a rising trend in the use of this pharmacological agent to control bruxing activity, despite its reported adverse effects. The aim of this review was to provide a brief overview to clarify the underlying essential ideas for the use of botulinum toxin in bruxism based on available scientific papers.

METHODOLOGY:

An electronic literature search was performed to identify publications related to botulinum toxin and its use for bruxism in PubMed. Hand searching of relevant articles was also made to identify additional studies.

RESULTS:

Of the eleven identified studies, only two were randomized controlled trials, compared with the effectiveness of botulinum toxins on the reduction in the frequency of bruxism events and myofascial pain after injection. The authors of these studies concluded that botulinum toxin could be used as an effective treatment for reducing nocturnal bruxism and myofascial pain in patients with bruxism.

CONCLUSION:

Evidence-based research was limited on this topic. More randomized controlled studies are needed to confirm that botulinum toxin is safe and reliable for routine clinical use in bruxism.

People who suffer from bruxism (teeth-grinding) often ask their dentists whether their condition is hereditary. The purpose of this study is to enable dentists to provide an 'evidence-based' answer to this question. The biomedical literature was searched using PubMed, and 32 publications were identified, of which nine proved relevant to the research question. The references cited by the publications identified yielded one further publication, bringing the total number of publications included in the analysis to 10. Four publications related to family studies, five related to twin studies and one related to a DNA analysis. With the exception of one of the twin studies, all the included studies concluded that bruxism appears to be (in part) genetically determined. Dentists whose patients ask them about bruxism can therefore tell them that teeth-grinding does indeed 'run in families'.

Aims: Botulinum toxin, the most potent biological toxin, has been shown to be effective for a variety of disorders in several medical conditions, when used both therapeutically and cosmetically. In recent years, there has been a rising trend in the use of this pharmacological agent to control bruxing activity, despite its reported adverse effects. The aim of this review was to provide a brief overview to clarify the underlying essential ideas for the use of botulinum toxin in bruxism based on available scientific papers. Methodology: An electronic literature search was performed to identify publications related to botulinum toxin and its use for bruxism in PubMed. Hand searching of relevant articles was also made to identify additional studies. Results: Of the eleven identified studies, only two were randomized controlled trials, compared with the effectiveness of botulinum toxins on the reduction in the frequency of bruxism events and myofascial pain after injection. The authors of these studies concluded that botulinum toxin could be used as an effective treatment for reducing nocturnal bruxism and myofascial pain in patients with bruxism. Conclusion: Evidence-based research was limited on this topic. More randomized controlled studies are needed to confirm that botulinum toxin is safe and reliable for routine clinical use in bruxism.

PURPOSE:

To test the null hypothesis of no difference in the implant failure rates, postoperative infection, and marginal bone loss after the insertion of dental implants in bruxers compared with the insertion in non-bruxers against the alternative hypothesis of a difference.

METHODS:

An electronic search was undertaken in June 2014. Eligibility criteria included clinical studies, either randomized or not.

RESULTS:

Ten publications were included with a total of 760 implants inserted in bruxers (49 failures; 6.45%) and 2989 in non-bruxers (109 failures; 3.65%). Due to lack of information, meta-analyses for the outcomes "postoperative infection" and "marginal bone loss" were not possible. A risk ratio of 2.93 was found (95% confidence interval, 1.48-5.81; P = 0.002).

CONCLUSIONS:

These results cannot suggest that the insertion of dental implants in bruxers affects the implant failure rates due to a limited number of published studies, all characterized by a low level of specificity, and most of them deal with a limited number of cases without a control group. Therefore, the real effect of bruxing habits on the osseointegration and survival of endosteal dental implants is still not well established.

Objective: To systematize the scientific evidence on the efficacy of botulinum toxin type A in thetreatment of bruxism. Method: A bibliographical search was made by researching the PubMedCentral Journals and Allergan Products Literature (APL) - botulinum toxin within the last 10 years,with the following descriptors: ?bruxism,? ?botulinum toxin,? and ?treatment?. The methodologicalquality of the studies was evaluated by the Jadad Scale. Results: Two studies of double blindrandomized clinical trials were selected. The two clinical studies showed that the application ofbotulinum toxin could diminish levels of pain, lower the frequency of occurrences of bruxism,and satisfy the patients in terms of efficacy of the botulinum toxin in this pathology, in additionto having no important adverse effects. Thus, the treatment with botulinum toxin type A couldpresent itself as one possible treatment for patients with bruxism. Conclusion: More studies areneeded that follow the quality criteria to reach a definitive conclusion about efficacy and safety.

Objective: To conduct a systematic review to assess and analyze the scientific evidence about the available therapies for bruxism in children. Method and Materials: The literature was searched using Medline, PubMed, Ovid, Biomed Central, EBSCOhost, ISI, Cochrane Library, Embase, LILACS, Scielo, Scirus, the Internet at large, and databases of universities from March 1985 to the end of September 2007. Studies had to be intervention studies for bruxism in children, and the children included in the studies had to be 3 to 10 years old. Results: From 52 records found, 2 fulfilled the inclusion criteria. In 1 study, bruxism was treated by widening the upper airway through adenoidectomy, and the other study proposed to treat bruxism in children with psychologic techniques. When analyzed, the 2 considered studies did not fully accomplish the requirements to treat the etiology of bruxism in children. Conclusion: The available literature does not provide adequate support to treat bruxism in children, as the diagnosis methods in the studies are insufficient and are not comparable to confirm the presence of bruxism. Very few studies about therapies for bruxism in children meet the quality criteria required for the evidence-based practice. Treatment for bruxism in children requires further study.

