Bruxism treatment on Youtube: evaluating reliability and information accuracy.

BACKGROUND: The aim of this study was to evaluate the content and quality of videos about bruxism treatments on YouTube, a platform frequently used by patients today to obtain information. METHODS: A YouTube search was performed using the keywords "bruxism treatment" and "teeth grinding treatment". "The sort by relevance" filter was used for both search terms and the first 150 videos were saved. A total of 139 videos that met the study criteria were included in the study. Videos were classified as poor, moderate or excellent based on a usefulness score that evaluated content quality. The modified DISCERN tool was also used to evaluate video quality. Additionally, videos were categorized according to the upload source, target audience and video type. The types of treatments mentioned in the videos and the demographic data of the videos were recorded. RESULTS: According to the usefulness score, 59% of the videos were poor-quality, 36.7% were moderate-quality and 4.3% were excellent-quality. Moderate-quality videos had a higher interaction index than excellent-quality videos (p = 0.039). The video duration of excellent-quality videos was longer than that of moderate and poor-quality videos (p = 0.024, p = 0.002). Videos with poor-quality content were found to have significantly lower DISCERN scores than videos with moderate (p < 0.001) and excellent-quality content (p = 0.008). Additionally, there was a significantly positive and moderate (r = 0.446) relationship between DISCERN scores and content usefulness scores (p < 0.001). There was only a weak positive correlation between DISCERN scores and video length (r = 0.359; p < 0.001). The videos uploaded by physiotherapists had significantly higher views per day and viewing rate than videos uploaded by medical doctors (p = 0.037), university-hospital-institute (p = 0.024) and dentists (p = 0.006). The videos uploaded by physiotherapists had notably higher number of likes and number of comments than videos uploaded by medical doctors (p = 0.023; p = 0.009, respectively), university-hospital-institute (p = 0.003; p = 0.008, respectively) and dentists (p = 0.002; p = 0.002, respectively). CONCLUSIONS: Although the majority of videos on YouTube about bruxism treatments are produced by professionals, most of the videos contain limited information, which may lead patients to debate treatment methods. Health professionals should warn patients against this potentially misleading content and direct them to reliable sources.

Effectiveness of bruxism treatment in young adults.

OBJECTIVE: Aim: This study aimed to assess the effectiveness of the developed algorithm for treatment and prevention measures aimed at eliminating clinical manifestations of bruxism in young people. PATIENTS AND METHODS: Materials and Methods: A cohort of 377 individuals aged 25 to 44 years underwent examination. Based on identified etiological factors, three distinct groups were delineated. Treatment and preventive strategies were then implemented and evaluated. Tailored treatment algorithms were devised for each group: Group one received selective grinding of supracontacts (up to 0.5-0.75 mm) and treatment for orthodontic issues utilizing removable and fixed orthodontic structures. Group two underwent finger self-massage of masticatory muscles, fabrication of biting dental splints, and anti-inflammatory drug therapy. Group three received sedative drug therapy in conjunction with psychiatric consultation, based on indications. Treatment efficacy was assessed 12 months post-initiation. Statistical analyses were conducted using Statistica 10.0 (StatSoft, Inc., USA) and Microsoft Office Excel 2010. RESULTS: Results: In cases where orthodontic pathology and supracontacts predominated (r=0.99, p<0.05), employing selective grinding and orthodontic treatment according to specific indications yielded significant efficacy. This approach resulted in a notable reduction in bruxism severity, corroborated by occludogram results 12 months post-treatment initiation. Notably, 90.0% of occludogram indicators fell within the 90-100% range, accompanied by a decrease in the BruxChecker abrasion facets area (p<0.05). Further, there was a substantial enhancement in occlusal contacts (Ck=0.68, Ck =0.71, Ck =0.93). In instances where TMJ pathology predominated with high reliability (r=0.98, p<0.05), effective normalization of masticatory muscle tone and alleviation of temporomandibular joint issues were observed. After 12 months, palpation revealed minimal tenderness in specific muscle areas and normalization of electromyography readings from initial indicators (p<0.05). Moreover, when the psycho-emotional factor primarily contributed to bruxism etiology (r=0.97, p<0.05), medical intervention proved effective. This approach led to bruxism disappearance and normalization of the psycho-emotional state within 12 months (p<0.05). CONCLUSION: Conclusions: The conducted studies provide high-confidence evidence of the effectiveness of bruxism treatment when diagnosing the prevailing etiological factor and targeting its specific impact, leading to the normalization of all other factors, a reduction in bruxism intensity, and its complete disappearance.

