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Title No Evidence To Support Botulinum Toxin As A Treatment For Bruxism In Children
Clinical Question In children with bruxism, is the use of botulinum toxin effective in reducing bruxism compared to no treatment at all?
Clinical Bottom Line While botulinum toxin has been shown to be effective in reducing events and symptoms of bruxism in adults (see Best Evidence below), there have been no studies involving the effects of treatment in children. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19855255Lee/201012 adult patients with nocturnal bruxismRandomized Controlled Trial
Key resultsBruxism in the masseter muscle decreased in the subject group that was injected with botulinum toxin (p = 0.027). In the temporalis muscle, bruxism events did not differ between the two groups. Subjective bruxism symptoms decreased in both the botulinum toxin and saline injected groups (P < 0.001).
#2) 18468272Guarda-Nardin/200820 patients (age range 25-45) with bruxism and myofascial painRandomized Controlled Trial
Key resultsImprovements in both objective and subjective symptoms were higher in the botulinum toxin injected group compared to the placebo group. Patients treated with the toxin also had higher subjective perceptions of treatment efficacy than the placebo group. Differences were not significant in some cases due to the small sample size.
Evidence Search ("Bruxism"[Mesh]) AND ("Botulinum Toxins"[Mesh]) ...view in PubMed
Comments on
The Evidence
Both the Lee and Guarda-Nardin studies were double-blind, with similar groups at the start. Completion, compliance, and follow-up were all adequate. However, both studies had a small sample size consisting of only adults.
Applicability For children, especially with severe bruxism, this may be a feasible treatment option However, a child must be fairly cooperative to receiving injections and there may be contraindications related to growth and development. More research needs to be conducted to determine the applicability and long-term effects of this treatment.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords bruxism, botulinum toxin, botox, children
ID# 782
Date of submission: 03/17/2011spacer
E-mail patelr5@livemail.uthscsa.edu
Author Roshan Patel
Co-author(s) e-mail
Faculty mentor/Co-author John D. Rugh, PhD
Faculty mentor/Co-author e-mail rugh@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Shiva Toghyani (San Antonio, TX) on 08/28/2013
I conducted a PubMed search on this topic in August 2013 and found several more recent publications. The strongest level of evidence on the topic is a systematic review performed by Long et. al., in 2012 (PMID# 22251031) which strengthens the conclusion of this CAT confirming that although botulinum toxin injections are considered as a safe and effective treatment in adults, no studies have been done indicating the effects of treatment in children.

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