About all

Side effects of jaw clenching: Teeth grinding (bruxism) – NHS


Teeth grinding (bruxism) – NHS

Teeth grinding and jaw clenching (also called bruxism) is often related to stress or anxiety.

It does not always cause symptoms, but some people get facial pain and headaches, and it can wear down your teeth over time.

Most people who grind their teeth and clench their jaw are not aware they’re doing it.

It often happens during sleep, or while concentrating or under stress.

Symptoms of teeth grinding

Symptoms of teeth grinding include:

  • facial pain
  • headaches
  • earache
  • pain and stiffness in the jaw joint (temporomandibular joint) and surrounding muscles, which can lead to temporomandibular disorder (TMD)
  • disrupted sleep (for you or your partner)
  • worn-down teeth, which can lead to increased sensitivity and even tooth loss
  • broken teeth or fillings

Facial pain and headaches often disappear when you stop grinding your teeth.

Tooth damage usually only happens in severe cases and may need treatment.

When to see a dentist or GP

See a dentist if:

  • your teeth are worn, damaged or sensitive
  • your jaw, face or ear is painful
  • your partner says you make a grinding sound in your sleep

The dentist will check your teeth and jaw for signs of teeth grinding.

You may need dental treatment if your teeth are worn through grinding to avoid developing further problems, such as infection or a dental abscess.

See a GP if your teeth grinding is related to stress. They’ll be able to recommend ways to help manage your stress.

Treating teeth grinding

There are a number of treatments for teeth grinding.

Using a mouth guard or mouth splint reduces the sensation of clenching or grinding your teeth.

They also help reduce pain and prevent tooth wear, as well as protecting against further damage.

Other treatments include muscle-relaxation exercises and sleep hygiene.

If you have stress or anxiety, cognitive behavioural therapy (CBT) may be recommended.

What causes teeth grinding?

The cause of teeth grinding is not always clear, but it’s usually linked to other factors, such as stress, anxiety or sleep problems.

Stress and anxiety

Teeth grinding is most often caused by stress or anxiety and many people are not aware they do it. It often happens during sleep. 


Teeth grinding can sometimes be a side effect of taking certain types of medicine.

In particular, teeth grinding is sometimes linked to a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI).

Examples of SSRIs include paroxetine, fluoxetine and sertraline.

Sleep disorders

If you snore or have a sleep disorder, such as obstructive sleep apnoea (OSA), you’re more likely to grind your teeth while you sleep. OSA interrupts your breathing while you sleep.

You’re also more likely to grind your teeth if you:

  • talk or mumble while asleep
  • behave violently while asleep, such as kicking out or punching
  • have sleep paralysis, a temporary inability to move or speak while waking up or falling asleep
  • have hallucinations, where you see or hear things that are not real, while semi-conscious


Other factors that can make teeth grinding more likely, or make it worse, include:

Teeth grinding in children

Teeth grinding can also affect children. It tends to happen after their baby teeth or adult teeth first appear, but usually stops after the adult teeth are fully formed.

See a GP if you’re concerned about your child’s teeth grinding, particularly if it’s affecting their sleep.

Page last reviewed: 04 May 2020
Next review due: 04 May 2023

Bruxism (teeth grinding) – Symptoms and causes


Bruxism (BRUK-siz-um) is a condition in which you grind, gnash or clench your teeth. If you have bruxism, you may unconsciously clench your teeth when you’re awake (awake bruxism) or clench or grind them during sleep (sleep bruxism).

Sleep bruxism is considered a sleep-related movement disorder. People who clench or grind their teeth (brux) during sleep are more likely to have other sleep disorders, such as snoring and pauses in breathing (sleep apnea).

Mild bruxism may not require treatment. However, in some people, bruxism can be frequent and severe enough to lead to jaw disorders, headaches, damaged teeth and other problems.

Because you may have sleep bruxism and be unaware of it until complications develop, it’s important to know the signs and symptoms of bruxism and to seek regular dental care.

Products & Services

Show more products from Mayo Clinic


Signs and symptoms of bruxism may include:

  • Teeth grinding or clenching, which may be loud enough to wake up your sleep partner
  • Teeth that are flattened, fractured, chipped or loose
  • Worn tooth enamel, exposing deeper layers of your tooth
  • Increased tooth pain or sensitivity
  • Tired or tight jaw muscles, or a locked jaw that won’t open or close completely
  • Jaw, neck or face pain or soreness
  • Pain that feels like an earache, though it’s actually not a problem with your ear
  • Dull headache starting in the temples
  • Damage from chewing on the inside of your cheek
  • Sleep disruption
When to see a doctor

See your dentist or doctor if you have any of the symptoms listed above or have other concerns about your teeth or jaw.

If you notice that your child is grinding his or her teeth — or has other signs or symptoms of bruxism — be sure to mention it at your child’s next dental appointment.


Doctors don’t completely understand what causes bruxism, but it may be due to a combination of physical, psychological and genetic factors.

  • Awake bruxism may be due to emotions such as anxiety, stress, anger, frustration or tension. Or it may be a coping strategy or a habit during deep concentration.
  • Sleep bruxism may be a sleep-related chewing activity associated with arousals during sleep.