Benefits of the combination of digital and analogic tools as a strategy to control possible awake bruxism: A randomised clinical trial.

BACKGROUND: Awake Bruxism (AB) management includes cognitive and behavioural changes. Digital and analogic tools can be used to remind the individual to control/avoid AB behaviours. However, no study addressed both tools together. OBJECTIVE: To compare the efficacy of the combination of digital (smartphone application) and analogic (adhesive reminders) tools versus digital tool alone for AB management. METHODS: Seventy-two individuals diagnosed with probable AB were divided into 3 groups: Group 1 (n = 24), used both digital and analogic tools during 30 days; Group 2 (n = 24), used only a digital tool during 30 days and Group 3 (n = 24), used only a digital tool for the first 15 days and then added the analogic tool for 15 days. The AB frequency was measured in real-time with a smartphone app, which sent alerts asking the individuals if they were doing any AB behaviours (bracing, teeth contact, clenching or grinding). Groups were compared using one-way ANOVA and before-after adding an analogic tool (group 3) by paired t-test, considering α = 0.05. RESULTS: All groups showed a decrease in AB behaviours at the end of the evaluation period. Group 1 (digital and analogic tools) showed the lowest average of AB behaviours among all groups; however, statistically significant differences were found only for the comparison between groups 1 and 2. In group 3, a significantly greater reduction in AB behaviours was found after combining both approaches. CONCLUSION: The combination of digital and analogic tools showed the greatest reduction of AB frequency and can be recommended for AB control.

Effects of different interventions on bruxism: an overview of systematic reviews.

OBJECTIVE: This study aimed to evaluate, qualify, and summarize evidence presented in systematic reviews (SR) on treatments for bruxism. METHODS: The overview was conducted using the PICO strategy: children, adolescents, and adults with bruxism (P) were submitted to different treatments (I) compared to other treatments, placebo, or no treatment (C) in order to evaluate incidence, prevalence, and number of episodes of bruxism (O). The search was carried out in six databases and gray literature up to July 2023. Data were extracted, and the ROBS tool was used, followed by a descriptive synthesis of the results. RESULTS: A total of 31 SR were included. Sixteen showed a positive effect on episodes of bruxism (BE), while two had negative, one had neutral, and nine had inconclusive effects. Using the risk of bias in systematic reviews tool (ROBIS), risk of bias varied from low (n = 23) to high (n = 5) among the SR. Pharmacological treatment, oral rehabilitation, and other therapeutic approaches presented inconclusive or negative effects on BE, while oral appliances showed controversial effects. Biofeedback, physical therapy, laser therapy, and botulinum toxin showed positive effects on the reduction of BE. CONCLUSION: Biofeedback, physical therapy, laser therapy, and botulinum toxin showed positive effects on the reduction of BE; there is still a lack of studies to support the safe and long-term use of these therapies. REGISTRATION NUMBER: PROSPERO CRD42021273905.

Research routes on awake bruxism metrics: Implications of the updated bruxism definition and evaluation strategies.

BACKGROUND: With time, due to the poor knowledge on it epidemiology, the need to focus on awake bruxism as a complement of sleep studies emerged. OBJECTIVE: In line with a similar recent proposal for sleep bruxism (SB), defining clinically oriented research routes to implement knowledge on awake bruxism (AB) metrics is important for an enhanced comprehension of the full bruxism spectrum, that is better assessment and more efficient management. METHODS: We summarised current strategies for AB assessment and proposed a research route for improving its metrics. RESULTS: Most of the literature focuses on bruxism in general or SB in particular, whilst knowledge on AB is generally fragmental. Assessment can be based on non-instrumental or instrumental approaches. The former include self-report (questionnaires, oral history) and clinical examination, whilst the latter include electromyography (EMG) of jaw muscles during wakefulness as well as the technology-enhanced ecological momentary assesment (EMA). Phenotyping of different AB activities should be the target of a research task force. In the absence of available data on the frequency and intensity of wake-time bruxism-type masticatory muscle activity, any speculation about the identification of thresholds and criteria to identify bruxers is premature. Research routes in the field must focus on the improvement of data reliability and validity. CONCLUSIONS: Probing deeper into the study of AB metrics is a fundamental step to assist clinicians in preventing and managing the putative consequences at the individual level. The present manuscript proposes some possible research routes to advance current knowledge. At different levels, instrumentally based and subject-based information must be gathered in a universally accepted standardised approach.

