Medications and Addictive Substances Potentially Inducing or Attenuating Sleep Bruxism and/or Awake Bruxism

This review focuses on the topic of bruxism, making the distinction between sleep bruxism and awake bruxism by leveraging the 2017 international consensus meeting defining the symptom/condition. This narrative focuses on two external risk factors, looking at medication and addictive substances. The search terms (MeSH) used for the review were “bruxism,” “adverse effect,” “medication,” and “addictive substances.” In addition, a PubMed search for “alleviating effect” was established to garner the possibility of attenuating the condition of bruxism via pharmaceutical strategies or effects. In the end, the search resulted in a distinction among sleep, awake, and nonspecific bruxism based on relatively weak evidence.

The review states that, during the current century, literature reviews have reported evidence of bruxism as an adverse side effect of various medications and addictive substances. This article offers to serve as a starting point and guideline to describe the relationships between the various forms of bruxism and classes of medications and addictive substances. The challenge is to understand whether or not the classes of medications that were reviewed actually induced bruxism in its various forms or merely stimulated an unrecognized symptom of a pre-existing condition for which the medication was used.

As an example, phenethylamines and atomoxetine, which were reviewed as part of this study, are medications used to treat ADHD in children, adolescents, and adults; yet, there is a good amount of evidence that suggests that poor quality and/or quality of sleep most often results in the ADHD profile of symptomology where bruxism is highly associated. Other classes of medications used to manage anxiety and depression that were reviewed such as atomoxetine, venlafaxine, and alcohol, present with similar associations. Many of the other classes of pharmaceuticals that were reviewed are used to manage other well-established comorbidities of gas perturbations resulting in fragmented sleep and bruxism.

In a bioregulatory systems medicine¹ approach, the recognition of the complexity of diseases and the idea of autoregulation underlying dysregulated biologic networks may offer a better opportunity for understanding the association between various pharmaceuticals and common symptoms/conditions, such as bruxism in its various forms.

Reference

1. Goldman AW, Burmeister Y, Cesnulevicius K, et al. Bioregulatory systems medicine: an innovative approach to integrating the science of molecular networks, inflammation, and systems biology with the patient's autoregulatory capacity? Front Physiol. 2015;6:225. https://www.frontiersin.org/articles/10.3389/fphys.2015.00225/full