Treating severe bruxism with botulinum toxin

Background. Locally administered botulinum toxin, or BTX, is an effective t reatment for various movement disorders. Its usefulness in treating bruxism , however, has not been systematically evaluated. Subjects and Methods. The authors studied 18 subjects with severe bruxism a nd whose mean duration of symptoms was 14.8 +/- 10.0 years (range three-40 years). These subjects audibly ground their teeth and experienced tooth wea r and difficulty speaking, swallowing or chewing. Medical or dental procedu res had failed to alleviate their symptoms. The authors administered a tota l of 241 injections of BTX type A, or BTX A, in the subjects' masseter musc les during 123 treatment visits. The mean dose of the BTX A was 61.7 +/- 11 .1 mouse units, or MU (range 25-100 MU), per side for the masseter muscles. Results. The mean total duration of response was 19.1 +/- 17.0 weeks (range six-78 weeks), and the mean peak effect on a scale of 0 to 4, in which 4 i s equal to total abolishment of grinding, was 3.4 +/- 0.9. Only one subject (5.6 percent) reported having experienced dysphagia with BTX A. Conclusion. The results of this study suggest that BTX administered by skil led practitioners is a safe and effective treatment for people with severe bruxism, particularly those with associated movement disorders. It should b e considered only for those patients refractory to conventional therapy. Fu ture placebo-controlled studies may be useful in further evaluating the pot ential of BTX in the treatment of bruxism.