Treatment of Bruxism with Trihexiphenidyl, a Case Series

Abstract

Bruxism is a sleep related movement disorder defined by repetitive jaw muscle activity that causes clenching or grinding of the teeth. Bruxism can lead to teeth and jaw damage and disturbs sleeping process. Although gastro-esophageal reflux, smoking and disturbances in CNS dopaminergic system implicated in etiology of bruxism but no clear etiology is defined. There are plenty of treatments were used for these patients included biofeedback, hypnosis, occlusal splints, beside drugs. Pharmacological treatments such as Clonidine, Clonazepam, Hydroxizine, Sodium valproate, selective serotonin reuptake inhibitors (SSRIs) sometimes induce bruxism. Case reports showed that SSRIs induced bruxism resolved by Buspirone but tricyclic antidepressants were not supported to be effective treatment for bruxism in papers. It is hypothesized that the direct and indirect pathways of the basal ganglia are involved in the coordination of movements is disturbed in bruxer like in Parkinson disease. Based on these facts we had thought Trihexyphenidyl may be effective in resistant patients. This study describes 4 patients whom suffered from bruxism which resisted to usual treatments. Trihexiphenidyl (Artane) an anticholinergic drug reduced symptoms in all cases. Anticholinergic drugs can be considered for treating bruxism. Both night and day types of bruxism, as a movement disorder was relieved in response to Thp, probably due to anticholinergic effects in basal ganglia. These isolated cases could not be generalized. Further placebo controlled clinical trials are needed to evaluate and proof the efficacy of anticholinergic drugs such as Thp for treating of bruxism.