When medications make teeth grind

Imagine your patient comes in with mysterious jaw pain, tooth sensitivity, and enamel erosion. They may not realize it, but the root cause of their discomfort could lie in their medicine cabinet. Bruxism—commonly characterized by involuntary muscle activity leading to clenching and grinding of the teeth—alarmingly affects more than one-third of people at some point in their lives.¹ While stress and anxiety are well-known contributors, the lesser-discussed link to medications is frequently overlooked, especially in today’s postpandemic world, where prescriptions for ADHD medications and antidepressants have skyrocketed.^2,3 Understanding the connection is crucial for improving patients’ oral health while boosting practice revenue.

Clinical signs of bruxism

When reviewing a patient’s medical history, dental hygienists should be vigilant for clinical signs of bruxism, which include clenching, grinding, and enamel erosion. Specific indicators, such as shiny facets of worn enamel—often seen on the canines—should be noted. Bruxism can lead to tooth sensitivity, a higher risk of decay, and, in some cases, unrestorable fractures that may necessitate extractions.

When these signs are observed, it’s time to initiate a conversation with the patient. A simple mention that their medication could be contributing to bruxism, followed by a referral to the dentist for further evaluation and recommendation, not only enhances patient care but also demonstrates the hygienist’s astuteness and thoroughness during an examination.

Common medications associated with bruxism

What many dental professionals may not realize is that there is a strong correlation between common medications and bruxism. Research has shown that alterations in neurotransmitters such as norepinephrine, dopamine, and serotonin play a significant role in bruxism.^4,5 While stress and neurological conditions such as Parkinson’s disease are well-known triggers, several medications can also heighten the risk.

ADHD medications

Stimulants such as Adderall, Vyvanse, and Ritalin, prescribed for attention deficit hyperactivity disorder (ADHD), influence neurotransmitter levels and may lead to bruxism.⁶ This is particularly relevant given the surge in ADHD medication prescriptions during the pandemic.

The 10 most common ADHD medications include:

Methylphenidate (Ritalin, Concerta, Metadate)
Amphetamine/dextroamphetamine (Adderall)
Dexmethylphenidate (Focalin, Focalin XR)
Lisdexamfetamine (Vyvanse)
Dextroamphetamine (Dexedrine)
Atomoxetine (Strattera)
Clonidine (Kapvay, Onyda XR) (note: this is a hypertension medication that has recently been approved for the treatment of ADHD)
Guanfacine (Intuniv)
Extended-release methylphenidate (Quillivant XR)
Methylphenidate transdermal patch (Daytrana)

Antidepressants

Certain antidepressants are commonly linked to bruxism.^7,8 Selective serotonin reuptake inhibitors (SSRIs) primarily affect serotonin levels, while norepinephrine and dopamine reuptake antagonists (NDRAs), such as bupropion (Wellbutrin), increase the availability of norepinephrine and dopamine.

Common SSRIs that may also have this effect include:

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Vilazodone (Viibryd)

Selective norepinephrine reuptake inhibitors (SNRIs) that may also have this effect include:

Duloxetine (Cymbalta, Drizalma, Irenka)
Levomilnacipran (Fetzima)
Milnacipran (Savella)
Venlafaxine (Effexor)

Antipsychotics

Antipsychotic medications can target both dopamine and serotonin receptors, exacerbating bruxism.⁹

Examples of antipsychotics include:

Risperidone (Risperdal)
Haloperidol (Haldol)
Chlorpromazine
Trifluoperazine
Perphenazine

Parkinson’s medications

Medications for neurological conditions such as Parkinson’s disease may contribute to bruxism due to their effect on dopamine levels.¹⁰ Conversely, Parkinson’s disease itself can also cause bruxism.¹¹ Patients with Parkinson’s may not be ideal candidates for conventional treatments such as nightguards.

Providing holistic care

By staying informed about the connection between medications and bruxism, dental professionals can elevate their practice to provide truly holistic care. For hygienists, monitoring patients’ medications is not merely a clinical best practice—it’s a vital opportunity to enhance patient outcomes and build trust. Early identification of bruxism can lead to timely interventions, such as nightguards or restorative treatments, helping prevent long-term complications while reinforcing a higher standard of care.

However, navigating the complexities of medication-related oral health can be challenging. That’s where innovative tools such as the Digital Drug Handbook come in. Designed specifically for modern dentistry, this resource transforms patients’ medication information into clear, actionable insights tailored for dental professionals. With the right tools and knowledge, hygienists can confidently address medication-related concerns, ensuring healthier smiles and better overall care.

Editor's note: This article appeared in the March 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

Pavlou IA, Spandidos DA, Zoumpourlis V, Papakosta VK. Neurobiology of bruxism: the impact of stress (review). Biomed Rep. 2024;20(4):59. doi:10.3892/br.2024.1747
Chai G, Xu J, Goyal S, et al. Trends in incident prescriptions for behavioral health medications in the US, 2018-2022. JAMA Psychiatry. 2024;81(4):396-405. doi:10.1001/jamapsychiatry.2023.5045
Chua KP, Volerman A, Zhang J, Hua J, Conti RM. Antidepressant dispensing to US adolescents and young adults: 2016-2022. Pediatrics. 2024;153(3):e2023064245. doi:10.1542/peds.2023-064245
George S, Joy R, Roy A. Drug-induced bruxism: a comprehensive literature review. J Adv Oral Res. 2021;12(2):187-192. doi:10.1177/2320206821992534
de Baat C, Verhoeff MC, Ahlberg J, et al. Medications and addictive substances potentially inducing or attenuating sleep bruxism and/or awake bruxism. J Oral Rehabil. 2021;48(3):343-354. doi:10.1111/joor.13061
Malki GA, Zawawi KH, Melis M, Hughes CV. Prevalence of bruxism in children receiving treatment for attention deficit hyperactivity disorder: a pilot study. J Clin Pediatr Dent. 2004;29(1):63-67. doi:10.17796/jcpd.29.1.3j86338656m83522
Study shows link between antidepressants, bruxism. J Am Dent Assoc. 2000;131(3):297. doi:10.14219/jada.archive.2000.0165
Garrett AR, Hawley JS. SSRI-associated bruxism: a systematic review of published case reports. Neurol Clin Pract. 2018;8(2):135-141. doi:10.1212/CPJ.0000000000000433
Reyad AA, Girgis E, Ayoub A, Mishriky R. Bruxism and psychotropic medications. Prog Neurol Psychiatry. 2020;24:31-35. doi:10.1002/pnp.560
Magee KR. Bruxism related to levodopa therapy. JAMA. 1970;214(1):147. doi:10.1001/jama.1970.03180010087026
Verhoeff MC, Lobbezoo F, Wetselaar P, Aarab G, Koutris M. Parkinson’s disease, temporomandibular disorders and bruxism: a pilot study. J Oral Rehabil. 2018;45(11):854-863. doi:10.1111/joor.12697