Fatal Complication of Mouthguard Used to Treat Awake Bruxism in Patient with Frontotemporal Dementia.

Awake bruxism is an understudied manifestation of frontotemporal dementia, yet awake bruxism can have fatal consequences in the aging population. This report presents a patient suffering from awake bruxism associated with frontotemporal dementia being treated with a mouthguard, which ultimately becomes lodged in her posterior oropharynx leading to asphyxiation. The case highlights the need for investigation into the occurrence and treatment of awake bruxism among patients with dementia, and the unique risk-benefit analysis that must be performed to develop proper treatment plans for patients with dementia.

Attitude of Italian dental practitioners toward bruxism assessment and management: A survey-based study.

INTRODUCTION: Bruxism is a spectrum of masticatory muscles activities. According to the recent evidence and international consensus, there is no indication to treat bruxism unless clinical consequences are present. The aim of the present study was to investigate the approach of Italian dentists to bruxism in their clinical practice. METHODS: An anonymous online survey was developed, composed by 26 items grouped into five sections: (1) Characteristics of the respondent (Q1-Q6); (2) Bruxism frequencies (Q7-Q11); (3) Bruxism assessment (Q12-Q15); (4) Bruxism management (Q16-Q20); (5) Occlusal splints therapy (Q21-Q26). RESULTS: A total of 384 practitioners, including specialists and non-specialists, participated in this survey. The majority of the respondents reported that 1-3 out of ten patients presented with bruxism. The diagnosis is mainly performed with non-instrumental methods, and facial pain and dental wear are the major clinical consequence associated with bruxism. Almost the entire sample of respondents report to offer occlusal splints to bruxism patients, and 41% refer to perform occlusal adjustments. Almost half of the respondents have never proposed any form of cognitive-behavioural therapy. CONCLUSION: The results of the current survey highlighted several inconsistencies in Italian dentists' approaches to bruxism, suggesting the need for better education of practitioners and for the development of a standardized protocol to assess and manage bruxism in dental practices.

Awake bruxism in temporomandibular disorders patients referred to tertiary care: A retrospective study on its assessment and TMD management.

BACKGROUND: Bruxism is defined as a repetitive jaw-muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can occur during sleep (sleep bruxism, SB) or during wakefulness (awake bruxism, AB). To date, the effect of AB on the purported negative consequences of bruxism has remained unclear. OBJECTIVES: The assessment of AB, its relation to temporomandibular disorders (TMD) treatment modalities, and their possible outcomes were investigated among TMD patients resistant to treatment in primary care and referred to a tertiary care clinic. METHODS: The records of 115 patients were studied. Patients were referred to the Head and Neck Centre, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, for TMD treatment between 2017 and 2020. The data derived from the eligible patients' records included the following: background data (age and sex), referral data (reason and previous treatment), medical background (somatic and psychiatric), clinical and possible radiological diagnoses at a tertiary care clinic, treatment modalities for masticatory muscle myalgia, bruxism assessment, its possible treatment modalities and their outcomes, and overall management outcome. We analysed the outcomes of single treatment modalities and combined groups of modalities. For the demographic data, the Chi-squared test and Fischer's Exact test were used to determine the associations between the categorical variables. A Sankey-diagram was used to describe the flow of treatment. RESULTS: Temporomandibular joint-pain-dysfunction syndrome (K07.60) was the most frequent single reason to refer a patient to tertiary care (17.4%). At referral, men had myalgia (M79.1) significantly more often (p = .034) than women. Similarly, men had depression (p = .002) more often and other psychiatric diagnoses (p = .034). At tertiary care, the presence of AB was assessed in 53.9%, and self-reported AB was recorded in 48.7%. In patients with possible AB, those who were prescribed neuropathic pain medication showed significantly less improvement in symptoms (p = .021) than those who underwent splint therapy (p = .009). Overall, half of the patients showed overall improvement in their TMD symptoms from the treatment combinations. CONCLUSION: Despite several treatment modalities, only half of the patients showed improvement in their symptoms in the present study. A standardised assessment method encompassing all factors contributing to bruxism behaviours and their consequences is suggested.

[Clinical efficiency of occlusive splints in the treatment of patients with temporomandibular joint dysfunction complicated by bruxism]. / Klinicheskaya effektivnost' okklyuzionnykh shin v lechenii patsientov s disfunktsiei visochno-nizhnechelyustnogo sustava, oslozhnennoi bruksizmom.