Risk factors

These factors increase your risk of bruxism:

  • Stress. Increased anxiety or stress can lead to teeth grinding. So can anger and frustration.
  • Age. Bruxism is common in young children, but it usually goes away by adulthood.
  • Personality type. Having a personality type that’s aggressive, competitive or hyperactive can increase your risk of bruxism.
  • Medications and other substances. Bruxism may be an uncommon side effect of some psychiatric medications, such as certain antidepressants. Smoking tobacco, drinking caffeinated beverages or alcohol, or using recreational drugs may increase the risk of bruxism.
  • Family members with bruxism. Sleep bruxism tends to occur in families. If you have bruxism, other members of your family also may have bruxism or a history of it.
  • Other disorders. Bruxism can be associated with some mental health and medical disorders, such as Parkinson’s disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, sleep-related disorders such as sleep apnea, and attention-deficit/hyperactivity disorder (ADHD).


In most cases, bruxism doesn’t cause serious complications. But severe bruxism may lead to:

  • Damage to your teeth, restorations, crowns or jaw
  • Tension-type headaches
  • Severe facial or jaw pain
  • Disorders that occur in the temporomandibular joints (TMJs), located just in front of your ears, which may sound like clicking when you open and close your mouth

Aug. 10, 2017

Show references

  1. AskMayoExpert. Bruxism. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  2. Tooth clenching or grinding. American Academy of Oral Medicine. http://www.aaom.com/index.php?option=com_content&view=article&id=129:tooth-clenching-or-grinding&catid=22:patient-condition-information&Itemid=120. Accessed Feb. 12, 2017.
  3. Sateia M. Sleep related bruxism. In: International Classification of Sleep Disorders. 3rd ed. Darien, Ill.: American Academy of Sleep Medicine; 2014. http://www.aasmnet.org/EBooks/ICSD3. Accessed Feb. 12, 2017.
  4. Mesko ME, et al. Therapies for bruxism: A systematic review and network meta-analysis (protocol). Systematic Reviews. 2017;6:4.
  5. Yap AU, et al. Sleep bruxism: Current knowledge and contemporary management. Journal of Conservative Dentistry. 2016;19:383.
  6. Guaita M, et al. Current treatment of bruxism. Current Treatment Options in Neurology. 2016;18:10.
  7. Teeth grinding. American Dental Association. http://www.mouthhealthy.org/en/az-topics/t/teeth-grinding. Accessed Feb. 12, 2017.
  8. Olson EJ (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 17, 2017.


Products & Services

Show more products and services from Mayo Clinic

Can Anxiety Affect Your Teeth? – Anxiety Disorders Center

Because of anxiety or other issues, some people grind their teeth or clench their jaw thousands of times a night while they sleep. They put so much pressure on their jaws — 250 pounds (or more) worth of force — that they wear down their teeth, sometimes even causing joint and muscle problems. And grinding teeth can be so loud that it wakes their partner.

Worse still, grinding teeth isn’t always confined to nighttime hours — it can occur during the day as well. Clenching and grinding teeth, often without even realizing you’re doing it, is called bruxism; it affects about one in three people and can lead to temporomandibular joint problems, or TMJ.

Understanding Bruxism

Often, people don’t even know they’re grinding their teeth. But dentists can look at their teeth and know they have a habit of grinding, and can look at their jaws and know they clench, says Michael Gelb, DDS, clinical professor of oral medicine and pathology at the New York University College of Dentistry in New York City. People who clench tend to do it in a rhythmic motion, as if they’re chewing something, and often end up with large jaw muscles. People with square jaws also are able to exert more force when they clench and cause more damage, Dr. Gelb says.

When you grind your teeth or clench your jaw, you’re likely to experience a host of symptoms, including:

Experts say those at risk for bruxism are people who may:

  • Be nervous
  • Be unable to deal with stress
  • Have problems with anger
  • Feel frustrated
  • Be aggressive
  • Be competitive

Because bruxism primarily occurs at night, it’s considered a sleep disorder, Gelb says. People who have sleep apnea problems, like snoring and breathing problems, tend to have bruxism, he adds. Bruxism also puts you at risk for TMJ, when the joints that connect your jaw to your skull become painful, have less movement, and become inflamed. The jaw may pop or click when it moves.

Anxiety, Bruxism, and TMJ

Not surprisingly, stress and anxiety problems can make bruxism worse. It’s easy to grind your teeth and clench your jaw when you’re under stress, says Susan Walsh, PsyD, a neurospsychologist and assistant professor in the department of psychiatry and behavioral neurosciences at Loyola University Health System in Maywood, Ill. That’s because a nerve runs from the muscles of your jaw to a part of your brain that’s the source of the fight-or-flight response, which kicks in when your body is under stress.

“If we’re too much in the fight mode and we’re chronically stressed, we feel it in our bodies 24 hours a day, even when we go to sleep,” Walsh says. “For some people, they carry their stress in their jaws.”

Does anxiety actually causecause bruxism? If you have bruxism or TMJ, there’s good reason to wonder if anxiety problems could be at the root of it. However, it’s hard to say what comes first, anxiety or grinding teeth and clenching the jaw. Doctors don’t actually know why some people grind and clench all day and all night and can’t say for sure that bruxism and TMJ are anxiety side effects. “People clench whether they’ve had a good day or a bad day, whether they’re happy or sad,” Gelb says.

