Title	Hydroxyzine may be an Acceptable Treatment Option for Children with Sleep Bruxism
Clinical Question	Can hydroxyzine be used as a treatment option for children suffering from sleep bruxism compared to no treatment?
Clinical Bottom Line	Children presenting sleep bruxism showed a clinically significant decrease in reported bruxism when taking a dose of hydroxyzine nightly. In these trials hydroxyzine treatment caused no adverse side effects and can be considered a viable treatment option.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 23609369 Ghanizadeh/2013 Three Children Case series Key results This study examined three children with sleep bruxism that were given 10-25mg of hydroxyzine nightly over a one to two month period. All 3 children's parents reported decreased bruxism on a Visual Analog Scale. No adverse side effects were reported. 23550945 Ghanizadeh/2013 30 Children Aged 4-17 with Sleep Bruxism Randomized Controlled Trial Key results In this randomized, double-blind placebo-controlled trial, 21 children received 25-50 mg hydroxyzine and 9 received a placebo. Ratings by parents on a Visual Analog Scale showed 89% of the children receiving hydroxyzine responded to the treatment. This was compared to 44% responding in the placebo group ( P<0.02). Response to treatment was defined as a 49% or grater decrease in the security of bruxism as reported on the Visual Analog Scale by the parents. No serious side effects were reported. The trial lasted 4 weeks.
Evidence Search	(("sleep bruxism"[MeSH Terms] OR ("sleep"[All Fields] AND "bruxism"[All Fields]) OR "sleep bruxism"[All Fields]) AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields]))
Comments on The Evidence	The evidence from both studies supports the use of hydroxyzine as a viable treatment option for sleep bruxism in children. No major side effects were reported and the RCT had only two patients lost to follow-up. However, hydroxyzine has not been investigated as a treatment for bruxism outside of these studies and because of their small sample size and short trial duration more clinical trials should be performed. No direct (EMG) measures were made of the levels of bruxism in these two studies. Nor were clinical signs and symptoms assessed as outcome measures. Both studies relied on the subjective reports of the children's patients.
Applicability	Hydroxyzine is an H1 receptor antagonist, that when compared to other pharmacological options, has fewer side-effects and should be considered safer for children. The current array of dental appliances have varying results and magnitude of compliance. Thus the potential for pharmacological intervention a treatment option should be considered. This treatment may be considered if the patient does not respond to prosthetic appliances or if there is concern about impeding growth and development in the child with long term use of an appliance.
Specialty	(General Dentistry) (Pediatric Dentistry)
Keywords	Bruxism, Hydroxyzine, Sleep Bruxism
ID#	2682
Date of submission	03/09/2014
E-mail	krantz@uthscsa.edu
Author	Robert Krantz
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Diane Sullivan, DDS
Faculty mentor e-mail	sullivand@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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available