Insufficient evidence to assess the effectiveness of biofeedback for sleep bruxism


Sleep bruxism (SB) is a sleep related disorder characterized by tooth grinding or jaw clenching during sleep, which is usually associated with sleep arousal. A wide range of treatments has been proposed including, relaxation exercises, behavioural approaches, dental splints and biofeedback.  The aim of this review was to evaluate the efficacy of any biofeedback treatment on SB.

Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, ISI Web of Science, System for Information on Grey Literature in Europe, Chinese Biomedical Literature Database, and PsycINFO databases with no language restriction. Randomized controlled trials (RCT) quasi-RCT and controlled clinical trials (CCT) were included.  Risk of bias assessment was carried out.

  • Seven studies involving 240 participants met the inclusion criteria.
  • Three studies had moderate risk of bias the other four were classified as high risk.
  • A range of biofeedback approaches were used, contingent electrical stimulation (2 studies) (CES), audio  (4 studies) and visual feedback (1 study) and relaxation (1 study).   Due to the range of approaches a qualitative description is provided.

The authors concluded

Although many positive studies (clinical trials and case reports) support the efficacy of biofeedback treatment for SB, accepted scientific evidence is still insufficient due to the limited number of included studies for statistical pooling.


While the authors did perform one meta-analysis comparing CES with control. This included only two small studies and found no difference between the two groups.  The review highlights the lack of good quality trial evidence available to assess the effectiveness of this intervention for SB.  A 2007 Cochrane review evaluating the effectiveness of occlusal splints for the treatment of SB also found insufficient that splints were effective in treating SB.


Wang LF, Long H, Deng M, Xu H, Fang J, Fan Y, Bai D, Han XL. Biofeedback treatment for sleep bruxism: a systematic review. Sleep Breath. 2013 Jun 12. [Epub ahead of print] PubMed PMID: 23756884.

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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