Bruxism can, however, begin after a trauma, like a car accident, Gelb adds. One recent study also found that preschoolers who had a hard time adjusting to school and who were withdrawn while there were more likely to grind their teeth.

And we also know that bruxism and anxiety can become a vicious cycle. Every time somebody clenches during sleep, the brain wakes up from the deep stage of sleep and moves to a lighter stage of sleep, Gelb says. Not getting the right amount of deep sleep means that a person who already has anxiety problems is going to feel even more anxious. And when you’re anxious, daytime grinding and clenching can become worse.

Getting treatment for any anxiety problems — medications and therapy — can improve symptoms of bruxism and TMJ, Gelb says. In particular, cognitive-behavioral therapy can help people change their reaction to stress and help them stop clenching during the day.

If teeth and jaw problems related to anxiety are causing you or a loved one difficulty, talk to your doctor or dentist. Help is available.

Teeth Grinding, Night Guard, Jaw Clenching, Treatment


What is bruxism (teeth grinding)?

You probably grind your teeth or clench them once in a while. Occasionally grinding your teeth most likely won’t cause any harm.

But if you regularly grind your teeth, you may have a condition called bruxism. It can hurt your:

  • Jaw muscles.
  • Teeth.
  • Temporomandibular joints (TMJs), which connect your jawbone to your skull and allow you to open and close your mouth.

What are the types of bruxism?

Bruxism can happen when you’re awake or asleep. The grinding action is the same, but awake and asleep bruxism are considered two separate conditions:

  • Awake bruxism: You clench your jaw and grind your teeth during the day with this condition. It’s usually tied to emotional issues. Feeling anxious, stressed or angry can lead to teeth grinding. But so can concentrating on something. Awake bruxism often doesn’t need treatment, if you’re more likely to notice and stop. Stress management can help and learning ways to become aware can also help reduce the frequency.
  • Sleep bruxism: You grind your teeth while asleep with this form, which may cause more harm. You may not get the help you need since you’re unaware it is happening. Another challenge with sleep bruxism is that people don’t realize how strong they’re clenching their jaw and teeth. They can use up to 250 pounds of force, causing jaw pain and teeth problems. Clenching can also lead to headaches.

Why is teeth grinding harmful?

Teeth grinding can cause several problems:

  • Changes in how you look (aesthetic problems) and your facial profile.
  • Fractured or loosened teeth.
  • Harming your TMJs and jaw and neck muscles.
  • Loss of teeth.
  • Wearing down of teeth.

Can children have teeth grinding?

Like adults, children can have bruxism. Parents may hear their children grinding their teeth in their sleep. But bruxism in children may not lead to long-term damage. Children’s teeth and jaws change quickly, and they may outgrow bruxism by the time they lose their baby teeth.

Still, some children continue to grind their teeth until their teenage years. And regardless of age, teeth grinding in children can lead to:

While stress is a main cause of bruxism in adults, that’s not usually the case with children. Teeth grinding in children may come from:

  • Allergies.
  • Misaligned teeth.
  • Mouth irritation.
  • Obstructive sleep apnea.
  • Heredity.

Talk to a healthcare provider or dentist if your child’s teeth look worn or you hear grinding. Also get any complaints of jaw or teeth pain checked out. Your provider may recommend a night guard for teeth grinding. This night guard can help until they outgrow bruxism. If the bruxism turns out to be stress related, providers can also recommend stress relief options.

Who is at risk for bruxism?

Men and women get bruxism at roughly the same rate. If you have a family history of teeth grinding, you may face a higher risk. Other risk factors include:

  • Personality type, as people who are very driven may be more prone to teeth grinding.
  • Stress.
  • Cigarette smoking and caffeine use.
  • Certain anti-anxiety medications.

How common is bruxism?

Bruxism is a common sleep disorder. It affects about 10% of adults and up to 15% of children.

Symptoms and Causes

What causes teeth grinding?

There are many causes of bruxism, including:

Lifestyle habits, such as drinking alcohol, using cigarettes and recreational drugs, and consuming a lot of caffeine (more than six cups of coffee a day). People who drink and smoke are twice as likely to grind their teeth as people who don’t.

  • Sleep disorders.
  • Stress and anxiety.
  • Taking certain medications, including a class of anti-anxiety drugs called selective serotonin reuptake inhibitors (SSRIs).

Is bruxism a sleep disorder?

Researchers have studied sleep bruxism. They’ve found it starts as a type of sleep disturbance in the central nervous system. Factors that can make the problem worse include:

  • Stress and anxiety.
  • Alcohol.
  • Certain drugs and diseases.
  • Heredity (if people in your family have this problem).
  • Smoking.

What are the symptoms of bruxism?

You may not realize that you’re grinding your teeth at night. But signs that you may have bruxism include:

  • Disrupted sleep.
  • Headaches or facial pain, especially in the morning.
  • Earaches.
  • Painful or loose teeth.
  • Sore jaw muscles.
  • Teeth fractures.
  • Wear on teeth.
  • TMJ, which sounds like clicking or popping in the jaw.
  • Pain with eating.
  • Jaw locking.

Diagnosis and Tests

How is bruxism diagnosed?

If you think you may be grinding your teeth, see your dentist. They can examine your TMJs, jaw muscles and teeth for signs of bruxism.

Healthcare providers can often diagnose bruxism based on the physical exam and your symptoms. But in some cases, you may need a sleep study called polysommography. This test takes place in a sleep center and can provide a definitive diagnosis.