El bruxismo es un factor iniciador y coadyuvante de alteraciones de la región temporomandibular, entre las que se incluye el síndrome de dolor miofascial. Sin embargo, en los diversos estudios realizados en la literatura científica no hay homogeneidad en los métodos diagnósticos, en la clasificación de bruxismo o en las alteraciones temporomandibulares, lo que no permite asegurar que existe una relación causa-efecto entre el bruxismo y los diferentes desórdenes temporomandibulares. Para intentar aclarar la relación entre el bruxismo y el síndrome de dolor miofascial se realizó una revisión sistemática de la literatura sobre estudios que hayan buscado identificar la asociación entre las dos condiciones. Los estudios que han sugerido una relación causal entre bruxismo nocturno y dolor miofascial han utilizado métodos diagnósticos variables, apoyándose, principalmente, en encuestas de corte transversal, lo cual ha limitado la posibilidad de lograr conclusiones firmes; mientras que aquéllos que usan métodos objetivos, como polisomnografía, no han encontrado una concluyente relación causal (AU)

Discutir las principales y más eficaces actividades terapéuticas en el control del bruxismo nocturno. Para la identificación de los estudios, fue realizada una estrategia de búsqueda detallada y avanzada en los bancos de datos: PubMed y Medline. Fueron utilizados como

PALABRAS CLAVE:

bruxism, therapeutics y drug therapy. Los criterios de inclusión fueron: artículos clínicos, estudios controlados aleatorios, estudios in vitro, revisiones de literatura y revisiones sistemáticas con y sin meta-análisis de los últimos 10 años, que aborden el tema propuesto. Los criterios de exclusión fueron: artículos sin resumen, estudios en animales, artículos cuyo idioma no sea el inglés y artículos de revistas que no pertenecen al área odontológica. De un total de 83 artículos, después de un análisis según el criterio de inclusión y exclusión, fueron seleccionados 33 artículos. A pesar de la pequeña cantidad de estudios clínicos prospectivos con alto grado de confiabilidad y que la mayoría de los estudios que evaluaron la eficacia de tratamientos alternativos fueron reportes de casos clínicos aislados, la literatura muestra que la utilización de la toxina botulínica se mostró eficaz para el control del bruxismo nocturno. Por otro lado, aspectos importantes como el efecto transitorio, dosis segura y técnica de aplicación aún son poco estudiados, de esa manera más investigaciones son necesarias para que esas dudas sean esclarecidas...

OBJETIVOS:

Realizar una revisión sistemática de la literatura sobre la prevalencia del bruxismo en las poblaciones adultas.
Métodos: Se realizó una búsqueda sistemática de la literatura médica para identificar todos los resúmenes pareados de estudios en Inglés que trataran de la evaluación de la prevalencia del bruxismo diurno o nocturno en la población en general mediante la adopción de los cuestionarios, evaluaciones clínicas y registros polisomnográficos (PSG ) o electromiografía (EMG). La evaluación de calidad de los trabajos revisados ​​se realizó de acuerdo a la lista de control de la Evaluación Metodológica de la Investigación Observacional (MORE), que permite la identificación de fallas en la validez interna y externa. Se establecieron los criterios de corte para una validez externa aceptable para seleccionar los estudios para el examen de los datos de prevalencia. Para cada estudio incluido, se registraron las características de la muestra, la estrategia de diagnóstico, y la prevalencia del bruxismo en relación con la edad, el sexo, y el ritmo circadiano, si se encontraba disponible,.

RESULTADOS:

Treinta y cinco publicaciones se incluyeron en la revisión. Varios problemas metodológicos que limitan la validez externa de los resultados en la mayoría de los estudios y la extracción de datos de prevalencia se realizó sólo en siete artículos. De ellos, sólo un artículo tenía un defecto de validez externa menor, mientras que la validez interna fue baja en todos los trabajos seleccionados por su modo de diagnóstico de bruxismo, basada principalmente en sólo uno o dos ítems del cuestionario. No se obtuvieron daos epidemiológicos de estudios que adoptaran otras estrategias de diagnostico (eg, PSG, EMG). Se evaluó identificado genéricamente "bruxismo" en dos estudios que informaron una prevalencia del 8% al 31,4%, bruxismo diurno se investigó en dos estudios que describen un 22,1% a un 31% de prevalencia, y se encontró que la prevalencia del bruxismo del sueño era más consistente a través de los tres estudios que investigaron el reporte de bruxismo "frecuente" (12,8% ± 3,1%). No se encontró que el bruxismo tuviera relación con el sexo, y una disminución con la edad fue descrita en las personas de edad avanzada.

CONCLUSIÓN:

La presente revisión sistemática describe los datos de prevalencia variables para el bruxismo. Los resultados deben ser interpretados con cautela debido a la mala calidad metodológica de la literatura revisada y a posibles sesgos de diagnóstico relacionado con depender del auto-reporte de bruxismo.