Principles for the management of bruxism

The management of bruxism has been the subject of a large number of studies. A PubMed search, using relevant MeSH terms, yielded a total of 177 papers that were published over the past 40 years. Of these papers, 135 were used for the present review. Apparently, research into bruxism management is sensitive to fashion. Interest in studying the role of occlusal interventions and oral splints in the treatment of bruxism remained more or less constant over the years: between 1966 and 2007, approximately 40-60% of the papers dealt with this subject. The percentage of papers that dealt with behavioural approaches, on the other hand, declined from > 60% in the first 2 decades (1966-1986) to only slightly > 10% in the most recent decade (1997-2007). In the latter period, > 40% of the papers studied the role of various medicines in the treatment of bruxism, while in the preceding decade (1987-1996), only approximately 5% of the studies dealt with the pharmacological management of bruxism. Unfortunately, a vast majority of the 135 papers have a too low level of evidence. Only 13% of the studies used a randomized clinical trial design, and even these trials do not yet provide clinicians with strong, evidence-based recommendations for the treatment of bruxism. Hence, there is a vast need for well-designed studies. Clinicians should be aware of this striking paucity of evidence regarding management of bruxism.