Risk Factors and Medications Related To Sleep Bruxism and Potential TMJ Pain!

Bruxism is a repetitive jaw‐muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. It can occur during sleep, indicated as sleep bruxism, or during wakefulness, indicated as awake bruxism.

Risk factors for sleep-related bruxism:

Comorbid sleep disorders

• Parasomnias (eg, sleep talking, sleepwalking, enuresis)

• Obstructive sleep apnea

Medications and substances

• Antipsychotic drugs

• Selective serotonin reuptake inhibitors

• Serotonin noradrenaline reuptake inhibitors

• Noradrenaline-dopamine reuptake inhibitors

• Amphetamines

• Cocaine

• Ecstasy

Neurologic disorders

• Rett syndrome

• Down syndrome

• Cerebral palsy

• Autism spectrum disorders

• Dentatorubral pallidoluysian atrophy

• Cranial-cervical dystonia

• Advanced Alzheimer disease

• Huntington disease

• Multiple system atrophy

• Severe traumatic brain injury

Psychiatric disorders

• Anxiety

• Psychotic disorders


• Gastroesophageal reflux disease

• Temporomandibular joint disorders*

• Family history

Let’s Expand on which medications can contribute to Bruxism

Psychiatric Disorders

Most cases of bruxism related to medications are caused by antidepressants. That’s largely because antidepressants are one of the most commonly prescribed drugs in the country, with nearly 11% of Americans (about 1 in 9) taking them. Several types of antidepressants have been associated with bruxism, including SSRIs, SNRIs, and lithium.

SSRIs, selective serotonin reuptake inhibitors, include Fluoxetine, Sertraline, Paxil, Prozac, Zoloft, and others, including generic forms. These are the most commonly used antidepressants, and the ones most strongly associated with bruxism. SNRIs, and serotonin norepinephrine reuptake inhibitors, including Effexor, Pristiq, and Cymbalta, are also associated with nighttime bruxism.

Anticonvulsants: Paraldehyde, Stiripentol, Barbexaclone, Methylphenobarbital

ADHD: Phenethylamines: Medications that contain Methylphenidate used for ADHD ( Attention Deficit Hyperactivity Disorder), such as Ritalin, Concerta, Focalin, Daytrana, and amphetamines found in Adderall, Dexedrine, Vyvanse.

Parkinson’s Disease: Most dopamine agents cause awake bruxism. Dopamine agents that have been linked to bruxism include L-Dopa, used to treat Parkinson’s disease.

Acid Reflux Medications: Metoclopramide (Reglan), also used to help digestion and migraines, can also cause daytime bruxism. Check out the rest of the references below for a more exhaustive list, along with potential medications to help attenuate Bruxism.

Just remember in life, as well as in medicine, for every good intention, there tend to be unintended consequences! To your TMJ Health! Mike

de Baat C, Verhoeff M, Ahlberg J, et al. Medications and addictive substances potentially induce or attenuating sleep bruxism and/or awake bruxism. Journal of Oral Rehabilitation. Published online August 10, 2020. doi:https://doi.org/10.1111/joor.13061

Michael Karegeannes
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