How to manage bruxism in a patient with a helminthic infection?

Management of Bruxism in Helminthic Infection

Treat the underlying helminthic infection first with appropriate anthelmintics, as there is no established direct causal relationship between bruxism and helminth infections, and bruxism management should follow standard approaches regardless of concurrent parasitic disease.

Primary Treatment: Address the Helminthic Infection

The priority is identifying and treating the specific helminth infection, as this addresses the underlying systemic condition:

Empirical Treatment for Unidentified Helminth

• For asymptomatic eosinophilia or suspected helminthic infection: Administer albendazole 400 mg single dose plus ivermectin 200 μg/kg single dose 1
• This empirical approach covers most common nematode infections that might be associated with systemic symptoms 1

Species-Specific Treatment

If the helminth is identified, treat according to the specific pathogen 1:

• Ascaris lumbricoides: Albendazole 400 mg, mebendazole 500 mg, or ivermectin 200 μg/kg as single oral dose 2
• Strongyloides stercoralis: Ivermectin 200 μg/kg single dose (immunocompetent) or extended regimen on days 1,2,15, and 16 if immunocompromised 1
• Hookworm: Single dose albendazole 400 mg or mebendazole 500 mg 1
• Schistosoma species: Praziquantel 40 mg/kg (dose varies by species) 1

Concurrent Bruxism Management

Since bruxism is not a recognized manifestation of helminthic infections in the available guidelines 1, manage it using standard approaches:

Conservative Management (First-Line)

• Occlusal splint therapy: Dental evaluation for custom-fitted oral appliance to protect teeth from grinding damage 3, 4
• Stress reduction interventions: Address psychological stressors that may exacerbate bruxism 3, 5
• Sleep positioning modification: Evaluate and adjust sleep posture 3

Behavioral Approaches

• Biofeedback training: Can help patients become aware of and control jaw clenching 3, 4
• Physical therapy: For masticatory muscle pain or temporomandibular joint symptoms 3

Pharmacological Options (If Conservative Measures Fail)

• Consider muscle relaxants or other medications only after dental evaluation and failure of conservative measures 4
• Evidence for pharmacological management remains limited 4

Important Clinical Caveats

Do not delay helminth treatment: Some helminthic infections can cause serious complications if untreated, particularly Strongyloides in immunocompromised patients (hyperinfection syndrome with high mortality) 1 and Schistosoma haematobium (associated with bladder carcinoma) 1

Neurological helminth infections require special consideration: If CNS involvement is suspected (neurocysticercosis, neuroschistosomiasis, neurotoxocariasis), corticosteroids may be needed alongside anthelmintics 1. However, avoid corticosteroids in strongyloidiasis due to hyperinfection risk 1

Bruxism is multifactorial: The etiology includes stress, occlusal disorders, allergies, and sleep positioning—not helminthic infection 6, 3, 5. Therefore, standard bruxism management principles apply regardless of concurrent parasitic disease.

Dental referral is mandatory if: Significant tooth attrition, mobility, fracture, or temporomandibular joint disorders are present 3

Follow-Up Strategy

• Reassess after helminth treatment completion: Monitor for resolution of any systemic symptoms that might have been misattributed to bruxism 1
• Continue bruxism management: If teeth grinding persists after successful helminth eradication, this confirms bruxism is independent and requires ongoing dental/behavioral management 4, 5
• No specific helminth follow-up needed: Unless symptoms persist or complications develop 2