Botulinum toxin for bruxism


Bruxism can be classified as primary (idiopatic) or secondary (iatrogenic).  While secondary bruxism is associated with medical conditions (e.g. neurologic, psychiatric, sleep disorders medication), primary bruxism ( which includes clenching and sleep bruxism ) is not. Dental treatments for bruxism include occlusion adjustment, tooth surface restoration, and orthodontic treatment. These interventions are extensive and irreversible and these are not recommended in most cases.  The aim of this study was to assess the efficacy of botulinum toxins (BT) on bruxism.

A good search strategy for relevant studies appears to have been conducted with several databases being searched; PubMed, Embase and Science Citation Index, Cochrane Central Register of Controlled Trials,  and SIGLE (System for Information on Grey Literature in Europe) with no language restriction.

Only four studies met the inclusion criteria, two  randomised controlled trials and two  controlled before-and-after studies.

The abstract indicates that the included studies show that BT injections

  • reduce the frequency of bruxism events,
  • decrease bruxism-induced pain levels and
  • satisfy patients’ self-assessment with regard to the effectiveness of BT on bruxism.
  • Compared with oral splint, BT are equally effective on bruxism.
  • BT injections at a dosage of <100U are safe for otherwise healthy patients.

They concluded

Botulinum toxin injections are effective on bruxism and are safe to use. Therefore, they can be used clinically for otherwise healthy patients with bruxism.

Long H, Liao Z, Wang Y, Liao L, Lai W. Efficacy of botulinum toxins on bruxism: an evidence-based review. Int Dent J. 2012 Feb;62(1):1-5. doi:10.1111/j.1875-595X.2011.00085.x. PubMed PMID: 22251031.


Only the abstract of this paper was available for review.  This gives limited information on inclusion and exclusion criteria and no information on whether the risk of bias was assessed for the included studies or the number of participants.

Related review

Macedo CR, Silva AB, Machado MAC, Saconato H, Prado GF. Occlusal splints for treating sleep bruxism (tooth grinding). Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005514. DOI: 10.1002/14651858.CD005514.pub2.


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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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