WHAT TO DO WITH BRUXISM 7/30/2020

Involuntary grinding of teeth, otherwise known as bruxism, is frequently a concern raised by patients with stress, sleep problems (especially sleep apnea), myofacial tenderness, and, on occasion, those who take various psychotropic agents.
Stimulants, SSRI medications, SNRI medications and antipsychotic agents are among the psychotropics that can cause or aggravate bruxism,
Conservative approaches to managing bruxism include dose reduction of medications that are suspected to cause bruxism and non-medication treatment of anxiety such as behavioral strategies. When smokers decrease their tobacco use, they often report initial agitation but quitting use of nicotine can also reduce or stop detrimental teeth grinding. Thus, smoking cessation is recommended for management of bruxism related to nicotine.
Treatment involves watching and waiting for a month to check for spontaneous remission. Referrals to dentists often result in the use of mouth guards to avoid tooth damage and pain. Rarely, tooth damage requires dental correction to reshape the chewing surfaces of teeth.
Lifestyle adaptations such as relaxation exercises and stress reduction help reduce grinding of teeth. In many children bruxism is simply outgrown. However, there is a wear and tear of dental surfaces that sometimes requires intervention when bruxism persists.
For patients who are motivated to change their stress-associated bruxism, biofeedback has been effective in teaching one to relax the muscle activity in a jaw. While it is possible to target bruxism with muscle relaxers and Botox injections, our primary care settings are best suited for dose reductions of stimulants or antidepressant medications and behavioral therapies.
Buspirone has been successfully used in doses of 10mg BID or TID if prescribed in off label method for bruxism rather than on label for anxiety itself. There is much less support for the use of low dose benzodiazepines at bedtime or gabapentin up to 300mg for night time bruxism.
References
1. Medication Fact Book for Psychiatric Practice, 4th ed. Carlat Publishing 2018 p 147
2. Diagnosis and Treatment of Bruxism, Mayo Clinic.org/disease-conditions/bruxism/diagnosis-treatment/drc
3. Teeth Grinding: Causes, Treatments and Consequences Jan 06, 2020 www.cedars-sinai.org/blog/teeth-grinding.html