Management and Treatment

How is bruxism treated?

There are no medications to stop teeth grinding. Your dentist may fit you with a night guard. You put this customized orthotic device in your mouth before bed. It protects your teeth, muscles and TMJs from the force created during grinding. Your healthcare provider may also prescribe a muscle relaxant to take before bed.

What else can I do to stop grinding my teeth?

Your provider may review your medications to see if any are contributing to bruxism. Stress may also be a factor. Talk to your healthcare provider about ways to reduce stress:

Other ways to cut back on teeth grinding include:

  • Avoid alcohol and smoking.
  • Avoid or reduce caffeine in foods and drinks such as colas, chocolate and coffee.
  • Be aware of teeth clenching during the day. Try to stop yourself: Keep your lips together, teeth apart and tongue behind the front teeth.
  • Don’t chew on nonfood items, such as pencils or pens. Also avoid constant, daily gum chewing.


How can I prevent teeth grinding?

To prevent bruxism:

  • Avoid cigarettes, drugs and alcohol, which can make sleep bruxism worse.
  • Get regular dental checkups. A dentist can treat problems from teeth grinding as soon as possible, so you can avoid long-term damage.
  • Treat other dental problems you may have, including misaligned or missing teeth.

Outlook / Prognosis

What’s the outlook for people with bruxism?

The outlook for people with bruxism is good. Children often outgrow teeth grinding by adolescence. For adults, follow your provider’s recommendations. For example, if you have a night guard for teeth grinding, wear it regularly. Sticking with your treatment plan helps improve symptoms, so you feel your best.

Living With

How can I best take care of my jaw and teeth?

You might find that certain sleeping positions cause you to grind your teeth more. You may be able to decrease bruxism by avoiding those positions.

Also look for ways to manage stress. Many people find that stress management can greatly relieve teeth grinding. In addition to talk therapy, you can try at-home stress relief, including a warm bath before bed and listening to soothing music.

What else should I ask my provider about bruxism?

If you have bruxism, ask your provider:

  • Do I need a night guard?
  • Do I need dental treatment to fix teeth problems?
  • What other treatments can help stop teeth grinding?
  • Will I need a sleep study to diagnose bruxism?
  • What medications can help?
  • Will there be long-term effects from teeth grinding?

A note from Cleveland Clinic

Teeth grinding, or bruxism, happens when you clench and grind your teeth. It can happen when you’re awake or asleep. Sleep bruxism can cause more problems since you don’t realize you’re doing it. Without treatment, teeth grinding can lead to problems with your teeth, jaw muscles and jaw joints. If you wake up with headaches or have jaw soreness, see a healthcare provider. They can find the right treatment for you, which may include a night guard for sleeping. Stress management can also help reduce teeth grinding.

Stress Side Effects and Your Jaw

Have you recently noticed that your teeth are sore or sensitive to cold? Do your jaw muscles hurt in the morning? Does your face ache?

You’re not alone. As a result of the stress of our current circumstances, many of our patients are noticing symptoms that they haven’t had before. In particular, a significant uptick in facial muscle pain and temporomandibular joint dysfunction (TMJ).

Many transient cases of TMJ can be managed by simply being more aware of your own behavior (such as clenching during the day), and taking measures such as eating a soft diet, massaging affected muscles, and applying a warm compress at night. However, there are times when the symptoms arise or are exacerbated by discrepancies in the way that your teeth come together.

The temporomandibular joint is a actually highly complex set of two joints that connect your jaw to your skull. Any symptoms related to the function of the joint are collectively referred to as TMJ syndrome and may include the following:

Common symptoms of TMJ include:
  • Headaches with any pattern or consistency. For example, waking up in the morning with a headache, or every afternoon while you are working, or after exercising.
  • Increased cold sensitivity or spontaneous throbbing
  • Aching, tired feeling in your facial muscles
  • Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouth wide
  • Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth — or when chewing
  • Difficulty chewing or a sudden onset of an uncomfortable bite – as if the upper and lower teeth don’t fit together properly
What causes TMJ?

Common causes of temporomandibular joint disorder include excess stress on the joint associated with clenching or grinding teeth. The effect of the excess stress on the joint may be exacerbated by discrepancies in your bite. 

Bruxism is a condition that occurs when you unconsciously clench or grind your teeth during sleep. It is often associated with morning headaches or a feeling of tiredness in your jaw upon waking.

While stress-induced TMJ is the most common, TMJ facial pain may also result from a variety of other factors, such as genetics, arthritis or jaw injury. 

You don’t have to live with TMJ pain

In most cases, the pain and discomfort associated with TMJ disorders is temporary and may be relieved with self-managed care or nonsurgical treatments.

You may be able to help yourself by following some simple steps:  

  • Make a conscious effort to avoid clenching your teeth during the day. Lips together and teeth apart should become your mantra!
  • Try a soft diet.
  • Avoid chewy foods, like bagels or gum.
  • Apply a warm compress to the jaw muscles before bed to help relax the joints.

Some of the worst strain on your jaw may occur while you sleep, causing these issues to be particularly noticeable in the morning.  A custom-fitted dental night guard is a helpful appliance for treating TMJ disorder, because it can eliminate discrepancies in your bite that may trigger your symptoms and will effectively simulate a perfect bite.

