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Lobbezoo F, van der Zaag J et al. J Oral Rehabil 2008; 35: 509–523

Despite 'at least $1 billion per year' spent in the USA on the fabrication of mouth guards, the authors were only able to identify less than 20 randomised control studies investigating all treatment approaches for bruxism. During the past decade, well-designed studies using pharmacological approaches have been carried out. The drugs include muscle relaxants and other agents that have effects at the neuromuscular junction. This current strategy has replaced behavioural methods such as group therapy using habit retraining. With regard to occlusal approaches the authors state that there is '...no support in the literature for... equilibration, rehabilitation and orthodontic alignment for the management of bruxism'. In addition, there is no evidence 'for the long term efficacy or safety' of the new chair-side fabricated appliances such as NTI. The authors conclude, 'in the absence of definitive evidence, bruxism is best managed using the triple-P approach – plates, pep talks and pills'.