OBJECTIVE: Improving the effectiveness of treatment of patients with temporomandibular joint (TMJ) dysfunction complicated by bruxism. MATERIAL AND METHODS: 70 patients with signs of parafunction of the masticatory muscles were selected for the clinical study. The patients were divided into 2 groups of 35 people. Splints were made for patients from the groups using 2 different 3D printing methods. The treatment was monitored using clinical and instrumental studies, electromyography of the muscles themselves and computed tomography of the TMJ after 3, 6 and 12 months. RESULTS: The severity of hypertonicity of the masticatory muscles decreased by the end of 3 months of treatment with the help of repositioning occlusal splints. After 6 months of treatment, the mean BEA decreased in both study groups, but to a lesser extent than in the first 3 months. After wearing a splint after 12 months, the decrease in muscle tone was insignificant. CONCLUSION: The clinical use of positioning splints plays a crucial role in the stabilization of occlusion and is a mandatory stage of complex treatment of patients with pathology of the occlusal-musculoskeletal complex.

3D Printing of Thermoflexible Therapeutic Splints: Treating Bruxism More Comfortably.

Three-dimensional (3D) printing has helped drive rapid and abundant growth in the field of digital dentistry and has been largely spurred on by the development of material innovation. Thermoflexible occlusal splints represent a recent innovation in this area, as they feature a remarkably elastic behavior. Now, practitioners can provide patients with a comfortable, soft, class II medical device generated through a simple digital workflow. This article presents a case report that demonstrates the management of temporomandibular joint disorders by means of a flexible 3D-printed splint. Providing the patient relative comfort while wearing the splint to prevent the negative effects of bruxism helped enhance patient acceptance and compliance. The simple, non-invasive splint fabrication described in this report can be performed by any clinicians willing to incorporate occlusal devices into their digital workflow.

Bruxism in children: What do we know? Narrative Review of the current evidence.

BACKGROUND: Bruxism is a repetitive masticatory muscles activity whose definition is being thoroughly reviewed in recent years. As in adults, two different forms of bruxism exist in children, namely awake and sleep bruxism. Scarcity of data, however,still persists about paediatric bruxism and no clear consensus has been developed. Therefore, the current review overviews the literature on bruxism in children tries to outline the state of art about this condition METHODS: Bruxism affects from 5% to 50% of the worldwide paediatric population. Sleep disturbances, parafunctional habits and psycho-social factors emerged to be the most likely associated factors with paediatric bruxism. Bruxism is characterised by several signs and symptoms variously combined, such as tooth wear and fractures, teeth impressions on soft tissues, temporomandibular disorders, headaches, behavioural and sleep disorders. About diagnosis, the most reliable tool in children remains the report of teeth grinding by parents or caregivers which must be accompanied by oral interview and accurate clinical examination. Electromyography and sleep polysomnography, albeit suitable in the diagnostic process, are not easy-to-use in children and are not strongly recommended. Currently, no evidence exists to support any kind of therapeutic options for bruxism in children. Management should be based on the identification of the underlying condition and conservative approaches are recommendable. CONCLUSION: Notwithstanding the high prevalence, several aspects need to be further assessed in paediatric bruxism. Parental reports are still the most suitable diagnostic tool and conservative approaches are recommended in the management. Bruxism should be considered through a biopsychosocial model, and sleep, personality traits, stress and headaches are the factors towards whom research questions must be addressed to improve diagnosis and management.

Neuromuscular and occlusion analysis to evaluate the efficacy of three splints on patients with bruxism.

OBJECTIVE: Occlusal splints are always applied on individuals with bruxism to reduce tooth wear and relieve orofacial symptoms such as myofascial pain. The stomatognathic system is mainly composed of tooth, occlusion, masticatory muscles, and temporomandibular joint. The occlusion and masticatory muscles function are regarded as the important parameters for evaluating the stomatognathic system state objectively. However, the effects of occlusal splints on individuals with bruxism is rarely elucidated from accurate neuromuscular analysis and occlusion evaluation. The aim of the present study was to estimate the effects of three different splints (two clinically common full coverage occlusal splint and an modified anterior splint) on subjects with bruxism using K7-J5 neuromuscular analysis system and Dental Prescale II (DP2) to evaluate occlusion. METHODS: Sixteen subjects claimed to be suffering from nocturnal bruxism,with complete dentition and stable occlusal relationship, were selected for study.The intermaxillary space and the baselines of EMG-activity of the anterior temporalis and masseter were recorded for all the subjects. The participants was treated with three different splints, and outcomes were estimated by comfort index, occlusion and surface electromyography of anterior temporalis and masseter. RESULTS: At teeth clenched position, EMG data were significantly lower in the participants with use of modified anterior splint than with hard, soft occlusal splint or without splint (p < 0.05). The maximum bite force and bite area occur in subjects without use of splint, while the minimal occur in subjects with use of modified anterior splint. Intermaxillary space increased and masticatory muscles presented significant reduction of EMG data at rest position as a result of J5 (p < 0.05). CONCLUSION: Modified anterior splint seems to be more comfortable and effective in reducing occlusion force and electromyographic activity of anterior temporalis and masseter for subjects with bruxism.

