The aetiology of bruxism is outlined and referenced, giving a clear context to the reader. Recommended treatment options are listed, with a brief summary of the evidence concerning pharmaceutical options, oral appliances, splints, psychology and physiotherapy. The author discusses a number of practical considerations in the context of treatment with botulinum toxin type A (BoNTA). The salient anatomy is described, including structures to avoid, such as risorius, depressor anguli oris, and the parotid gland. The author correctly alludes to the variation in the degree of masseteric hypertrophy from one side of the face to the other, and tailoring the dose of BoNTA accordingly. The inconsistency within current literature with reference to the most effective injection site, is discussed, but may have been more insightful for the reader to critically explore the injection techniques in relation to the anatomical considerations in more depth, for example, the variability in size of the parotid gland and why this is significant to depth and location of injection. A useful table is included, listing muscles of mastication and their actions, as well as patient information sources. In addition, the author describes reported adverse events in detail, with referenced guidance on how to avoid complications.

Bruxism: a practical guide to treatment with botulinum toxin type A.
Boxley S.
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Anna Baker

BJN Aesthetic Nurse of the Year 2016.

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