Bruxism - Emerging treatments | BMJ Best Practice

Contingent stimulation

Application of electrical stimuli to the trigeminal area is known to elicit an inhibitory reflex response in contracting jaw-closing muscles. This principle can be used for contingent stimulation when the jaw muscles become active during bruxism behaviours.[116] Once jaw muscle activity exceeds a threshold, a train of electrical, non-painful pulses are applied to the skin, which inhibits muscle contraction. One proof-of-concept study indicated a 40% decrease in jaw-muscle activity during sleep with this stimulation.[96] A preliminary polysomnographic study has also shown that contingent, non-painful electrical stimuli do not cause significant disturbances in sleep quality or additional micro-arousals.[117] However, more research is needed to establish the efficacy of biofeedback devices.[97] Ambulatory electromyography (EMG) devices may have the potential to be used in primary care settings for monitoring purposes and for intervention with increased jaw-muscle activity.[54] Various types of stimuli (vibration, auditory, taste) have been used to unlearn the increased jaw-muscle activity, but the level of evidence in support of these techniques is very low.[87][90] One study providing an electrical stimulus to the masseter muscle to suppress its sleep time activity supports the effectiveness of such stimulation to reduce sleep bruxism (SB).[118]

Botulinum toxin type A

Injections into the masseter and/or temporalis muscles for the management of sleep bruxism have been described in case series that indicate success in decreasing bruxism activity; however, the level of evidence for its use is low, and this treatment modality is typically restricted to patients resistant to other conventional treatments.[90][119] The effects of botulinum toxin on bruxism show a reduced intensity but not frequency of SB episodes, which suggests that such peripherally acting drugs do not affect the genesis of SB episodes.[120][121] Several studies demonstrated significant decreases in jaw-muscle EMG activity during sleep for up to 12 weeks following administration of botulinum toxin in the masseter muscles.[87] Although some evidence advocates for the use of botulinum toxin injections into the jaw muscles as a safe and effective treatment option for otherwise healthy people with bruxism, a conservative approach and restricting the use of botulinum toxin to more extreme cases seems warranted.[122][123][124]

Hydroxyzine

Preliminary evidence indicates that hydroxyzine (an antihistamine with skeletal muscle relaxing properties) could be effective for parent- or carer-reported bruxism in children, but its routine use is not recommended due to risk-to-benefit considerations.[125]