Effectiveness of Biofeedback in Individuals with Awake Bruxism Compared to Other Types of Treatment: A Systematic Review.

Excessive masticatory muscle activity is generally present in awake bruxism, which is related to increased anxiety and stress. It has been hypothesized that biofeedback could potentially manage awake bruxism, however, its effectiveness has not been empirically analyzed in a systematic manner. Therefore, this systematic review was designed to determine the effectiveness of biofeedback compared to other therapies in adults with awake bruxism. Extensive searches in five databases looking for randomized controlled trials (RCTs) that included biofeedback to manage awake bruxism were targeted. The risk of bias (RoB) assessment was conducted using the Cochrane RoB-2 tool. Overall, four studies were included in this systematic review, all of which used the electromyographic activity of the masticatory muscles during the day and night as the main endpoint. Auditory and visual biofeedback could reduce the excessive level of masticatory muscle activity in a few days of intervention. The majority of the included studies had a high RoB and only one study had a low RoB. The standardization of the biofeedback protocols was also inconsistent, which makes it difficult to establish the ideal protocol for the use of biofeedback in awake bruxism. Thus, it is proposed that future studies seek to reduce methodological risks and obtain more robust samples.

Ultrasonographic and electromyographic evaluation of three types of occlusal splints on masticatory muscle activity, thickness, and length in patients with bruxism.

OBJECTIVE: To evaluate occlusal splint type differences in patients with bruxism. METHODS: Seventeen controls and 51 patients were divided into three subgroups, each assigned to use a different occlusal splint (hard, soft, or semi-soft) for 3 months and assessed by ultrasonography and electromyography (EMG) before (BT) and 3 months after treatment (AT). RESULTS: EMG values in all of the occlusal splint groups were significantly lower AT than BT (p < 0.05). BT and AT EMG values in the control group did not differ. Mean muscle thicknesses in bruxism patients was greater than in controls, and the greatest muscle thickness changes occurred with the hard occlusal splint (p < 0.05). DISCUSSION: A decrease in EMG activity occurred with all three splint types and was most prominent in the hard occlusal splint group. Ultrasonographic measurements of muscle length and thickness should be used alongside EMG to measure muscle activity in bruxism patients.

Common therapeutic approaches in sleep and awake bruxism - an overview.

Bruxism, a common medical condition characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible, can occur during sleep, when it is known as sleep bruxism (SB), or during wakefulness, when it is known as awake bruxism (AB). Although bruxism often causes headaches, temporomandibular joint pain, masticatory muscle pain, mechanical tooth wear, prosthodontic complications and cracked teeth, there is still not enough data to define and support a standardised approach to its treatment. The aim of this review was to present the pathophysiology, consequences, types and treatment methods of bruxism in order to increase readers' knowledge of this topic. Differences between awake and nocturnal bruxism are included, as well as risk factors and indicators visible during the clinical examination of affected patients. Among the causes we consider are genetics, stress, oral parafunctions and changes in the Central Nervous System (CNS). Potential and common methods of treatment are presented, along with suggested guidelines that should be followed when determining an appropriate treatment method. We draw attention to the notably dynamic development of bruxism in today's society and the importance of informational and preventive projects, especially those targeted at high-risk patients as well as those targeted at specialists, in order to better tackle the bruxism 'epidemic'.

Masseter Muscle Thickness And Elasticity in Bruxism After Exercise Treatment: A Comparison Trial.

