Occlusion Connections — The Center for Gneuromuscular Dentistry & Orthopedic Advancement

Medications and TMJ Grinding and Clenching

                                               

Medications and TMJ Grinding and Clenching

Originally published June 2015 · Last updated May 2026
By Clayton A. Chan, D.D.S. — Founder/Director of Occlusion Connections™

Teeth Grinding and Clenching

There are commonly prescribed psychotropic medications and drugs that can contribute to teeth grinding and clenching, including antidepressant medications, SSRIs (selective serotonin reuptake inhibitors), anti-panic agents, and anti-obsessive agents. They are listed in the diagram below.
Teeth grinding and clenching — a condition in which you grind, gnash, or clench your teeth — has been reported by people with osteoporosis, depression, stress and anxiety, osteopenia, and attention deficit hyperactivity disorder. (Latest reports from 2,537 teeth grinding and clenching patients →)

What Are SSRIs?

SSRI (selective serotonin reuptake inhibitor) refers to any of a class of antidepressants — such as fluoxetine or sertraline — that inhibit the inactivation of serotonin by blocking its reuptake by presynaptic nerve cell endings.
There have been several reported incidents of iatrogenic bruxism (involuntary clenching or grinding of the teeth). Diurnal bruxism (Micheli et al, 1993) has been associated with dopaminergic blockade, and nocturnal bruxism has been reported with several psychotropic medications.
Nocturnal bruxism has been reported with venlafaxine, a serotonin/noradrenaline reuptake inhibitor — which responded to gabapentin (Brown & Hong, 1999) — as well as three selective serotonin reuptake inhibitors (SSRIs): paroxetine (Romanelli et al, 1996), fluoxetine and sertraline (Ellison & Stanziani, 1993).
SSRI medications and teeth grinding clenching diagram — psychotropic drugs that contribute to bruxism — Dr. Clayton Chan, Occlusion Connections

Gabapentin and Bruxism

As of February 26, 2016, 37,299 people reported side effects when taking Gabapentin (Neurontin). Among them, 48 people (0.13%) reported teeth grinding and clenching.
Trend of teeth grinding and clenching reports in patients taking Gabapentin (Neurontin)

Benzodiazepines and Bruxism

Benzodiazepines are widely prescribed for a variety of conditions, particularly anxiety and insomnia. Four of them — alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) — are considered among the top 100 most commonly prescribed medications.
They are relatively safe and, with overdose, rarely result in death. However, used chronically, benzodiazepines can be addicting. These agents are often taken in combination with other drugs of abuse by patients with addiction disorders. Alternatives to benzodiazepines may be preferable and may include antidepressants, anticonvulsants, buspirone, antihypertensive agents, and the newer neuroleptic medications.

Note: Caution must be used when prescribing benzodiazepines to patients with a current or remote history of substance abuse. Addictions to these kinds of medications can result in chronic dependence. Those who have been prescribed benzodiazepines long-term and have been taking these medications as directed by their physician have been shown to become dependent.

Benzodiazepines are also widely prescribed for other reasons, such as muscle spasticity, convulsive disorders, presurgical sedation, involuntary movement disorders, detoxification from alcohol and other substances, and anxiety associated with cardiovascular or gastrointestinal conditions.

Toxicity and Side Effects of Benzodiazepines

Benzodiazepines carry an extremely low risk of acute toxicity. However, benzodiazepines often are used with other types of medications, including other drugs with abuse potential, and these drugs can enhance the toxic effects of benzodiazepines.

Characteristics of These Types of Medications:

  • Psychomotor Retardation — decreased rates of metabolism or greater susceptibility to central nervous system depression. Psychomotor symptoms include drowsiness, poor concentration, ataxia, dysarthria, motor incoordination, diplopia, muscle weakness, vertigo, and mental confusion.
  • Memory Impairment
  • Paradoxical Disinhibition — Increased excitement, irritability, aggression, hostility, and impulsivity may occur in some patients who take benzodiazepines.
  • Depression and Emotional Blunting — depression and the emergence of suicidal ideation.
  • Adverse Effects During Pregnancy — Benzodiazepines may lead to the development of dependence and consequent withdrawal symptoms in the fetus. They are excreted in breast milk and thus are usually contraindicated in breast-feeding mothers.
  • Tolerance — Tolerance to the hypnotic effects tends to develop rapidly. Patients typically notice relief of insomnia initially, followed by a gradual loss of efficacy.
  • Dependency — Benzodiazepine therapy can give rise to physiologic and psychologic dependence based on the drug’s dosage, duration of therapy, and potency.
  • Withdrawals — Effects from therapeutic dosages of benzodiazepines are mainly anxiety symptoms. In addition, autonomic instability (i.e., increased heart rate and blood pressure level, tremulousness, diaphoresis), insomnia, and sensory hypersensitivity are common. The most serious acute withdrawal symptoms are seizures and delirium tremens, which most commonly occur with abrupt discontinuation.
  • Protracted Withdrawals — Symptoms include prolonged (for several months) anxiety, depression, and insomnia. In addition, physical symptoms related to gastrointestinal, neurologic, and musculoskeletal effects may occur.
  • Effects in the Elderly — the risk of drug interactions, psychomotor slowing, cognitive dysfunction, and paradoxical disinhibition may be amplified.
  • Abuse — Potential drugs of abuse, short-acting benzodiazepines seem to be preferred among addicts because of the rapidity of their onset of action.

References

  • Longo, MD, Lance P: Addiction: Part I. Benzodiazepines — Side Effects, Abuse Risk and Alternatives. Am Fam Physician. 2000 Apr 1;61(7):2121-2128.
  • Review: Could Gabapentin Cause Teeth Grinding and Clenching (Bruxism)? →

Continue Learning

🔹 Understand the Clinical Picture

🔹 Understand the GNM Foundation

🔹 TMJ Care and Management

🔹 Find a GNM Dentist or Train With Dr. Chan

Written by Clayton A. Chan, D.D.S. — Founder and Director, Occlusion Connections | Las Vegas, Nevada

Doctor EducationDoctor Education
Patient EducationPatient Education

Like this:

Like Loading…