ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Botulinum Toxin reduces Nocturnal EMG and Symptoms in Patients with sleep Bruxism
Clinical Question Is the use of botulinum toxin in patients with sleep bruxism effective in reducing bruxism compared to no treatment?
Clinical Bottom Line Botulinum toxin has been shown to reduce the muscle activity and symptoms of patients with sleep bruxism compared to placebo injections, however has not been systematically compared with occulsal splint therapy. (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 patients with sleep bruxismRandomized Controlled Trial
Key resultsBruxism events as measured by electromyography were significantly decreased in the muscles that received the botulinum toxin (P = 0.027)" as compared to the group which received injections of saline. Subjective bruxism symptoms reported by the patients decreased in both groups after injection (P<0.001)
#2) 18468272Guarda-Nardin/200820 patients with bruxism & myofascial pain of masticatory muscleRandomized Controlled Trial
Key resultsImproved outcomes of both objective (mandibular movements) and subjective (pain at rest, pain during chewing) in BTX-A-injected patients compared to placebo-injected patients. Patients receiving botulinum toxin reported greater subjective improvement in the efficacy of their treatment than the placebo group. Small sample size led to differences that were not significant for some outcome variables.
Evidence Search "Bruxism"[Mesh] AND "Botulinum Toxins"[Mesh] AND (Randomized Controlled Trial[ptyp] AND English[lang]) ...view in PubMed
Comments on
The Evidence
In the Lee study, the temporalis muscle was used as a control and was not given botulinum toxin in either group. Electromyography showed no difference in the temporalis muscles of the two groups. Both studies had a small sample size. Power analysis should be calculated and a larger study completed. A recently published (2011) case series of 120 patients reported good/very good improvement in bruxism related symptoms with no significant side effects PMID: 21301762). There is need for direct RCT comparisons with other current therapy for bruxism.
Applicability Adult patient with sleep bruxism. Given other treatment options, this treatment may be reserved for patients with severe bruxism. More research is needed to determine applicability.
Specialty/Discipline (General Dentistry)
Keywords Sleep bruxism, Bruxism, TMD, Botulinum toxin, Botox
ID# 583
Date of submission: 04/01/2010spacer Revised: 09/14/2011
E-mail kartaltepe@uthscsa.edu
Author Christen Kartaltepe
Co-author(s)
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
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Peyton Cometti, Eileen Kwee, Thomas Lloyd (San Antonio, TX) on 01/07/2013
A PubMed search revealed a more current article by Long et al. published in 2012 (PMID 22251031). This was a systematic review that not only supported the original findings of this CAT, but also showed a comparison with occlusal splint therapy to be equally effective in treating bruxism. This should bring more confidence in using botulinum toxin as an alternative to the conventional splint therapy.
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