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De la Torre Canales G, Câmara-Souza MB, Ernberg M, Al-Moraissi EA, Grigoriadis A, Poluha RL, Christidis M, Jasim H, Lövgren A, Christidis N. Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews. Drugs 2024:10.1007/s40265-024-02048-x. [PMID: 38900335 DOI: 10.1007/s40265-024-02048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. METHOD An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included. RESULTS In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. CONCLUSION The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.
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Affiliation(s)
- Giancarlo De la Torre Canales
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal
- Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil
| | | | - Malin Ernberg
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - Anastasios Grigoriadis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
| | | | - Maria Christidis
- The Institute of Health Sciences, The Swedish Red Cross University, SE-141 21, Huddinge, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-14183, Huddinge, Sweden
| | - Hajer Jasim
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
- Public Dental Services, Department of Orofacial Pain and Jaw Function, Folktandvården Stockholms län AB, Eastmaninstitutet, SE-102 31, Stockholm, Sweden
| | - Anna Lövgren
- Clinical Oral Physiology, Department of Odontology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Nikolaos Christidis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden.
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Soares-Silva L, de Amorim CS, Magno MB, Tavares-Silva C, Maia LC. Effects of different interventions on bruxism: an overview of systematic reviews. Sleep Breath 2024; 28:1465-1476. [PMID: 38177829 DOI: 10.1007/s11325-023-02961-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE This study aimed to evaluate, qualify, and summarize evidence presented in systematic reviews (SR) on treatments for bruxism. METHODS The overview was conducted using the PICO strategy: children, adolescents, and adults with bruxism (P) were submitted to different treatments (I) compared to other treatments, placebo, or no treatment (C) in order to evaluate incidence, prevalence, and number of episodes of bruxism (O). The search was carried out in six databases and gray literature up to July 2023. Data were extracted, and the ROBS tool was used, followed by a descriptive synthesis of the results. RESULTS A total of 31 SR were included. Sixteen showed a positive effect on episodes of bruxism (BE), while two had negative, one had neutral, and nine had inconclusive effects. Using the risk of bias in systematic reviews tool (ROBIS), risk of bias varied from low (n = 23) to high (n = 5) among the SR. Pharmacological treatment, oral rehabilitation, and other therapeutic approaches presented inconclusive or negative effects on BE, while oral appliances showed controversial effects. Biofeedback, physical therapy, laser therapy, and botulinum toxin showed positive effects on the reduction of BE. CONCLUSION Biofeedback, physical therapy, laser therapy, and botulinum toxin showed positive effects on the reduction of BE; there is still a lack of studies to support the safe and long-term use of these therapies. REGISTRATION NUMBER PROSPERO CRD42021273905.
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Affiliation(s)
- Larissa Soares-Silva
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325 - Cidade Universitária, Rio de Janeiro, RJ, CEP: 21941-971, Brazil.
| | - Camila Silva de Amorim
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325 - Cidade Universitária, Rio de Janeiro, RJ, CEP: 21941-971, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325 - Cidade Universitária, Rio de Janeiro, RJ, CEP: 21941-971, Brazil
| | - Claudia Tavares-Silva
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325 - Cidade Universitária, Rio de Janeiro, RJ, CEP: 21941-971, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 325 - Cidade Universitária, Rio de Janeiro, RJ, CEP: 21941-971, Brazil.
