Les patients atteints de pathologies mentales souffrent de bruxisme plus que la population générale. De ce fait, la connaissance des effets des psychotropes sur le bruxisme est importante dans leur prise en charge. Une revue de la littérature a été faite sur Medline, impliquant tous les articles publiés en français ou en anglais depuis 1993 concernant ce sujet. Les termes utilisés sont « bruxisme » ou « trouble de l’articulation temporo-mandibulaire » en association avec un des termes suivants : antipsychotiques, neuroleptiques, antidépresseurs, stabilisateurs de l’humeur, anticonvulsivants, antiépileptiques, antiparkinsoniens, anxiolytiques, benzodiazépines, stimulants, alphabloquants, bêtabloquants, anticholinergiques, antihistaminiques. Au total, 32 articles ont été lus et évalués. Les antipsychotiques sont directement incriminés dans l’induction ou l’exacerbation du bruxisme à travers leur antagonisme dopaminergique. Ainsi, le bruxisme pourrait être considéré comme une dystonie aiguë ou une dyskinésie tardive. Les inhibiteurs sélectifs de la recapture de la sérotonine (ISRS) sont aussi incriminés dans l’induction et l’aggravation du bruxisme du fait que leur effet sérotoninergique pourrait mimer les effets d’un antagonisme dopaminergique. Les bêtabloquants comme le propranolol, les agonistes partiels sérotoninergiques comme la buspirone peuvent diminuer les symptômes de bruxisme. Les données concernant les autres psychotropes sont controversées.

Bruxism is the parafunctional clenching or grinding of teeth, which can occur during sleep or during wakefulness. Psychiatric patients have been shown to suffer from bruxism more than healthy controls. Updating knowledge on bruxism and psychopharmacology, and the elucidation of the induction-effect of psychotropic drugs on this temporo-mandibular joint disorder is important in order to manage it in psychiatric patients.

A review of the published literature in English or in French was made via Medline. The terms used for the search were “bruxism” or “temporo-mandibular joint disorder” in association with one of the following: antipsychotic, neuroleptic, antidepressant, mood stabilizers, anticonvulsant, antiepileptic, antiparkinsonian, anxiolytic, benzodiazepines, stimulants, alpha-blockers, beta-blockers, anticholinergic, or antihistaminergic. Thirty-two articles were found to be related to our subject since 1993.

Psychotropic drugs are directly incriminated in the induction or exacerbation of bruxism. Antipsychotic drugs are involved in the induction of bruxism as a part of their induced movement disorders due to their dopamine receptor blockade. Bruxism could be related to acute dystonia making it respondent to propranolol treatment, or to tardive dyskinesia making it respondent to dose augmentation or switching to atypical drugs such as clozapine. Tricyclic antidepressants do not seem to induce or exacerbate bruxism. Other antidepressants, especially SSRIs, are involved in bruxism induction or aggravation since their serotonergic effect mimics dopaminergic antagonism. This effect could be reversed with the administration of beta-blockers such as propranolol or partial serotonin agonists such as buspirone or tandospirone. Data concerning the influence of dopaminergic agonists such as antiparkinsonian drugs or amphetamines is controversial and needs to be evaluated in randomized controlled studies. Other psychotropic drugs were not found to induce or exacerbate bruxism.

Although psychiatric patients present frequently with temporo-mandibular joint disorders such as bruxism, treatment of their psychiatric symptoms should take into consideration the effect of psychotropic drugs. Typical antipsychotic drugs and SSRIs are the psychotropic drugs that are clearly involved in the induction or aggravation of bruxism.