If you have tried the above recommendations and symptoms persist, you may need to see us for an evaluation. Please call the office at 978 664 3141 or complete the Contact form here: Contact Us

Photo attribution: Kate Mango Star, Freepick.com

SSRI-associated bruxism

Neurol Clin Pract. 2018 Apr; 8(2): 135–141.

A systematic review of published case reports

Department of Neurology, Walter Reed National Military Medical Center, Bethesda, MD.

Corresponding author.

The views expressed in manuscript are those of the authors alone, and do not necessarily reflect the views of the US Department of Defense or Federal Government.

Received 2017 Aug 25; Accepted 2017 Dec 27.

Copyright © 2018 American Academy of NeurologyThis article has been cited by other articles in PMC.


Purpose of review

Antidepressant-associated movement disorders are a well-described phenomenon. However, antidepressant-associated bruxism, jaw pain, or jaw spasm, while reported in dental literature, is less commonly recognized among neurologists. We summarize the clinical features and treatment of antidepressant-associated bruxism and associated jaw pain through a systematic review of case reports.

Recent findings

Antidepressant-associated bruxism may occur in pediatric and adult patients, most commonly among female patients. Patients may develop symptoms with short-term and long-term antidepressant use. Fluoxetine, sertraline, and venlafaxine were the most commonly reported offending agents. Symptoms may begin within 3–4 weeks of medication initiation and may resolve within 3–4 weeks of drug discontinuation, addition of buspirone, or substitution with another pharmacologic agent. The incidence of this phenomenon is unknown.


Bruxism associated with antidepressant use is an underrecognized phenomenon among neurologists, and may be treated with the addition of buspirone, dose modification, or medication discontinuation.

Bruxism is a common stereotyped movement disorder characterized by repetitive clenching of the jaw and grinding of the teeth.1 Sleep bruxism is associated with sleep arousal, and is characterized by lateral teeth grinding. Patients often complain of jaw pain and trismus upon awakening, and bed partners often witness or hear grinding during nighttime hours. Bruxism can also occur during wakefulness, and is often associated with stress. Severe cases of bruxism can result in extreme tooth wear or tooth fracture.2 Jaw pain is common, along with headaches, facial pain, and sleep disorders. Despite its comorbid association with neurologic disorders such as migraine, facial pain, and sleep dysregulation, much of the literature on bruxism is outside of general neurology in sleep medicine and dentistry. The causes of bruxism are poorly understood, and often related to emotional stress. The understanding of the cause of the condition is complex, thought to be entirely involuntary or as a habit/behavior described as parafunctional. Despite the notion of bruxism being a behavioral phenomenon, there are several case reports and series describing a possible relationship between bruxism and serotonergic antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs). Meta-analyses of these cases are lacking, and there are few data on the incidence, clinical manifestations, and mechanism of antidepressant-associated bruxism. We present a case of SSRI-associated bruxism encountered in our neurology clinic, followed by a systematic review of similar case reports. We also include a discussion of epidemiology and proposed pathophysiology of this phenomenon. Finally, we discuss effective treatment strategies based on literature review.

Case report

A 40-year-old woman with a history of anxiety, depression, and posttraumatic stress disorder presented with persistent right-sided jaw pain and jaw opening limitations for approximately 2 years. She had seen multiple providers for these symptoms, including orofacial pain and dentistry. She described her symptoms as an achy, persistent right-sided pain, worse in the morning. Her symptoms had been so severe that she had been unable to open her mouth widely or chew food on the right side. Consequently, she had only been eating soft foods and chewing food on the left side of her mouth. She denied headaches, numbness and tingling of the face, changes in vision and hearing, loss of taste, difficulty with coordination, or numbness, tingling, and weakness in any other parts of the body.

Over the course of her workup, the patient was fitted with a mouth guard for sleep bruxism, which did not improve her symptoms. Brain MRI obtained prior to her referral to neurology was unremarkable. Her only medications were sertraline 40 mg daily for depression and occasional cetirizine for allergic rhinitis. She had never taken dopamine-blocking therapies. Her neurologic examination at that time was notable for right-sided masseter hypertrophy and tenderness to palpation of the muscles of mastication bilaterally. She was noted to be cautious with opening her mouth for examination, and was unable to open it widely due to pain and spasm.

The patient’s symptoms were initially thought to be due to idiopathic refractory temporomandibular joint disorder with a possible oromandibular dystonia given her jaw opening limitations on the right side. She was treated with a trial of onabotulinum toxin injections to the right masseter. Three months later, the injections had had no effect on her jaw pain or jaw opening limitation (which was still painful). However, she was concerned that her jaw pain may have been related to her SSRI, revealing that her symptoms started soon after she began this medicine 2 years prior. As a result, she decided to discontinue her antidepressant. Approximately 3 days after discontinuing this medicine, her jaw pain and spasm completely resolved, and she was again able to fully open her mouth. After her depression symptoms worsened, she was started on venlafaxine. She noted that her jaw symptoms returned, but were less severe than with sertraline. The patient’s Adverse Drug Reaction Probability Scale score for sertraline was 9, correlating to Definite Adverse Drug Reaction.3 Upon changing her venlafaxine to bupropion, her jaw pain resolved, and her depression was adequately treated.