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Buzatu R, Luca MM, Castiglione L, Sinescu C. Efficacy and Safety of Botulinum Toxin in the Management of Temporomandibular Symptoms Associated with Sleep Bruxism: A Systematic Review. Dent J (Basel) 2024; 12:156. [PMID: 38920857 PMCID: PMC11203296 DOI: 10.3390/dj12060156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/11/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Sleep bruxism, characterized by involuntary grinding or clenching of teeth during sleep, poses significant challenges in management due to its potential to induce temporomandibular joint disorders (TMDs) and other related symptoms. The use of Botulinum toxin Type A (BoNT-A), also known as Botox®, has been proposed as a therapeutic intervention. This systematic review aims to evaluate the efficacy and safety of BoNT-A in the management of sleep bruxism, focusing on pain reduction, improvement in jaw function, reduction in bruxism episodes, and the incidence of adverse effects. An exhaustive search was conducted across PubMed, Scopus, and Embase databases up to January 2024, adhering to the PRISMA guidelines. Nine randomized clinical trials (RCTs) involving 137 participants were analyzed for efficacy and safety outcomes. The studies demonstrated a significant reduction in mean pain scores (from 7.1 to 0.2 at 6 months and 1 year post-treatment in one study) and a notable decrease in the number of bruxism events (from 4.97/h to 1.70/h in the BoNT-A group in another study). Additionally, improvements were observed in jaw stiffness and total sleep time. Adverse effects varied but were generally mild and transient, including injection site pain in 20% of participants in one study and cosmetic changes in smile in 15.4% of patients in another. These findings suggest that BoNT-A injections may provide some benefits for treating nocturnal bruxism, potentially reducing TMD symptoms like pain and improving jaw function. However, these findings are preliminary due to variability in study designs and the absence of detailed statistical analysis.
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Affiliation(s)
- Roxana Buzatu
- Department of Dental Aesthetics, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Revolutiei Boulevard 9, 300041 Timisoara, Romania;
| | - Magda Mihaela Luca
- Department of Pediatric Dentistry, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Luca Castiglione
- Doctoral School, Faculty of General Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Cosmin Sinescu
- Department of Prostheses Technology and Dental Materials, Faculty of Dental Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
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Zhang AB, Zhang JY, Zhou X, Sun LS, Li TJ. Can botulinum toxin injection alleviate the pain of bruxism? A Bayesian network analysis and a single-arm analysis. J Dent Sci 2024; 19:885-893. [PMID: 38618107 PMCID: PMC11010618 DOI: 10.1016/j.jds.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 07/31/2023] [Indexed: 04/16/2024] Open
Abstract
Background/purpose There is inconsistent evidence regarding whether the botulinum toxin A (BTA) injection can relieve pain caused by bruxism. This study aimed to estimate the efficiency of BTA injection in relieving pain caused by bruxism at different follow-up periods. Materials and methods Five electronic databases were searched from 2005 to 2022 using search terms related to botulinum toxin and bruxism. Only controlled clinical trials were included. Two investigators reviewed each article and discussed any disagreements until a consensus was reached. Pain outcomes as evaluated by the visual analogue scale (VAS) were subjected to single-arm and Bayesian network meta-analyses. Pooling data were measured by a random-effects model. Results Eleven studies with a total of 365 bruxism patients were included. According to the single-arm analyses of the pooled data, the reduction in bruxism-related pain after BTA injection measured 4.06 points (95% CI = 3.37 to 4.75) on the VAS, and the pain relief was significant in the first 6 months after treatment (P < 0.01). According to the Bayesian analysis, BTA also resulted in significantly greater pain relief than oral splinting (mean difference (MD), -1.5; 95% credible interval (CrI) = -2.7 to -0.19) or saline injection (MD, -3.3; 95% CrI = -6.2 to -0.32). Conclusion BTA significantly relieves the pain of bruxism for 6 months after injection, and its therapeutic efficacy was higher than that of oral splinting. Nevertheless, further long-term follow-up randomized controlled trials comparing BTA with other management or drugs are warranted.
