Drugs and Bruxism: A Critical Review

Aims: Bruxism associated with drugs can be destructive, resulting in severe consequences to health that include destruction of tooth structure, irreversible harm to the temporomandibular joint, severe myofascial pain, and muscle contraction headache. However, reports concerning a possible association between brux-ism and various pharmacologic drugs are scarce and mostly anec-dotal. The purpose of this article was to review the existing litera-ture concerning the exacerbating or ameliorating effect of drugs on bruxism in humans. Methods: A search of the MEDLINE, EMBASE, and PsicINFO databases from 1982 to 2001 was con-ducted, and the term bruxism and one of the following terms were used: drugs, medicine(s), pharmaceutical, movement disorders, akathisia, dyskinesia, dystonia, central or autonomic nervous sys-tem, dopamine, serotonin, and GABA. Furthermore, a search using the term bruxism was carried out on the weekly journal Reactions, which deals with side effects of drugs. Several chemical terms were searched separately (eg, caffeine, nicotine). Relevant information was also derived from reference lists of the retrieved publications. Results: The search yielded complex information referring to the association between bruxism and dopamine-related drugs, antidepressant drugs, sedative and anxiolytic drugs, and drugs of abuse. Conclusion: There is insufficient evidence-based data to draw definite conclusions concerning the effects of various drugs on bruxism. Although certain substances related to the dopaminergic, serotonergic, and adrenergic systems suppress or exacerbate bruxist activity in humans and animals, the litera-ture is still controversial, and based mostly on anecdotal case reports. More controlled, evidence-based research on this under-explored subject is needed.

bruxism; medication(s); drug(s); dopamine; serotonin; GABA; SSRI

1. Wirshing WC. Movement disorders associated with neuroleptic treatment. J Clin Psychiatry 2001;62(22, suppl):15–18.

2. Allen RP, Earley CJ. Restless legs syndrome: A review of clinical and pathophysiologic features. J Clin Neurophysiol 2001;18:128–147.

3. McNeill C (ed). Temporomandibular Disorders: Guidelines for Classification, Assessment, and Management. The American Academy of Orofacial Pain. Chicago: Quintessence, 1993.

4. Kato T, Montplaisir JY, Blanchet PJ, Lund JP, Lavigne GL. Idiopathic myoclonus in the oromandibular region during sleep: A possible source of confusion in sleep brux-ism diagnosis. Mov Disord 1999;14:865–871.

5. Vertrugo R, Provini F, Plazzi G, et al. Familial nocturnal faciomandibular myoclonus mimicking sleep bruxism. Neurology 2002;58:644–647.

6. Velly-Miguel AM, Montplaisir JY, Rompre PH, Lund JP, Lavigne GL. Bruxism and other orofacial movements during sleep. J Craniomandib Disord 1992;6:71–81.

7. Lavigne GJ, Montplaisir JV. Bruxism: Epidemiology, diagnosis, pathophysiology, and pharmacology. In: Fricton JR, Dubner R (eds). Orofacial and Temporomandibular Disorders. New York: Raven Press, 1995:387–404.

8. Lobbezoo F, Naeije M. Bruxism is mainly regulated centrally not peripherally. J Oral Rehabil 2001;28: 1085–1091.

9. Pierce CJ, Chrisman K, Bennett ME, Close JM. Stress, anticipatory stress, and psychologic measures related to bruxism. J Orofac Pain 1995;9:51–56.

10. Pingitore G, Chrobac V, Petrie J. The social and psychological factors of bruxism. J Prosthet Dent 1991;65: 443–446.

11. Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism in the general population. Chest 2001;119: 53–61.

12. Winocur E, Gavish A, Volfin G, Halachmi M, Gazit E. Oral motor parafunctions among heavy drug addicts and their effects on signs and symptoms of temporomandibular disorders. J Orofac Pain 2001;15:56–63.

13. Rugh JD, Harlan J. Nocturnal bruxism and temporo-mandibular disorders. In: Jankovic J, Tolosa E (eds). Advances in Neurology, Vol 49: Facial Dyskinesias. New York: Raven Press, 1988:329–341.

14. Gatchel RJ. Psychological disorders and chronic pain: Cause-and-effect relationships. In: Gatchel RJ, Turk DC (eds). Psychological Approaches to Pain Management: A Practitioner’s Handbook. New York, London: The Guilford Press, 1996:33–54.

15. Fitzgerald K, Healy D. Dystonias and dyskinesias of the jaw associated with the use of SSRIs. Hum Psychopharmacology 1995;10:215–219.

16. Shiwach RS, Woods S. Risperidol and withdrawal brux-ism in Lewy body dementia. Int J Geriatr Psychiatry 1998;13:64–67.

17. Bostwick JM, Jaffee MS. Buspirone as an antidote to SSRI-induced bruxism. J Clin Psychiatry 1999;60: 857–860.

18. Jaffee MS, Bostwick JM. Buspirone as an antidote to venlafaxine-induced bruxism. Psychosomatics 2000;41: 535–536.

19. Koshikawa N, Koshikawa F, Tomiyana T, Kikuchi de Beltran K, Kamimura F, Kobayashi M. Effects of dopamine D1 and D2 agonists and antagonists injected into the nucleus accumbens and globus pallidus on jaw movements on rats. Eur J Pharmacol 1990;182:375–380.

20. Spooren WPJM, Petra A, Cools AR. Dopamine D1 recep-tors in the subcommissural part of the globus pallidus and their role in orofacial dyskinesia in cats. Eur J Pharmacol 1991;204:217–222.

21. Andreassen OA, Meshuk CK, Moore C, Jorgensen HA. Oral dyskinesias and morphological changes in rat striatum during longterm haloperidol administration. Psychopharmacology 2001;157:11–19.

22. Waddington JL. Spontaneous orofacial movements induced in rodents by very long-term neuroleptic drug administration: Phenomenology, pathophysiology and putative relationship to tardive dyskinesia. Psychophar-macology 1990;101:431–447.