Management of awake bruxism: a systematic review

Awake bruxism is a masticatory muscle activity reported by approximately one in four individuals in the general population. Bruxism can have various manifestations such as tooth clenching, grinding or bracing, with different possible clinical consequences, ranging from tooth wear and fractures of dental restorations to orofacial pain related to the musculoskeletal overload. However, no official guidelines exist on the management of awake bruxism. The aim of this systematic review was to review published literature on management of awake bruxism. The review followed the PRISMA guidelines. After registration in Prospero (CRD42022351309), an electronic literature search was conducted in Medline, Embase, Scopus, LILACS, CINAHL, OpenGrey, Trip Medical, and Google on 30 August 2023 to identify articles on management of awake bruxism in participants aged 13 years and above. The electronic search was complemented with a hand search of reference lists. The review process was managed in Covidence. Two researchers independently screened titles, abstracts, and full-text articles according to the inclusion criteria which required the studies to be clinical studies involving teenagers or adults, written in English, and presented as randomized controlled trials, non-randomized controlled trials, reports or trials, or case series reports. Risk of bias was assessed using the Newcastle-Ottawa Scale, the Joanna Briggs Institute Critical Appraisal Checklist for case-series, or the RoB 2 scale, depending on study design. After screening of 4358 abstracts, 210 articles were assessed in full text and nine studies, with 165 participants, were included and summarized in a qualitative synthesis. The most common reason for exclusion was having the wrong study design. In addition, 30 articles were excluded because of not evaluating an awake bruxism population. In the included studies, most evaluated strategies fall within the broad category of cognitive behavioural therapy. The included studies, despite varying risks of bias, generally suggested positive effects of biofeedback, guided music listening, habit reversal, medication, reminder prompts, and counselling with self-management. Given the heterogeneity of included studies, meta-analysis was deemed not appropriate. The available evidence is limited but still suggests benefits of a behavioural approach to managing the frequency and consequences of awake bruxism.