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Paper text:
bruxism is a repetitive muscle activity involving the clenching or grinding of one s teeth 
 during sleep or waking hours1 .
this habit can have harmful effects on the teeth , 
 periodontium , masticatory muscles , and temporomandibular joint2,3,4 .
treatment should be directed at reducing 
 the habit through awareness of the problem and mechanical prevention to avoid wear of the 
 permanent dentition8,9,10 .
there is no consensus in 
 the literature regarding the treatment of bruxism in children10 , 11 .
clinical management 
 ranges from the use of a bite plate12 to 
 provision of information the patient and guardian , psychological techniques , and 
 medication13 . due to the divergences 
 found in the success rate of different therapeutic methods ,
there is a need for further 
 studies to offer assistance to healthcare professionals regarding the proper choice of 
 treatment14,15,16,17 .
drugs such as type a botulinum toxin , benzodiazepine , anticonvulsants , beta blockers , 
 dopamine , antidepressants , and muscle relaxers may help control bruxism , but the use of 
 these agents in children is restricted15,16,17,18 .
herbal products have been used since 
 antiquity by humans as a way to improve or recover health . since the declaration of alma - ata 
 in 1978 , the world health organization ( who ) has expressed the need to appreciate the use of 
 medicinal plants in public health systems , as some studies have indicated that almost 80% of 
 the world population uses these plants in primary care18,19,20 . according to druss
, the majority of people use medicinal plants in therapies in 
 conjunction with conventional medical treatment21 . the search for alternative products continues , and natural 
 phytochemicals isolated from plants used as traditional medicines are considered good 
 alternatives21 , 22 . from the results of these investigations , it would appear that 
 phytotherapy is a matter of great importance to the world s population , and is of interest 
 in different areas of health .
the use of these practices has also been incorporated into dentistry and numerous studies 
 have been conducted to evaluate vegetable species as natural agents that are economically 
 feasible and provide effective alternatives for treating oral , diseases22,23,24 .
lemon balm ( melissa officinalis l. ) may be employed as a natural therapy 
 due to the sedative , anxiolytic , anti - inflammatory , and anti - spasm properties of the 
 chemical constituents of the essential oil obtained from its leaves25 , 26 .
no previous 
 study has employed this substance as a complementary therapeutic method for the treatment of 
 bruxism .
the choice of melissa officinalis l was related to its properties 
 reported in the literature as well as the scarcity of studies on it in the field of 
 dentistry21 , 27,28,29,30 .
electromyographic evaluation of the masticatory muscles is currently the most widely 
 employed method for measuring muscle hyperactivity31 , 
 32 .
the bitestrip allows 
 this evaluation to be performed by the patient himself / herself through proper positioning of 
 the device on the muscle of choice .
studies have demonstrated the efficacy of the 
 bitestrip in detecting the presence / absence of bruxism33 .
thus , the aim of the present study was to evaluate 
 electromyographic signals in the temporal muscle using the bitestrip test in 
 children with sleep bruxism before and after therapy with melissa officinalis 
 l.
a randomized controlled clinical trial was carried out involving 24 children with a 
 diagnosis of bruxism .
all parents / guardians received information on the objectives and 
 procedures of the study and signed a statement of informed consent in compliance with 
 resolution 196/96 of the brazilian national board of health .
this study received approval 
 from the human research ethics committee of nove de julho university ( brazil ) under process 
 no .
bruxism was determined using the criteria established by the american academy of sleep 
 medicine33 : 1 ) parents / guardian s 
 report of the occurrence of teeth clenching and/or grinding and 2 ) incisal and/or occlusal 
 tooth wear .
group 1 ( n = 12 ) ingested a 
 tincture containing melissa officinalis l. 20% in the form of 15 drops 
 twice a day ( 1 hour after lunch and 1 hour after dinner ) for 30 days .
group 2 ( n = 12 ) 
 received a placebo solution ( water with food dye ) with the same dose and frequency as group 
 1 ( fig .
all volunteers were instructed to use a bitestrip throughout a night of sleep 
 prior to the therapy and one night following the completion of therapy . for this , the 
 caregiver was instructed on the location of the left temporal muscle and how to use the 
 device according to the manufacturer s instructions .
this device records the number of 
 contractions above 30% of the maximum voluntary contraction , which is calibrated at the time 
 of positioning .
the score is classified based on the number of events in a five - hour period 
 ( 0 = less than 30 events , 1 = 31 to 60 events , 2 = 61 to 100 events , and 3 = more than 100 
 events ) .
the sample was made up of 24 children aged 6 to 10  years ( 7.67 1.17  years ) .
boys accounted 
 for 54.2% of the sample ( n = 13 ) , and girls accounted for 45.8% of the sample ( n = 11 ) . 

