Are there any medications that can decrease the impulse to grind teeth, specifically for treating bruxism?

Medications for Treating Bruxism (Teeth Grinding)

Several medications can effectively reduce the impulse to grind teeth in patients with bruxism, with muscle relaxants and certain antidepressants showing the most promising results for symptom management. 1

First-Line Pharmacological Options

• Muscle relaxants are recommended for acute episodes of bruxism to reduce muscle hyperactivity and provide relief from grinding episodes 1
• Amitriptyline (a tricyclic antidepressant) has shown benefit in reducing bruxism symptoms in open-label studies, likely through its muscle relaxant properties and effects on sleep architecture 1
• Non-steroidal anti-inflammatory drugs (NSAIDs) can be used for pain management associated with bruxism but don't directly address the grinding behavior 1

Second-Line Pharmacological Options

• Botulinum toxin injections to the masticatory muscles may reduce the frequency and intensity of bruxism by temporarily paralyzing the muscles involved, though concerns exist regarding possible adverse effects 1, 2
• TRPV1 agonists (like capsaicinoids) have shown some efficacy in improving swallow function and may help with oral motor control in some patients with bruxism 3
• Dopaminergic agents may be considered in cases where bruxism is associated with movement disorders, as they can help normalize oral motor function 3, 4

Important Considerations When Prescribing

• Before initiating pharmacological treatment, a proper clinical evaluation should be performed to confirm the diagnosis of bruxism and rule out other conditions 1
• Medications should generally be used as adjuncts to non-pharmacological approaches rather than as standalone treatments 1
• Treatment decisions need to be individualized based on careful risk-benefit analysis, as most medications have limited evidence specifically for bruxism 3
• When bruxism coexists with temporomandibular disorders (TMD), treatment should address both conditions 1

Non-Pharmacological Approaches to Consider First

• Occlusal splints (night guards) are the most common dental intervention for protecting teeth from damage caused by grinding/clenching 1
• Behavioral strategies including stress reduction techniques are recommended as they address potential psychological factors contributing to bruxism 1, 5
• Physical therapy techniques including massage of masticatory muscles can provide relief of associated muscle tension 6, 1
• Cognitive behavioral therapy (CBT) with or without biofeedback has shown effectiveness in reducing bruxism symptoms 6, 1

Cautions and Contraindications

• Avoid using anti-muscarinic medications in patients with narrow-angle glaucoma unless approved by an ophthalmologist 3
• Use caution with medications that may impair cognitive function, especially in elderly patients or those with existing cognitive issues 3
• Avoid combining NSAIDs with opioids for pain management, as this carries significant risk without clear additional benefit 2
• Irreversible dental procedures should be avoided as first-line treatments for bruxism 1

Special Populations

• In patients with movement disorders (like Parkinson's disease), bruxism may be exacerbated by certain medications, requiring careful medication selection 4
• Bruxism is particularly common in certain neurodevelopmental disorders, with high prevalence in Rett's syndrome (97%), Down syndrome (42%), and autism spectrum disorders (32%), which may require specialized approaches 4
• Children with bruxism are usually managed with observation and reassurance rather than medication 7

While pharmacological interventions can be helpful for managing bruxism, they should be part of a comprehensive treatment plan that includes addressing underlying causes and implementing appropriate non-pharmacological strategies.