Jaw pain associated with antidepressant use

Jaw pain and bruxism are common, associated with a wide variety of disorders. Idiopathic bruxism is estimated to affect between 5% and 20% of the adult population.1,4,5 Age at onset is typically between age 10 and 20, and children tend to be affected at similar rates compared to adults.1,4 Awake bruxism is more commonly observed in women,4 where no sex preference is observed in sleep bruxism.1 Children of sleep bruxers are more likely to develop sleep bruxism than children of people who never experienced either sleep or daytime bruxism, suggesting a possible genetic predisposition.1 Bruxism can resolve spontaneously and may recur later in life,5 but is overall less commonly observed among the elderly.4

The epidemiology of antidepressant-associated bruxism and jaw pain is unknown. Commonly reported adverse effects related to SSRI use include sexual dysfunction, drowsiness, and weight gain, which occur most commonly within the first 3 months of treatment.6 Among SNRIs, nausea, dry mouth, diaphoresis, dizziness, and headache are most common.7 Bupropion, a norepinephrine-dopamine reuptake inhibitor (NDRI), is more likely to cause weight loss when compared to other antidepressants, and is less likely to cause sexual dysfunction.8 Bruxism may be an underreported side effect of these medications, as data are limited to case reports and cross-sectional studies. Data may be limited by reporting bias or limited awareness of this effect by clinicians.

There is some evidence that bruxism and jaw pain may be associated with SSRI/SNRI use. Along with several case reports, one cross-sectional study assessed rates of sleep bruxism among patients taking serotonergic antidepressants compared to controls.5 The overall prevalence of bruxism was higher in the antidepressant group compared to the control group (24.3% vs 15.3%, p = 0.002), with highest prevalence of bruxism among patients taking paroxetine, venlafaxine, and duloxetine. This study also reported that most patients reported onset of bruxism within 4 months of starting their antidepressant, with a mean onset time of 2.85 months after starting therapy. Finally, while there was no significant relationship with sex, marital status, level of education, employment status, or smoking, mean patient age was higher among patients experiencing antidepressant-associated bruxism compared to controls who did not experience this effect (41.37 vs 37.48, p = 0.003). These data suggest that age may influence the development of bruxism in the setting of antidepressant use. Given the paucity of reports in the neurologic literature, further exploration of this topic may provide increased awareness among neurologists about the existence of this condition and effective management strategies. The objective of this article was to review the existing literature for the clinical features of antidepressant-associated bruxism, to identify common offending agents, and to explore successful treatment strategies.

Systematic review

Data sources and data extraction

We searched PubMed for case reports and case series relating to antidepressant-associated bruxism using the following search terms: “SSRI bruxism,” “SNRI bruxism,” “citalopram bruxism,” “escitalopram bruxism,” “buspirone bruxism,” and “antidepressant bruxism.” Search was not limited by publication date, and we applied no language restrictions. Case reports, case series, and letters to the editor containing reports of at least one case of suspected antidepressant-associated bruxism were included. Articles were excluded if they did not include information regarding symptom management. We identified additional reports from the reference lists of retrieved reports and from reviews found during literature search. We recorded demographic information, psychiatric diagnoses, time to symptom onset, offending agents, interventions, and time to symptom resolution for inclusion in our systematic review. The purpose of this systematic review was to compare clinical features and effective treatment interventions of antidepressant-associated bruxism using patient data from published case reports.


Literature search initially returned 67 unique articles, with 4 additional articles identified using references in articles above, for a total of 71 articles reviewed for inclusion. Of the 71 total articles reviewed, 42 were excluded for failing to meet inclusion criteria, and a total of 29 articles were included, containing a total of 45 unique cases.9-37 Basic demographic data (age and sex) for each patient were included in all but 1 article, which documented offending agent and treatment, but did not include sex or age of the 2 patients presented.9 Data from the case presented above were added to the total number of cases and included in data analysis ( and ).

Table 1

Patient data included in literature search and analysis, by article

Table 2

A total of 46 patients were included in this analysis. The average age was 39.8 years, with an age range of 7–81 years. Thirty of the 44 reported patients were female (68%). Most patients (76%) were being treated for a diagnosis of major depressive disorder, generalized anxiety disorder, or a combination of these conditions (data not shown below). Other diagnoses included bipolar II, attention-deficit/hyperactivity disorder, somatoform disorder, fibromyalgia, obsessive-compulsive disorder, and complicated grief.

A total of 10 offending agents were identified. Six SSRIs were reported (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), along with 3 SNRIs (atomoxetine, duloxetine, and venlafaxine), and 1 NDRI (bupropion). The majority of agents reported were SSRIs (74%), followed by SNRIs (24%). The most commonly reported agents were fluoxetine (12 cases), followed by venlafaxine and sertraline (7 cases each).

A total of 11 beneficial interventions were reported. The most commonly reported intervention was the addition of buspirone to the patient’s current regimen (reported in 20 cases), followed by cessation of the medicine (12 cases) and dose reduction (7 cases). One article reported successful use of electroconvulsive therapy in alleviating symptoms after 2 weeks of adjunctive tandospirone was ineffective.10 Three articles reported alleviation of symptoms with cessation of the offending agent in combination with buspirone therapy.11-13 One case reported spontaneous resolution of symptoms without any interventions.14 In the above articles, buspirone dosage typically ranged between 5 and 30 mg administered in 1–3 doses per day.

