The Current Trend in Management of Bruxism and Chronic Pain: An Overview of Systematic Reviews

Abstract

Bruxism, specifically sleep bruxism (SB), is a worldwide discussed topic in the literature; however, there is insufficient evidence to define and support a standard approach for the treatment of SB. The purpose of this overview was to map the evidence from systematic reviews (SR), examining the effects of interventions to improve chronic pain related to bruxism. The methodological quality of SRs was assessed using the AMSTAR-2 tool. We conducted a comprehensive literature search in April 2020, in the following databases: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, LILACS, BBO, and Epistemonikos. Nine SRs with critically low to high methodological quality were included. Considering the main findings, botulinum toxin type A (BTX-A) showed a significant pain and sleep bruxism frequency reduction when compared to placebo or conventional treatment (behavioral therapy, occlusal splints, and drugs), after 6 and 12 months. Occlusal splints combined to muscle massage showed some benefit in pain reduction. There was no difference in pain and bruxism frequency between biofeedback therapy and an inactive control group. Regarding drug therapy, there is no difference when amitriptyline, bromocriptine, clonidine, propranolol, and levodopa were compared to placebo. In conclusion, there is some evidence to support the use of occlusal splints plus massage, and BTX-A to reduce chronic pain related to SB. No evidence was provided to support the recommendation of biofeedback therapy and drug therapy. There is still a need for more methodologically rigorous randomized clinical trials (RCT) to be conducted on the efficacy and safety of different therapies for SB.