there was a predominance of scores of 3 for the muscle event index ( more than 100 events ) in 
 both genders and both groups
. however , no statistically significant association was found 
 between these variables and bruxism ( table 
 1table 1.analysis of muscle activity using the bitestrip according to gender 
 and groupbitestrip score23totalgendermale5611female5813group1571225712 test ) .
the wilcoxon and mann - whitney tests were employed for statistical analysis 
 of the data ( p < 0.05 ) . a reduction in muscle events was found after both therapies . however , the wilcoxon test 
 revealed no statistically significant differences between initial and final muscle activity 
 in either group ( group 1 , p = 0.157 ; group 2 , p = 0.414 ) .
the mann - whitney test revealed no 
 statistically significant differences in intergroup comparisons at either evaluation 
 ( initial , p = 1.00 ; final , p = 0.551 ) ( table 
 2table 2.analysis of muscle activity using the bitestrip before and after 
 therapy with melissa officinalis lbitestrip score123group 1initial057final174p - value0.157group 2initial057final156p - value414intergroupinitial - final- ) .
in the past , pharmaceutical companies have been interested in investigating plants as 
 sources for new phototherapeutic agents with proven efficacy , safety , and quality .
groppo et 
 al.23 , 35 , 
 36 reported the increasing use of 
 phytotherapy in dentistry .
however , further studies are needed to evaluate the safety and 
 efficacy of this type of therapy in clinical practice .
the present findings demonstrate that use of mellissa officinalis does not alter the muscle 
 activity in children with bruxism .
although various studies have evaluated the reasons for and individual factors associated 
 with the use of herbal remedies by primary care patients , the characteristics of the 
 population that use herbal medicines for oral health problems are relatively unknown .
thus , 
 studies such as that of tomazzoni et al.37 are encouraged in dentistry because they support the inclusion of 
 phytotherapies in the brazilian public healthcare system .
the present investigation is a pioneering study regarding the possible effect of 
 melissa officinalis l on bruxism .
this substance is reported to have a 
 sedative effect and has been used as a phytotherapy in the field of dentistry34 .
studies have also investigated its 
 effects on the inhibition of dental plaque38 and the control of anxiety . in general , the literature has 
 demonstrated that melissa officinalis l may have an effect on muscle 
 contractions in certain organs .
thus , this phytotherapeutic agent was employed with the aim 
 of promoting muscle relaxation and controlling anxiety in children with bruxism . in the 
 present study , no significant difference in muscle activity was found between the lemon balm 
 group and placebo group . as this was a pilot study , investigations with a larger sample size 
 should be conducted to confirm these preliminary results . because studies with melissa officinalis l involving children are scarce , 
 the decision was made to use the minimum dose indicated , which may have limited the action 
 of the agent .
further studies with different doses are needed to determine whether 
 melissa officinalis l should be indicated for the control of this habit . 

moreover , the lack of investigations into other variables that could confirm the 
 effectiveness of this substance may have been a limitation of the present study .
as there is 
 no consensus on the proper dosage , the dose employed in this study may have exerted an 
 influence on the results .
thus , further studies that investigate anxiety and sleep quality 
 are needed to confirm the present findings .
there are no effective treatments for bruxism - only therapies aimed at controlling signs and 
 symptoms of it , such as bite plate usage , relaxation techniques , occlusal equilibrium , 
 physical therapy , and prosthetic rehabilitation .
a number of therapies are described in the 
 literature for sleep disorders , including the use of natural drugs14 , 15 , 27 . as bruxism can occur during sleep , there is a need for 
 studies on extracts from this plant , because such agents do not cause dependence , unlike 
 other drugs used for the control of bruxism , such as benzodiazepine26 .
a limitation of the present study was not having evaluated the presence of pain in the 
 subjects , which was not the objective of the investigation . however , the literature reports 
 that melissa officinalis l extract has antinociceptive action through 
 cholinergic systems , such as nicotinic and muscarinic acetylcholine receptors14 .
thus , further studies are needed to 
 determine the mechanisms of action of this phytotherapeutic agent with regard to orofacial 
 pain . based on the present
finding , use of the melissa officinalis l. tincture 
 at the dose employed did not lead to a reduction in muscle activity in children with 
 bruxism .
further studies are necessary to provide scientific evidence concerning the 
 efficacy and safety of melissa officinalis in order for it to become an 
 accessible alternative in public health services for the prevention and treatment of oral 
 health problems .
[ purpose ] bruxism is a repetitive muscle activity involving the clenching or grinding of 
 one s teeth during sleep or waking hours . 
 melissa officinalis l. may be 
 employed as a natural therapy due to the sedative , anxiolytic , anti - inflammatory , and 
 anti - spasm properties of the chemical constituents of the essential oil obtained from its 
 leaves . 
 the aim of the present study was to evaluate electromyographic signals in the 
 temporal muscle using the bitestrip test on children with sleep bruxism before 
 and after therapy with melissa officinalis l. [ subjects and methods ] the 
 subjects were randomly allocated to two groups . 
 group 1 ( n = 12 ) ingested a tincture 
 containing melissa officinalis l. for 30 days . 
 group 2 ( n = 12 ) received 
 a placebo solution with the same dose and frequency as group 1 . 
 the wilcoxon and 
 mann - whitney tests were employed for statistical analysis . 
 [ results ] the sample was made 
 up of 24 children aged 6 to 10  years . 
 no statistically significant differences were found 
 between initial and final muscle activity in either group or in an intergroup comparison . 
 
 [ conclusion ] use of the melissa officinalis l. tincture at the dose 
 employed did not lead to a reduction in muscle activity in children with bruxism .