title: 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.
authors.affiliation: Temporomandibular Disorders Clinic, Department of Maxillofacial Surgery, University of Padova, Padova, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Manfredini
authors.affiliation: Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Ahlberg
authors.affiliation: Rehabilitation Department, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ephraim
authors.initials: E
authors.lastname: Winocur
authors.affiliation: Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Lobbezoo
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D004599:Electric Stimulation Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000502:physiology; D019186:Mandibular Advancement / Q000379:methods; D008410:Masticatory Muscles / Q000502:physiology; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D017286:Polysomnography; D036301:Qualitative Research; D020186:Sleep Bruxism / Q000175:diagnosis / Q000628:therapy*; D013565:Sympatholytics / Q000627:therapeutic use; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D009465:Neuromuscular Agents; D013565:Sympatholytics
keywords: biofeedback; bruxism; cognitive-behavioural therapy; management; oral appliances; pharmacology; sleep bruxism; treatment