Comparison of the effectiveness of botulinum toxin, dry needling, pharmacological treatment, and manual therapy for bruxism-induced myalgia: a prospective randomized study

Bruxism is a significant phenomenon that should not be underestimated, given its prevalence and consequences. The major symptoms associated with bruxism include myalgia, decreased quality of life, and limited mandibular movements. This study aimed to evaluate and compare the effectiveness of four treatment methods for managing bruxism-related symptoms: botulinum toxin (BoNT-A), dry needling (DN), pharmacological therapy (PT), and manual therapy (MT). Eighty patients with bruxism (44 female, 36 male) were randomly assigned to four groups of 20 patients each. All therapies were administered by the same maxillofacial surgeon. Measurements were recorded at baseline (pre-treatment) and at 2, 4 and 12 weeks post-treatment. The metrics assessed included the visual analog scale (VAS) for pain, maximum painless mouth opening (MMO), and the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Statistical analysis was performed using a mixed-design repeated measures two-way analysis of variance (ANOVA) to compare changes within and among the groups over time. Tukey's multiple comparison test was applied for further analysis. The results indicated that both objective and subjective clinical outcomes were similar across all treatment groups. Considering their competitive efficiency, non-invasiveness or minimal invasiveness, and cost-effectiveness, DN, MT and PT appear to be promising alternatives for managing bruxism and its symptoms, especially in the early stages.