Bruxism secondary to brain injury treated with Botulinum toxin-A: a case report

Bruxism secondary to brain injury treated with Botulinum toxin-A: a case report
Published online 2006 November 23
Received July 4, 2006; Accepted November 23, 2006
Mohammed El Maaytah,1,2 Waseem Jerjes,1 Tahwinder Upile,1 Brian Swinson,1 Colin Hopper,1 and Peter Ayliffe1
Head & Face Medicine
PubMed Central

1Oral & Maxillofacial Surgery/Head & Neck Unit, University College London Hospitals, London, UK

2Division of Maxillofacial, Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, UK

Corresponding author.
Mohammed El Maaytah: elmaaytah@hotmail.com; Waseem Jerjes: waseem_wk1@yahoo.co.uk; Tahwinder Upile: mrtupile@yahoo.com; Brian Swinson: brianswinson@totalise.co.uk; Colin Hopper: c.hopper@ucl.ac.uk; Peter Ayliffe: peter.ayliffe@uclh.org

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a successful treatment of bruxism in a patient with anoxic brain injury using botulinum toxin-A (BTX-A). On examination the mouth opening was 0 mm, no feeding was possible through the mouth. Botulinum toxin was injected into the masseter and temporalis; great improvement in trismus and bruxism was noted after 3 weeks. One further treatment improved the mouth opening on the following week and the patient was discharged from our care to be reviewed when required.

Background

The term bruxism is derived from the Greek work "brychein", which means "to grind or gnash the teeth". The reported prevalence is 5 to 96% in adult populations [1-5] and 15% in children [6]. Bruxism is often noted in patients with altered states of consciousness, but its occurrence after brain injury is still unknown. Resolution of bruxism is often associated with improvement in the level of consciousness.

The appearance of bruxism has been closely linked to the return of sleep-wake cycles and improvement of level of consciousness in patients who were initially comatose [7]. To prevent dental wear, mouth guards, spasmolytic medications and relaxation therapy have been used with variable success.

In this report, we describe a successful treatment of bruxism in a patient with anoxic brain injury using botulinum toxin-A (BTX-A).

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