Five drug classes tested in a meta-analysis
STUDY: Li D et al, Journal of Oral Rehabilitation 2026
STUDY TYPE: Systematic review and meta-analysis
FUNDING: Natural Science Foundation of Shandong Province
Background
Bruxism, the clenching and grinding that damages teeth, is common under stress, psychiatric disorders, or as a side effect to psychotroptics. It is caused by brief arousals during non-REM sleep rather than a simple excess of muscle activity. Many patients use a mouth guard like the one above, and this analysis looks at pharmacotherapy options.
The Study
- Nine trials (six randomized), 116 adults total, all confirmed by polysomnography.
- Most exposures lasted a single night; only gabapentin was tested over two months.
Results
No meds stood at as clearly effective, but clonidine and gabapentin came closest. Clonidine reduced grinding by nearly 60% in its positive trials (0.1-0.3 mg qhs), but this hope lost significance when pooled together. Gabapentin reduced grinding by 30-40%, but the trials lacked adequate blinding or placebo control (100 mg qhs x3 nights, 200 mg qhs x3 nights, then 300 mg qhs).
Benzodiazepines, dopamine agonists, and propranolol did not separate from placebo.
Side Effects
Clonidine caused mild sedation, dry mouth, and low blood pressure.
Limitations
Small trials, most lasting only a night. Certainty of evidence was low to very low across the board.
Practice Implications
- Clonidine and gabapentin are worth trying as a last resort, or if the patient has another reason to use these, such as ADHD (clonidine) or restless leg syndrome (gabapentin).
- I’ve seen good results with magnesium (300–400 mg qhs), but this mineral only has uncontrolled support in the literature (from 1974 and 1980). The dose is based on the elemental magnesium, not the total weight (which includes the binding agent).
- Magnesium comes in many forms. Diarrhea is more likely with the low-cost oxide and less likely with chloride. Glycinate, citrate, chloride, and chelated magnesium are better absorbed. Here are lab-tested brands.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
