What is the recommended psychopharmacological management of bruxism in children?

Psychopharmacological Management of Bruxism in Children

Direct Recommendation

There is no evidence-based psychopharmacological treatment recommended for bruxism in children, and conservative non-pharmacological approaches should be prioritized. 1, 2

Evidence Base and Clinical Approach

Current State of Evidence

• No established pharmacological treatment exists for pediatric bruxism, and management should focus on identifying and addressing underlying conditions rather than prescribing medications 1
• The limited research on medications (hydroxyzine, trazodone, flurazepam) shows some reduction in self-reported bruxism and associated headaches, but these studies lack the rigor needed to support routine clinical use 2
• Bruxism should not be considered a disorder requiring treatment in otherwise healthy children, but rather a behavior that may signal underlying psychosocial or sleep disturbances 3, 2

Recommended Management Strategy

Step 1: Comprehensive Assessment

• Identify underlying factors including sleep disturbances, anxiety levels, psychosocial stressors, and parafunctional habits, as these are the most strongly associated factors with pediatric bruxism 1
• Rule out secondary causes such as medications (particularly psychotropic medications that may induce bruxism as a side effect) or medical conditions 4
• Assess for temporomandibular disorders, headaches, and behavioral/sleep disorders that commonly accompany bruxism 1

Step 2: Non-Pharmacological Interventions (First-Line)

• Psychological techniques including directed muscular relaxation and stress management have demonstrated effectiveness in reducing anxiety levels and temporomandibular joint disorders in children with bruxism (P < 0.05) 5
• Counseling regarding sleep hygiene, sleep habit modification, and relaxation techniques should be implemented as the initial therapeutic intervention 4
• Physical therapy interventions have shown reduction in self-reported bruxism and associated symptoms 2

Step 3: When to Consider Pharmacological Consultation

• If bruxism is associated with a diagnosed psychiatric disorder (anxiety, ADHD, depression), treatment should target the underlying psychiatric condition following AACAP guidelines for comprehensive psychiatric and medical evaluation before initiating any psychotropic medication 6
• Any psychotropic medication use must follow rigorous principles: complete psychiatric evaluation, develop treatment and monitoring plan, obtain informed consent/assent, and conduct adequate medication trials with clear target symptoms 6

Critical Caveats

Avoid These Common Pitfalls:

• Do not prescribe psychotropic medications specifically for bruxism in the absence of a diagnosed psychiatric disorder, as this represents inappropriate medication use 6, 1
• Be aware that some psychotropic medications can cause or worsen bruxism (particularly SSRIs and stimulants), so medication review is essential if bruxism develops or worsens during psychiatric treatment 4
• Do not use benzodiazepines routinely despite case reports of clonazepam for sleep bruxism in adults, as the evidence is insufficient and the risks in children (dependence, cognitive effects) outweigh potential benefits 4

Special Considerations

• Bruxism in children may serve as a warning sign of psychological disorders and should prompt evaluation for anxiety, stress, or other emotional difficulties 3
• The biopsychosocial model should guide assessment, with particular attention to sleep quality, personality traits, stress levels, and headaches 1
• Parental or caregiver reports of teeth grinding remain the most reliable diagnostic tool and should be accompanied by thorough clinical examination 1

When Psychiatric Medication Is Necessary for Comorbid Conditions

If a child with bruxism requires psychotropic medication for a separate psychiatric disorder:

• Follow AACAP principles requiring comprehensive evaluation before medication initiation 6
• Monitor for medication-induced or worsened bruxism as a side effect 4
• Reassess if bruxism worsens, as this may indicate the need for medication adjustment rather than adding another medication 6
• Avoid polypharmacy unless there is clear rationale for treating multiple distinct disorders 6