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Is there enough evidence to use botulinum toxin injections for bruxism management? A systematic literature review

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Abstract

Objective

The objective of the study was to conduct a systematic review of the literature assessing the effects of botulinum toxin (BoNT-A) injections in the management of bruxism.

Materials and methods

Search for articles involved the PubMed, Scopus, Web of Science, Embase, Cochrane, Scielo and Lilacs databases. Specific terms were used and the search carried out from 1980 to March 2016 by three independent researchers. Randomized controlled studies (RCTs), prospective and before–after studies that applied BoNT-A at the masseter and/or temporalis muscles were included.

Results

Three RCTs and two uncontrolled before–after studies out of 904 identified citations were included in this review. All five articles dealt with sleep bruxism and featured a small sample size. None of them was about awake bruxism. Two randomized clinical trials were double-blinded, with a control group using saline solution. Two studies used polysomnography/electromyography for sleep bruxism diagnosis, whilst others were based on history taking and clinical examination. All studies using subjective evaluations for pain and jaw stiffness showed positive results for the BoNT-A treatment. In contrast, the two studies using objective evaluations did not demonstrate any reduction in bruxism episodes, but a decrease in the intensity of muscles contractions.

Conclusion

Despite the paucity of works on the topic, BoNT-A seems to be a possible management option for sleep bruxism, minimizing symptoms and reducing the intensity of muscle contractions, although further studies are necessary especially as far as the treatment indications for bruxism itself is concerned.

Clinical relevance

BoNT-A has been increasingly diffused in dentistry over recent years, being also used for pain management in patients with bruxism. Nonetheless, there is no consensus about its effects in this disorder.

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Author information

Authors and Affiliations

  1. Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Avenida Limeira, no. 901, Bairro Areião, Piracicaba, SP, 13414-903, Brazil

    Giancarlo De la Torre Canales, Mariana Barbosa Câmara-Souza, Camilla Fraga do Amaral & Renata Cunha Matheus Rodrigues Garcia

  2. Temporomandibular Disorders Clinic, School of Dentistry, University of Padova, Padova, Italy

    Daniele Manfredini

Authors
  1. Giancarlo De la Torre Canales
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  2. Mariana Barbosa Câmara-Souza
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  3. Camilla Fraga do Amaral
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  4. Renata Cunha Matheus Rodrigues Garcia
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  5. Daniele Manfredini
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Corresponding author

Correspondence to Renata Cunha Matheus Rodrigues Garcia.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The work was supported by Piracicaba Dental School, University of Campinas, São Paulo, Brazil.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

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Appendix

Appendix

* CASP quality assessment items for before–after studies:

  1. Item 1:

    Did the study address a clearly focused issue?

  2. Item 2:

    Was the cohort recruited in an acceptable way?

  3. Item 3:

    Was the exposure accurately measured to minimize bias?

  4. Item 4:

    Was the outcome accurately measured to minimize bias?

  5. Item 5:

    Have the authors identified all important confounding factors?

  6. Item 6:

    Was the follow up of subjects complete enough?

  7. Item 7:

    What are the results of this study?

  8. Item 8:

    How precise are the results?

  9. Item 9:

    Do you believe the results?

  10. Item 10:

    Can the results be applied to the local population?

  11. Item 11:

    Do the results of this study fit with other available evidence?

  12. Item 12:

    What are the implications of this study for practice?

** CASP quality assessment items for case-control studies:

  1. Item 1:

    Did the study address a clearly focused issue?

  2. Item 2:

    Did the authors use an appropriate method to answer their question?

  3. Item 3:

    Were the cases recruited in an acceptable way?

  4. Item 4:

    Were the controls selected in an acceptable way?

  5. Item 5:

    Was the exposure accurately measured to minimize bias?

  6. Item 6:

    Have the authors taken account of the potential confounding factors in the design and/or in their analysis?

  7. Item 7:

    What are the results of this study?

  8. Item 8:

    How precise are the results?

  9. Item 9:

    Do you believe the results?

  10. Item 10:

    Can the results be applied to the local population?

  11. Item 11:

    Do the results of this study fit with other available evidence?

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De la Torre Canales, G., Câmara-Souza, M.B., do Amaral, C.F. et al. Is there enough evidence to use botulinum toxin injections for bruxism management? A systematic literature review. Clin Oral Invest 21, 727–734 (2017). https://doi.org/10.1007/s00784-017-2092-4

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  • DOI: https://doi.org/10.1007/s00784-017-2092-4

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