Management of sleep bruxism in adults: a qualitative systematic literature review

Abstract

This paper updates the bruxism management review published by Lobbezoo et al. in 2008 (J Oral Rehabil 2008; 35: 509-23). The review focuses on the most recent literature on management of sleep bruxism (SB) in adults, as diagnosed with polysomnography (PSG) with audio-video (AV) recordings, or with any other approach measuring the sleep-time masticatory muscles' activity, viz., PSG without AV recordings or electromyography (EMG) recorded with portable devices. Fourteen (N = 14) papers were included in the review, of which 12 were randomised controlled trials (RCTs) and 2 were uncontrolled before-after studies. Structured reading of the included articles showed a high variability of topics, designs and findings. On average, the risk of bias for RCTs was low-to-unclear, whilst the before-after studies had several methodological limitations. The studies' results suggest that (i) almost every type of oral appliance (OA) (seven papers) is somehow effective to reduce SB activity, with a potentially higher decrease for devices providing large extent of mandibular advancement; (ii) all tested pharmacological approaches [i.e. botulinum toxin (two papers), clonazepam (one paper) and clonidine (one paper)] may reduce SB with respect to placebo; (iii) the potential benefit of biofeedback (BF) and cognitive-behavioural (CB) approaches to SB management is not fully supported (two papers); and (iv) the only investigation providing an electrical stimulus to the masseter muscle supports its effectiveness to reduce SB. It can be concluded that there is not enough evidence to define a standard of reference approach for SB treatment, except for the use of OA. Future studies on the indications for SB treatment are recommended.

Frequency of awake bruxism behaviours in the natural environment. A 7‐day, multiple‐point observation of real‐time report in healthy young adults

“…And finally, as soon as the specific indications for treatment are defined, the potential for the use of smartphone‐EMA approaches as a strategy to implement cognitive‐behavioural management of AB could be assessed. Indeed, it could be possible that someone who notices to be an AB bruxer could actually try to stop his/her own oral behaviour.…”

The Evaluation of the Clinical Effects of Botulinum Toxin on Nocturnal Bruxism

“…Nocturnal bruxism (NB) is defined as abnormal maxillomandibular activity during sleep, characterized by grinding and clenching of the teeth [1, 2]. NB can lead to wear on the teeth, dental prostheses/implant failure, tooth sensitivity, pain in the teeth, jaw, masticatory muscle, and temporomandibular joint (TMJ), neck pains and headache, periodontal disease, oral or facial pain, and potentially tooth loss [3, 4].…”

“…In two comprehensive review studies, Tinastepe et al [1] and Manfredini et al [2] suggested that there is not enough evidence to use botulinum injection in the treatment of bruxism. The purpose of the present study was to investigate the potential performance of BTXA on nocturnal bruxism and to share this clinical experience.…”

Efficacy of biofeedback therapy on sleep bruxism: A systematic review and meta‐analysis

“…Within these premises, SB may have clinical consequences for the stomatognathic system (eg, tooth wear, temporomandibular joint (TMJ) and/or masticatory muscle pain, headaches, complications in prosthodontic rehabilitation) that have been systematically reviewed over the past several years . From a clinician's approach, SB should be viewed as a condition that requires management only when it has consequences, as a danger of overtreatment exists . General treatment approaches include behavioural strategies, pharmacotherapy and intra‐oral devices; however, the control of SB itself is exceedingly difficult and, unfortunately, none of the techniques can permanently “cure” or “stop” it …”