Time to onset of symptoms, in most cases, was between 3 and 4 weeks. One case reported bruxism of many years that was attributed to antidepressant use only after discontinuation of the medication resulted in rapid cessation of symptoms.15 Most patients reported cessation of symptoms, from the time of last intervention, between 2 and 3 weeks. The case of spontaneous symptom resolution without intervention, as mentioned, reported resolution after 4 weeks.14


The literature suggests an association with serotonergic antidepressants inducing jaw pain/jaw spasm reversible syndrome. Data from the pooled case reports above suggest that antidepressant-associated bruxism may occur in patients of any age, including children.16,17 Symptoms tend to appear within 3–4 weeks of beginning the antidepressant medicine or undergoing dose titration. Symptom resolution may be achieved through the addition of serotonin 1A (5HT1A) partial agonists (buspirone, tandospirone), by dose reduction, by medicine cessation, or by the addition of other pharmacologic agents, including tricyclic antidepressants (amitriptyline), antipsychotics (aripiprazole, chlorpromazine), norepinephrine-dopamine reuptake inhibitors (bupropion), or serotonin 2A/2C antagonist and reuptake inhibitors (trazodone). Symptoms may also resolve over time without pharmacologic intervention.

The available literature suggests a strategy for treatment of patients with SSRI/SNRI-associated jaw pain. Several cases reported success in alleviating symptoms with the addition of buspirone. This observation can be instructive in both understanding the underlying pathophysiologic mechanisms of antidepressant-associated bruxism, as well as in providing a foundation for treatment recommendations. First, buspirone is a serotonin 1A (5HT1A) partial agonist at both presynaptic and postsynaptic receptors at various sites, including the amygdala, prefrontal cortex, thalamus, and striatum.38 Buspirone is commonly used as a generalized anxiolytic, but can also be used to augment SSRIs/SNRIs, by combining its 5HT1A partial agonism with the serotonin transporter inhibition achieved by the SSRI/SNRI. It is also believed that buspirone may work via adaptive neuronal and receptor mechanisms, instead of acute receptor occupancy, which may explain the observed 2- to 3-week latency in alleviating bruxism associated with serotonergic antidepressants. This may also explain why buspirone is ineffective in treating idiopathic bruxism. Therefore, buspirone may help to alleviate antidepressant-associated bruxism through its partial agonism of striatal 5HT1A receptors. Interestingly, aripiprazole is also a 5HT1A partial agonist throughout the brain, and may work through a similar mechanism to alleviate antidepressant-associated bruxism.38

The above data suggest that the addition of buspirone 5–10 mg up to 3 times daily may be an effective first-line option for alleviating antidepressant-associated bruxism, particularly in patients who may not tolerate dose reduction or medication cessation. If the patient can tolerate dose reduction or drug discontinuation, this may likewise be a reasonable course of action. Finally, in patients who are not experiencing severe symptoms and who are satisfied with antidepressant effects otherwise, simple monitoring for spontaneous resolution of symptoms may be considered.

We recognize the limitations of this systematic review. Principally, the analysis above is based on a collection of case reports, and does not represent randomized or placebo-controlled study data. Publication bias limits the true number of cases available in the literature for review, and therefore other offending agents or treatments may have been observed by others that are not represented here. Finally, further prospective study would be helpful to elucidate the true underlying effect of the interventions described above compared to watchful waiting for symptom resolution.

Bruxism may develop as an adverse reaction to antidepressant therapy, and is most likely to develop within 2–3 weeks of medication introduction or dose titration. This phenomenon may be seen in a variety of serotonergic antidepressants, and may be most associated with fluoxetine, sertraline, or venlafaxine. Patients who experience this condition may benefit from the addition of buspirone 5 and 10 mg in daily, twice daily, or 3 times daily dosing; dose reduction and antidepressant cessation may also be considered. Antidepressant-associated bruxism may be an underreported condition, particularly in the neurology clinic. Further prospective trials may help to elucidate optimal therapies for this condition.


  • → Bruxism associated with antidepressant use is an underrecognized phenomenon, particularly among neurologists.

  • → Antidepressant-associated bruxism/jaw pain most commonly begins within 3–4 weeks of medication initiation or dose titration, and can resolve within 3–4 weeks of drug discontinuation.

  • → Patients commonly present with jaw pain, teeth grinding, and trismus in the setting of drugs like fluoxetine, sertraline, and venlafaxine.

  • → Besides drug discontinuation, alternative treatments for drug-induced bruxism include the addition of buspirone or the substitution of other pharmacologic agents.

Author contributions

A. Garrett: study concept and design, acquisition of data, analysis and interpretation of data. J. Hawley: study supervision, critical revision of manuscript for intellectual content.

Study funding

No targeted funding reported.


