Association between psychotropic medications and presence of sleep bruxism: A systematic review

Abstract

The purpose of this study was to systematically review the literature for studies that investigated the association between use of psychotropic medications and presence of sleep bruxism (SB). Observational studies were selected in a two-phase process. Searches were performed on six electronic databases, and a grey literature search was conducted on three databases. SB diagnosis was based on questionnaires or clinical examinations; no polysomnography examinations were performed. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Overall quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation criteria. Five analytical cross-sectional studies were included, evaluating antidepressants, anticonvulsants and psychostimulants. One study was judged as low risk of bias, three as moderate risk and one high risk. Antidepressants were evaluated in adult populations only; duloxetine (Odds Ratio [OR] = 2.16; 95% Confidence Interval [95% CI] = 1.12-4.17), paroxetine (OR = 3.63; 95% CI = 2.15-6.13) and venlafaxine (OR = 2.28; 95% CI = 1.34-3.86) were positively associated with SB risk. No increased odds of SB were observed considering use of citalopram, escitalopram, fluoxetine, mirtazapine and sertraline. With regard to anticonvulsants, only barbiturates were associated with SB in children (OR = 14.70; 95% CI = 1.85-116.90), while no increased odds were observed for benzodiazepine, carbamazepine and valproate. The only psychostimulant evaluated was methylphenidate, and an association with SB was observed in adolescents (OR = 1.67; 95% CI = 1.03-2.68). Findings from this SR suggested that medications such as duloxetine, paroxetine, venlafaxine, barbiturates and methylphenidate might be associated with SB; however, overall quality of evidence was considered very low, and therefore, caution is recommended.

Association between sleep bruxism and anxiety symptoms in adults: A systematic review

“…Furthermore, with regard to confounding factors, it is suggested that some comorbidities such as depression and stress, use alcohol, caffeine or tobacco, and even some psychotropic medications might be positively associated with SB, which may hinder the evaluation of an association between SB and anxiety in particular. Moreover, it is worth mentioning that the literature is sparse about the possible role of SB on the different disorders of the anxiety spectrum…”

Bruxism: An umbrella review of systematic reviews

“…Overall, three SR investigated prevalence rates among different populations, seventeen investigated associated factors, six evaluated effects on stomatognathic structures, two evaluated diagnostic accuracy of bruxism assessment tools, and thirteen assessed interventions' effectiveness . Statistical pooling of data using MA was available in 7 studies .…”

“…Overall, nine SR were judged with low risk, seventeen with moderate risk and fifteen with high risk of bias . Major concerns regarding risk of bias were observed, which included the following: (a) lack of a priori registration of the study protocol; (b) inappropriate range of database/electronic sources searched; (c) no risk of bias assessment; (d) study selection, data collection or bias assessment performed by only one reviewer; (e) no publication bias assessment or sensitivity analysis; (f) high risk of bias in included primary studies.…”

“…Garret et al, based on insufficient evidence from case reports, suggested that antidepressant‐associated bruxism may plausibly occur in paediatric and adult patients and that fluoxetine, sertraline and venlafaxine were the most commonly reported agents. Moreover, Melo et al suggested that SB might be consistently associated with use of duloxetine, paroxetine and venlafaxine among adults, whilst barbiturates and methylphenidate may exhibit a consistent association with the presence of SB among younger populations.…”

“…Overall, nine SR were judged with low risk, 23,25,39,41,46,50,53,54,59 seventeen with moderate risk 2,4,16,24,26,[28][29][30][31]33,34,43,45,47,49,57,58 and fifteen with high risk of bias. 3,27,32,[35][36][37][38]40,43,44,48,51,52,55,56 Major…”