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Affiliation(s)
- Ao-bo Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China
| | - Jian-yun Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China
| | - Xia Zhou
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Li-sha Sun
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tie-jun Li
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China
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Cox K, Ghebrehiwet M, Kee M, Rucker B, Flores H, Ottwell R, Vassar M. Assessing the Reporting of Harms in Systematic Reviews Focused on the Therapeutic and Cosmetic Uses of Botulinum Toxin. Clin Drug Investig 2023; 43:85-95. [PMID: 36626045 DOI: 10.1007/s40261-022-01235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The expanding use of botulinum toxin (BoNT) in medical practice demonstrates the need to highlight whether there is adequate information regarding its safety profile. The aim of our study was to identify completeness of harms reporting for BoNT treatment within systematic reviews (SRs), assess quality of SRs using the AMSTAR-2 tool, and determine the degree of overlap among primary studies within each SR. METHODS On May 31, 2022, we searched Embase, Epistemonikos, MEDLINE, and the Cochrane Database of Systematic Reviews for SRs on BoNT therapy. Screening and data extraction were performed in a masked, duplicate fashion. AMSTAR-2 was used to evaluate the methodological quality of included SRs. Corrected covered area (CCA) was calculated for SR dyads. RESULTS Of the 90 included SRs, we found that 70 completed less than 50% of harms items. The most reported items were BoNT as a favorable intervention (73/90, 81.1%) and harms as a primary outcome (72/90, 80.0%). The least reported items were grades and severity scales used to classify harms (8/90, 8.9%) and number of treatment discontinuations in each arm (10/90, 11.1%). Eighty-three SRs were rated "critically low" (83/90, 92.2%), while 5 SRs were rated "high" (5/90, 5.6%) via AMSTAR-2 tool. Significant associations were found between completion of harms reporting and: (1) a "critically low" appraisal on AMSTAR-2 tool (p = 0.0060) and (2) whether harms was reported as a primary outcome (p = 0.0001). The total CCA overlap was determined to be 0.8%. CONCLUSION Our results demonstrate that harms are underreported within BoNT SRs. Because healthcare professionals often refer to SRs to guide clinical decision making, it is important to continue to explore shortcomings among BoNT literature in future studies.
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Affiliation(s)
- Katherine Cox
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA.
| | - Merhawit Ghebrehiwet
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA
| | - Micah Kee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA
| | - Brayden Rucker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA
| | - Holly Flores
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA
| | - Ryan Ottwell
- Department of Dermatology, St. Joseph Mercy Hospital, Ann Arbor, MI, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK, 74107, USA.,Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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da Silva Ramalho JA, Palma LF, Ramalho KM, Tedesco TK, Morimoto S. Effect of botulinum toxin A on pain, bite force, and satisfaction of patients with bruxism: A randomized single-blind clinical trial comparing two protocols. Saudi Dent J 2023; 35:53-60. [PMID: 36817026 PMCID: PMC9931508 DOI: 10.1016/j.sdentj.2022.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/11/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
Purpose The current study aims to evaluate bite force, perception of orofacial pain, and treatment satisfaction of patients with bruxism using two protocols of botulinum toxin A (BTX-A) injections. Material and Methods Two groups of patients seeking bruxism treatment and presenting bilateral orofacial pain of muscle origin were randomly created according to BTX-A injection sites: masseter muscle only, bilaterally (3 points in each muscle, 10 U per point), and masseter and temporal muscles (3 points in each masseter muscle and 2 points in each temporal muscle, 10 U per point). The patients were evaluated preoperatively and longitudinally at 15, 90, 120, and 180 days by the use of visual analog scales for pain and treatment satisfaction and a gnathodynamometer for bite force recording. Results The final sample included 10 participants in each group. Both groups presented mitigation of pain at 15, 90, 120, and 180 days in comparison with baseline; however, reduction in the posterior bite force was noted only at 15, 90, and 120 days. Quite high treatment satisfaction was reported from both groups at 15, 90, 120, and 180 days. No differences were observed between the groups in all evaluations and study periods. Conclusion In general, considering pain relief, reduction in bite force, and treatment satisfaction, both protocols of BTX-A seem to be somewhat equally effective in the short-term management (up to 120 days) of bruxism.
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Affiliation(s)
| | - Luiz Felipe Palma
- Department of Pathology, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | | | - Susana Morimoto
- Postgraduate Course in Dentistry, Ibirapuera University, São Paulo, SP, Brazil,Corresponding author at: Av. Interlagos, 1329 - Chácara Flora, São Paulo, SP 04661-100, Brazil.
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