OBJECTIVE: The purpose of this study was to evaluate the effects of Rocabado's 6 × 6 exercises on masseter muscle thickness, muscle elasticity, and pain scores in patients with bruxism. METHODS: A total of 58 participants with bruxism were divided into 2 groups as the exercise group (EG) and control group (CG). A self-care program was applied for the participants in the CG. For those in the EG, in addition to the self-care program, an exercise treatment was performed for 6 days per week for a total of 8 weeks. Using ultrasonography, bilateral masseter muscle thickness and elasticity were assessed before and after treatment. Pain was measured using a visual analog scale. Changes over time within the groups and group-time interactions for continuous variables were assessed using mixed 2-way repeated measures analysis of variance. RESULTS: The improvement in muscle elasticity (P = .015; P = .004) and pain values (P = .049; P = .040) were greater in the EG compared with the CG. There was no significant difference between the 2 groups for masseter muscle thickness (P > .05). CONCLUSION: This study suggests that Rocabado's 6 × 6 exercises are effective in the treatment of muscle elasticity and pain values in participants with bruxism.

The dental demolition derby: bruxism and its impact - part 2: early management of bruxism.

Bruxism is a term that encompasses a range of presentations of rhythmic and repetitive muscular activity. For many, this is not a significant problem but for some, the behaviour leads to significant problems and extensive tissue damage. This is different to temporomandibular disorders. This paper will review methods of managing cases where bruxism is destructive, or potentially destructive, before needing to resort to full reconstruction.

The dental demolition derby: bruxism and its impact - part 1: background.

Bruxism may lead to changes or damage to the oral and perioral tissues. Bruxism may occur during sleep or when awake. Many patients will not require active management; however, for some, intervention is required. Control of bruxism may be difficult, if not impossible, but the need exists for preservation of the dentition and quality of life. A prediction of risk to the tissues for the planning of interventions is difficult and relies upon evidence of past damage and assessment of future risks. Treatment options may need to be imaginative and rescuable. This series of papers will review the aetiology of bruxism, its impacts and treatment strategies for persistent bruxers who are at risk of, or suffering, tissue damage.

Apical periodontitis after intense bruxism.

BACKGROUND: Bruxism is known to cause masticatory muscle pain, temporomandibular joint pain, headaches, mechanical tooth wear, prosthodontic complications and cracked teeth. Less known to the practitioner, and described only experimentally in literature, is that bruxism can also damage the pulp. To our knowledge, this is the first known clinical case of a patient developing apical periodontitis due to bruxism. CASE PRESENTATION: This article presents the case and successful treatment of a 28-year-old healthy male patient with apical periodontitis on teeth 36 and 46 requiring root canal treatment after an intense phase of bruxism. Due to an unclear diagnosis, treatment had been delayed. CONCLUSIONS: Incomprehensible tooth pain can be the result of bruxism. Practitioners need to be informed that intense bruxism can possibly lead to apical periodontitis. It is important, therefore, that a thorough anamnesis is collected and taken into account during diagnostics.

Short-term Effects of a First-Line Treatment Including Counseling and Self-Management Strategies on Chronic TMD Muscle Pain and Awake Bruxism in Women.

AIMS: To evaluate the short-term effects of a standardized first-line noninvasive approach (FL-A) including counseling and self-management strategies on pain, masticatory muscle tenderness, and awake bruxism in women with chronic temporomandibular disorder myalgia (mTMD) and to test whether patients' trait anxiety predicted their response to treatment. METHODS: FL-A was administered to 14 women with chronic mTMD (mean age ± SD = 33.8 ± 11.1 years; 8 with Graded Chronic Pain Scale [GCPS] grade I and 6 with grade II). Its effects on facial pain, masticatory muscle tenderness, and spontaneous awake bruxism episodes were evaluated using questionnaires, surface electromyography, and quantitative sensory testing. General linear models were used to test FL-A efficacy after 1 (T1) and 2 (T2) months. RESULTS: FL-A reduced pain (from baseline [T0] to T2, P = .010), the frequency of awake bruxism episodes (T0 to T1, P = .024), and their intensity by about 30% (T0 to T1, P < .001). Pressure pain thresholds at the masticatory muscle locations increased significantly from T0 to T2 (P < .001). Patients' trait anxiety decreased significantly from T0 to T2 (P = .030). Trait anxiety measured at baseline was not correlated with relative changes in pain (T0 to T2, P = .248). CONCLUSION: In the short term, FL-A reduces facial pain, masticatory muscle tenderness, and awake bruxism in women with chronic mTMD with low disability. A conservative management strategy should be prioritized for the initial management of these patients.