BackgroundIntramuscular injections of botulinum toxin A (BTX-A) have been used in the treatment of sleep bruxism (SB) however controlled trials are limited and the optimal injection strategy and dose is not known.MethodsThis double-blind, randomised, placebo-controlled, cross-over study evaluated the efficacy and safety of BTX-A in participants with SB. Average bruxism events per hour of sleep (Bruxism Index, BI) was calculated using surface electromyography. Participants with BI >5 were included and randomised by order of injection (active or placebo with the opposite 20 weeks later) and into one of three differing treatment groups: bilateral masseter (60 units(U)), bilateral masseter and temporalis (90U) and bilateral masseter, temporalis and medial pterygoid muscles (120U). Change in BI and subjective measures of headache, pain, and bruxism at 4 and 12 weeks was calculated following intervention, and differences between treatment groups analysed.Results41 participants were recruited, 35 randomised and data from 22 participants (14 female) were analysed. BI was significantly lower at 4 weeks after active treatment when compared with placebo (mean=−1.66, p=0.003), not sustained at 12 weeks. The difference was greater with higher doses injected and among those with greater baseline BI. There was no difference in subjective measures at any time point. Five participants injected had mild, transient side effects.DiscussionTargeted BTX-A injection is a safe and effective treatment for SB. A greater benefit may be achieved by administering BTX-A into more muscles and at higher total doses and among those with higher baseline BI.Trial registration numberACTRN12618001430224.

The shift of the juvenile justice system from its initial rehabilitative ideal toward a more punitive orientation highlights the need to systematically document key elements of the juvenile drug court model. In particular, it is important to clearly document the role of the juvenile court judge because he or she is considered vital to this program model. The current study used participant observation as well as confidential questionnaires on which youth shared their perceptions of the judge. Findings show the judge‐participant interactions typically were brief, varied by the participants' level of compliance with the program, and that sanctions were given twice as often as rewards. Youth perceived the judge to be fair, respectful, and concerned about their lives. Discussion focuses on the significant opportunity that juvenile drug court judges have for positively influencing the lives of drug‐involved youth.

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