Floral Remedies for Sleep-bruxism Patients
Floral Remedies for Sleep-bruxism Patients
Introduction: Bruxism is a parafunctional habit that affects the stomatognathic system and
 its support structures. Usually associated with stress and mostly occurring at night, bruxism
 leads to sleep disorders and daily tension headaches. Aiming to rebalance the emotional and
 physical state of patients, floral-essence therapy lacks side effects or drug interactions,
 and has been recognized by the World Health Organization. Aim and Methods: The investigators
 created a buccal-relaxant formula, combining 8 floral essences and testing it in a
 double-blind clinical assay conducted in bruxism patients. Results: An alcohol solution of
 the buccal relaxant containing Daughter of Gaia floral essences of Taraxacum officinale,
 Antirrhinum majus, Fuchsia × hybrida, Bidens bipinnata, Campanula carpatica, Achyrocline,
 Nymphaea caerulea, and Tetraoensis riparia significantly attenuated temporal headaches in the
 bruxism patients compared to the placebo group (69.46%±1.79 versus 3.55%±1.37, P=0.0001).
 Moreover, patients after 21 days using the buccal relaxant increased their quality of sleep
 and experienced attenuated jaw-muscle rigidity or morning mouth-opening difficulties. Less
 masseter hypertrophy and reduced sensitivity due to abfraction of enamel facets were noted as
 well. Conclusions: The buccal-relaxant formula may have sedative properties, preventing daily
 temporal headaches in sleep-bruxism patients, suggesting a muscle-relaxation effect. Although
 the results are promising, long-term studies are needed to clarify the pharmacological
 mechanism of each floral essence in the buccal-relaxant formula and their tolerance effects.
Bruxism is consensually defined as a repetitive jaw-muscle activity, characterized by the
 clenching or grinding of the teeth and by the bracing or thrusting of the mandible.
 Considered a common parafunctional activity, its symptoms include hypersensitive teeth,
 aching jaw muscles, headaches, tooth wear, damage to dental restorations (e.g. crowns and
 fillings) and damage to teeth20. Within the several types of bruxism, sleep bruxism mostly
 occurs during periods of sleep arousal and tends to worsen during the day4,10.

 Headache is the most frequent onset complaint evolving in the course of the bruxism
 parafunction. Functional disorders of chewing, speaking, and swallowing may occur, especially
 when bruxism is associated with temporal mandibular disorders3,19. Despite many published
 studies and reviews, there is no consensus about the treatment of bruxism11. Most of the
 approaches focus on preventing the progression of dental wear or on reducing the
 tooth-grinding sounds. Recently, botulinum toxin19, relaxant drugs, and bite plates for
 controlling the muscle discomfort2 were reviewed21. Considering the impact of stress on
 episodes of bruxism, any complementary therapy to aid in relaxation and in controlling
 distressing thoughts in bruxism patients is welcome. Floral remedies address the rebalancing
 of patients' emotional status, rather than prioritizing the healing of the disease
 itself1,6,8,14.

 Knowing that floral therapies are recognized by the World Health Organization (WHO) as an
 alternative treatment, and are known in Brazilian medicine and dentistry for their lack of
 side effects and low cost5,9, the investigators hypothesized that a floral-formulation
 therapy could reduce temporal cephalic pain in sleep-bruxism patients.

 Materials and methods

 A randomized, double-blind, non-gender-specific study was conducted with 74 patients seen in
 the Temporal Mandibular Disorders clinic of the Odontology Faculty of Universe University.
 Following physical examinations, 60 patients were randomly allocated to 2 groups of 30
 patients each, who had been diagnosed with sleep bruxism. Each patient received a small amber
 glass bottle containing the floral remedy or placebo, and was instructed to use four drops
 sublingually 4 times a day for 22 days. All examiners were different professionals, with no
 contact among each other, as follows: an examiner who conducted the physical examination, an
 examiner who randomly divided the patients, and an examiner who prepared the floral and
 placebo remedies. At the end of the study, each group of 30 patients was re-named: Group F,
 the group of patients who received the floral remedy; and Group P, the group of patients who
 received the placebo as treatment.

 Pain and sleep-quality assessment Pain was evaluated twice, in the beginning and after 21
 days of the treatment. Pain was scored using the visual analogue scale (VAS) described by
 Huskisson6 (1974) and modified by Finkel12.

 Patients, holding the VAS, were asked to point to the face/score number that indicated the
 level of his or her pain. Pain level was measured as follows: No pain or the absence of any
 discomfort, scored as 0 (zero); mild pain, scored from 1 to 3; moderate pain, scored as 4, 5,
 6 or 7; and severe pain, scored as 8, 9 or 10. A second question regarding sleep quality of
 the patients was answered after 21 days of the buccal-relaxant and placebo treatments. All
 results were recorded in each patient's folder, under restricted access.
Inclusion Criteria:

 Shear noise and/or tooth-grinding, confirmed by a room companion or family member.

 Observation of wear facets on the tooth surfaces, incompatible with age and function.

 Presence of two or more symptoms, such as headache in the temporal region, rigid jaw
 muscles or fatigue at night or upon awakening, locking or difficulty in opening the mouth
 in the morning, dental hypersensitivity, hypertrophy of the masseter muscles.

 Exclusion Criteria:

 Currently in treatment for bruxism, through the use of an interocclusal stabilization
 splint.

 Patients with alcoholism. Patients who make use of medications that affect episodes of
 bruxism, such as analgesics, anti-inflammatories, muscle relaxants, amphetamines, and
 inhibitors of serotonin reuptake.