Which One is Effective in Treatment of Bruxism? Occlusal Splints or Botulinum Toxin

A number of 173 patients were examined for myofascial pain due to TMD in the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University between April-August 2018. An informed consent was taken from all the patients after obtaining Institutional Ethical Committee approval. The study was performed in accordance with the Helsinki Declaration and all participants signed an informed consent agreement. Patients were included in this randomized, blinded, prospective study accordance with the Consolidated Standards of Reporting Trials (CONSORT) statement and the study was performed by blinded three examiners.

Patients older than 18 years with chronic myofascial pain, more than 6 months with myofascial pain, diagnosis of myofascial pain according to the Research Diagnostic Criteria (RDC) of TMD were included to the study. Patients having intracapsular TMD (disc displacement with or without reduction), a history of any treatment for bruxism, patients taking aminoglycosides, penicillamine, quinine and calcium blockers, pregnant or lactating mothers, having neuromuscular disorder (e.g. Orofacial tardive dyskinesia, Lambert-Eaton Syndrome, Myasthenia gravis), having rheumatoid arthritis, having temporomandibular joint osteoarthrosis with radiographic signs, history of previous joint surgery, patients who had undergone botulinum toxin (BTX) treatment before or an allergy to BTX-A were excluded from the study.

The patients who have myofascial pain were diagnosed and examined with using RDC/TMD diagnostic categories I in the RDC/ TMD by first examiner (M.E.Y) and 102 patients fulfilled inclusion criteria. 8 patients did not agree to participate. 94 patients were allocated to 3 groups according to a computer-generated randomization code. Block randomization was done. Patient groups were as follows:

Group A was treated with occlusal splint Group B was treated with botulinum toxin injection, Group C was treated with occlusal splint and botulinum toxin injection together Visual Analog Scale (VAS), TMD Pain Screener(TMD-PS), Graded Chronic Pain Scale (GCPS), Oral Behavior Checklist (OBC), Jaw Function Limitation Scale (JFLS) were administered to all patients before treatment and at 6th months after treatment by third examiner (K.T.S). Patients' pain was examined by palpation of the chewing muscles and the pain was marked from 0 to 10 on the VAS before and after the treatment.

Questionnaires TMD Pain Screener is a self-report, simple, reliable questionnaire used to assess for the presence of any pain-related TMD. Full version with 6 questions were applied. The total score is between 0 and 7. If the total score is between 0 and 3 points, there is no TMD. If the total score is between 4 and 7, there is TMD.