To summarize the evidence and explore the effectiveness of physiotherapy for adults with awake and sleep bruxism who present pain and tenderness as symptoms.
This review was registered in PROSPERO (CRD42021251182). The search was conducted on five databases, limited to randomized clinical trials (RCT) and clinical trials (CT), but not limited to date or language focusing on adulty with any type of bruxism. Two independent reviewers performed all study phases. The risk of bias (RoB) was assessed with the Cochrane RoB Tool-2. Data synthesis was performed based on the bruxism diagnosis (e.g., sleep bruxism, awake bruxism, sleep and awake bruxism, bruxism associated with other conditions), type of intervention, and outcome type. The certainty of the evidence was evaluated using the GRADE approach.
Electronic searches identified 1,745 studies, but only 13 met the inclusion criteria. Five studies included individuals with sleep bruxism (38.5%); two (15.4%) studies, awake and sleep bruxism together; three (23.1%) studies, bruxism without providing a precise diagnosis; two (15.4%) studies, sleep bruxism combined with TMD; and one study (7.7%), had a doubtful diagnosis associated with TMD. For individuals with awake and sleep bruxism, no differences were verified between manual therapy (MT) and MT plus kinesio tape (KT) regarding pain and tenderness. For individuals with sleep bruxism alone, massage plus occlusal splint (OS) was better than massage alone for relieving pain; however, KT did not differ from OS on pain or tenderness. Subjects with sleep bruxism treated with stretching and sleep hygiene advice had less tenderness after treatment than those receiving only sleep hygiene advice. For patients with sleep bruxism combined with TMD, no differences were verified between transcutaneous electrical nerve stimulator (TENS) and OS to relieve pain. However, OS presented better results on tenderness of the masticatory muscles than TENS. Individuals classified as having doubtful diagnoses of bruxism who received microcurrent electrical neuromuscular stimulation (MENS) treatment had significantly better pain and tenderness reduction than those receiving TENS treatment. Most studies (n=10, 76.9%) were considered to have a high RoB; three (23.1%) studies had some concerns. The quality/certainty of the overall evidence was very low.
This review showed positive benefits in subjects with sleep bruxism to manage pain and tenderness when muscle stretching, and MT were combined with other techniques (e.g., OS). This systematic review demonstrates limited evidence of physiotherapy to manage symptoms present in subjects with bruxism (specifically by diagnosis).
Since the evidence is limited and the certainty in the results is very low, we recommend that clinicians use combined approaches (massage therapy and OS as well as MT for the masticatory muscles combined with KT) to manage symptoms in individual with bruxism.
Physiotherapy treatment
Pain
