CRD summary

This review concluded that although the mandibular advancement device and clonidine had shown the best results in sleep bruxism, both treatments were associated with side-effects. The authors considered the occlusal splint and clonazepam to be acceptable short-term alternatives, although they recommended further research. The reliability of the review is uncertain, owing to several methodological problems, but the authors’ recommendations for further research appear reasonable.

Authors' objectives

To compare the effectiveness of different treatments for sleep bruxism (SB) in order to determine best options for further research.

Searching

MEDLINE was searched and a recent review was also consulted, in addition to studies carried out at the Centre de Recherche du Sommeil, Hopital du Sacre Coeur, Montreal.

Study selection

Assessment of study quality

The authors did not state how validity was assessed, or how many reviewers performed the assessment.

Data extraction

The authors did not state how many reviewers performed the data extraction.

<<HOW WERE THE DATA EXTRACTED FROM PRIMARY STUDIES?>>

Where possible, the number-needed-to-treat (NNT) or number-needed-to-harm was calculated for the included studies. The SB indices (SB episode/hour) were extracted. Effect sizes were calculated for all included studies, in terms of the ratio of the mean difference between treatment and placebo of the SB index relative to the standard deviation of that difference. The power of each study was also calculated.

Methods of synthesis

Results of the review

Ten RCTs were included in the review.

The best results for oral devices were observed for the MAD, with an effect size of 1.5 and an NNT of 2.17 based on a single study. Two studies found effect sizes of 0.28 and 0.3 for palatal splints, and 2 studies found effect sizes of 0.55 and 0.58 for occlusal splints. Among the pharmacologic trials, clonidine, clonazepam and L-dopa had an effect size of greater than 0.8, whilst all other pharmacological agents had effect sizes of less than 0.3.

Authors' conclusions

Although the MAD and clonidine had shown the best results, both treatments were associated with side-effects. The authors considered that the occlusal splint and clonazepam seemed to be acceptable short-term alternatives but further research is needed.

CRD commentary

Apart from study design, inclusion criteria for this review were rather unclear. The search was limited, which means that it is more likely that some relevant studies were not included. It was unclear how many reviewers had been involved in each aspect of the review process. If one reviewer selects studies, especially if criteria are not clearly detailed, this may lead to bias and errors; this is also the case with the data extraction. The authors did not report assessing study validity, which makes an assessment of the review conclusions difficult. The narrative synthesis appears appropriate given the diversity of the treatments. However, to demonstrate the superiority of one treatment over another, direct comparisons or formal indirect comparisons are needed, rather than a comparison of effect size in relation to placebo. The reliability of the conclusions is therefore uncertain, although the authors’ recommendation for further research appears reasonable.

Implications of the review for practice and research

Practice: The authors concluded that although the MAD and clonidine had shown the best results, both treatments were associated with side-effects. They considered that the occlusal splint and clonazepam seemed to be acceptable short-term alternatives.

Research: The authors stated that further, longitudinal, large sample size RCTs in SB management are needed.

Funding

CIHR and FRSQ.

Bibliographic details

Huynh N T, Rompre P H, Montplaisir J Y, Manzini C, Okura K, Lavigne G J. Comparison of various treatments for sleep bruxism using determinants of number needed to treat and effect size. International Journal of Prosthodontics 2006; 19(5): 435-441. [PubMed: 17323720]

Indexing Status

Subject indexing assigned by NLM

MeSH

Adrenergic alpha-Agonists /therapeutic use; Clonazepam /therapeutic use; Clonidine /therapeutic use; GABA Modulators /therapeutic use; Humans; Mandibular Advancement; Occlusal Splints; Randomized Controlled Trials as Topic; Research Design; Sample Size; Sleep Bruxism /therapy

AccessionNumber

12007005214

Database entry date

09/08/2008

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.