What medication is recommended for treating bruxism (teeth grinding)?

Medication for Teeth Grinding (Bruxism)

For bruxism, medications are second-line treatment options reserved for specific situations after conservative measures have been tried, with NSAIDs for pain management and muscle relaxants for acute episodes being the most evidence-supported pharmacological choices. 1, 2

Treatment Hierarchy: Conservative First, Medications Second

The evidence strongly supports starting with non-pharmacological interventions before considering medications 1, 2:

• Occlusal splints (hard full coverage stabilization splints) are the primary first-line intervention, designed to protect teeth from grinding damage rather than eliminate bruxism itself 1, 2
• Patient education, stress reduction, limiting caffeine, and improving sleep hygiene should be implemented initially 1, 2
• Physical therapy techniques including massage of masticatory muscles and heat/cold application provide symptom relief 1, 2

Pharmacological Options: When and What to Use

First-Line Medications (Second-Line Overall Treatment)

NSAIDs for pain management are the most straightforward pharmacological option when bruxism causes pain 1, 2:

• Use for symptomatic relief of jaw pain and muscle discomfort
• No specific NSAID is preferred over another in the guidelines
• Critical caveat: Avoid combining NSAIDs with opioids, which carries significant risk without clear additional benefit 2

Muscle relaxants for acute episodes when muscle spasm is prominent 1, 2:

• Reserved for acute flare-ups rather than chronic daily use
• Particularly useful when jaw muscle tension is severe
• Important warning: Use caution with medications that may impair cognitive function, especially in elderly patients or those with existing cognitive issues 1, 3

Alternative Pharmacological Options with Limited Evidence

Amitriptyline has shown some benefit in open-label studies, particularly for patients with significant anxiety or depression 1, 2, 3:

• Consider when psychological factors (stress, anxiety, depression) are prominent contributors 3
• May address both the bruxism and underlying mood disorder
• Evidence is from open-label studies, not high-quality RCTs 1

TRPV1 agonists (capsaicinoids) have shown some efficacy in improving oral motor control in select patients 1, 2:

• Very limited evidence base
• May help with swallow function and oral motor control 1
• Treatment decisions must be individualized based on careful risk-benefit analysis 1, 2

Dopaminergic agents may be considered when bruxism is associated with movement disorders 1, 2:

• Specifically for cases where bruxism appears related to abnormal movement patterns
• Can help normalize oral motor function 1
• Requires specialist evaluation to determine appropriateness

Clonazepam showed large effect size in reducing bruxism index in one study 4:

• Major limitation: Risk of dependency severely limits use over long periods 4
• May be considered for short-term therapy only
• Not recommended as a routine option due to addiction potential

Clonidine was found to reduce sleep bruxism in comparative studies 4:

• Has been linked to adverse effects 4
• Not a preferred option due to side effect profile

Interventions to Use Cautiously or Avoid

Botulinum toxin injections to masticatory muscles may reduce bruxism frequency, but are conditionally recommended against 1, 2:

• Concerns exist regarding possible adverse effects 1, 2
• An RCT showed no benefit for temporomandibular disorders 1, 2
• Should not be considered a first- or second-line option

Biofeedback has limited evidence and is conditionally recommended against 1, 2:

• May help patients develop awareness of muscle tension 1, 2
• Insufficient evidence to support routine use

Low-level laser therapy has insufficient evidence and is conditionally recommended against 1, 2

Critical Clinical Pitfalls to Avoid

Never perform irreversible occlusal adjustments 1, 2, 5:

• No evidence basis for managing bruxism 1, 2, 5
• Permanent alterations to dentition are strongly contraindicated 1, 2

Avoid proceeding to invasive procedures before exhausting conservative options 2:

• Medications should only be added after splints, behavioral strategies, and physical therapy have been tried
• Most patients can be managed with conservative approaches

Do not neglect the biopsychosocial approach 2, 3:

• Assess for stress, anxiety, depression, and anger systematically 3
• Approximately 18% of bruxism patients have moderate-to-severe depression 3
• Evaluate for comorbid chronic pain conditions including headaches, temporomandibular disorders, and fibromyalgia 3

When to Refer to Specialists

Primary referral should be to a dentist with training in temporomandibular disorders and sleep medicine 1, 2:

• This is the appropriate first specialist for bruxism evaluation and management 1, 2
• Provide complete medical history including medications, psychological comorbidities (anxiety, depression, stress), and associated conditions (sleep apnea, movement disorders, chronic pain) 1, 2, 3

Consider pain management specialist when patients have intractable pain unresponsive to dental interventions 1, 2, 3:

• Pain management alone does not constitute sufficient treatment but is an essential component 1
• Multidisciplinary pain team may be appropriate for complex cases 1, 3

Sleep medicine specialist may be needed when sleep-related bruxism requires specialized oral appliance fitting 1, 3

Special Considerations for Pediatric Patients

In childhood, sleep bruxism is typically self-limited and does not require specific treatment 6:

• Eliminate causative or triggering factors if possible 6
• Emphasize sleep hygiene: bedtime should be relaxed and enjoyable, limit mental stimulation and physical activity before bed 6
• For oral devices in children: Benefits and risks must be carefully weighed since orofacial structures are still developing 6
• Pharmacotherapy is not a favorable option and is rarely used in children 6
• Current evidence on effective interventions for pediatric sleep bruxism is inconclusive 6