1. American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic and Coding Manual. 3rd ed
Darien, IL: American Academy of Sleep Medicine; 2014. [Google Scholar]3. Naranjo CA, Busto U, Sellers EM, et al. .
A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther
1981;30:239–245. [PubMed] [Google Scholar]4. Shetty S, Pitti V, Satish Babu CL, Surendra Kumar GP, Deepthi BC.
Bruxism: a literature review. J Indian Prosthodont Soc
2010;10:141–148. [PMC free article] [PubMed] [Google Scholar]5. Uca AU, Uğuz F, Kozak HH, et al. .
Antidepressant-induced sleep bruxism: prevalence, incidence, and related factors. Clin Neuropharmacol
2015;38:227–230. [PubMed] [Google Scholar]6. Hu XH, Bull SA, Hunkeler EM, et al. .
Incidence and duration of side effects and those rated as bothersome with selective serotonin reuptake inhibitor treatment for depression: patient report versus physician estimate. J Clin Psychiatry
2004;65:959–965. [PubMed] [Google Scholar]8. Patel K, Allen S, Haque MN, Angelescu I, Baumeister D, Tracy DK.
Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Ther Adv Psychopharmacol
2016;6:99–144. [PMC free article] [PubMed] [Google Scholar]10. Miyaoka T, Yasukawa R, Mihara T, et al. .
Successful electroconvulsive therapy in major depression with fluvoxamine-induced bruxism. J ECT
2003;19:170–172. [PubMed] [Google Scholar]11. Albayrak Y, Ekinci O.
Duloxetine-induced nocturnal bruxism resolved by buspirone: case report. Clin Neuropharmacol
2011;34:137–138. [PubMed] [Google Scholar]12. Jaffee MS, Bostwick JM.
Buspirone as an antidote to venlafaxine-induced bruxism. Psychosomatics
2000;41:535–536. [PubMed] [Google Scholar]14. Iskandar JW, Wood B, Ali R, Wood RL.
Successful monitoring of fluoxetine-induced nocturnal bruxism: a case report. J Clin Psychiatry
2012;73:366. [PubMed] [Google Scholar]15. Raja M, Raja S.
Two cases of sleep bruxism associated with escitalopram treatment. J Clin Psychopharmacol
2014;34:403–405. [PubMed] [Google Scholar]16. Çolak Sivri R, Akça ÖF.
Buspirone in the treatment of fluoxetine-induced sleep bruxism. J Child Adolesc Psychopharmacol
2016;26:762–763. [PubMed] [Google Scholar]17. Yüce M, Karabekiroğlu K, Say GN, Müjdeci M, Oran M.
Buspirone use in the treatment of atomoxetine-induced bruxism. J Child Adolesc Psychopharmacol
2013;23:634–635. [PMC free article] [PubMed] [Google Scholar]18. Ak M, Gulsun M, Uzun O, Gumus HO.
Bruxism associated with serotonin reuptake inhibitors: two cases. J Clin Psychopharmacol
2009;29:620–622. [PubMed] [Google Scholar]19. Alonso-Navarro H, Martín-Prieto M, Ruiz-Ezquerro JJ, Jiménez-Jiménez FJ.
Bruxism possibly induced by venlafaxine. Clin Neuropharmacol
2009;32:111–112. [PubMed] [Google Scholar]20. Bostwick JM, Jaffee MS.
Buspirone as an antidote to SSRI-induced bruxism in 4 cases. J Clin Psychiatry
1999;60:857–860. [PubMed] [Google Scholar]21. Detweiler MB, Harpold GJ.
Bupropion-induced acute dystonia. Ann Pharmacother
2002;36:251–254. [PubMed] [Google Scholar]22. Ellison JM, Stanziani P.
SSRI-associated nocturnal bruxism in four patients. J Clin Psychiatry
1993;54:432–434. [PubMed] [Google Scholar]23. Fitzgerald K, Healy D.
Dystonias and dyskinesias of the jaw associated with the use of SSRIs. Hum Psychopharmacol
1995;10:215–219. [Google Scholar]24. Grinshpoon A, Weizman A, Amrami-Weizman A.
The beneficial effect of trazodone treatment on escitalopram-associated nocturnal bruxism. J Clin Psychopharmacol
2014;34:662. [PubMed] [Google Scholar]25. Jose SP.
Venlafaxine-induced severe sleep bruxism in a patient with generalized anxiety disorder. Indian J Psychol Med
2015;37:249–250. [PMC free article] [PubMed] [Google Scholar]26. Kishi Y.
Paroxetine-induced bruxism effectively treated with tandospirone. J Neuropsychiatry Clin Neurosci
2007;19:90–91. [PubMed] [Google Scholar]27. Kuloglu M, Ekinci O, Caykoylu A.
Venlafaxine-associated nocturnal bruxism in a depressive patient successfully treated with buspirone. J Psychopharmacol Oxf Engl
2010;24:627–628. [PubMed] [Google Scholar]28. Lobbezoo F, van Denderen RJ, Verheij JG, Naeije M.
Reports of SSRI-associated bruxism in the family physician’s office. J Orofac Pain
2001;15:340–346. [PubMed] [Google Scholar]29. Mendhekar D, Lohia D.
Worsening of bruxism with atomoxetine: a case report. World J Biol Psychiatry
2009;10:671–672. [PubMed] [Google Scholar]30. Mukherjee S, Sen S, Biswas A, Chatterjee SS, Tripathi SK.
Escitalopram induced bruxism: a case report. Sch J Appl Med Sci
2014;2:1162–1163. [Google Scholar]31. Şahin Onat S, Malas FÜ.
Duloxetine-induced sleep bruxism in fibromyalgia successfully treated with amitriptyline. Acta Reumatol Port
2015;40:391–392. [PubMed] [Google Scholar]32. Oulis P, Dimitrakopoulos S, Konstantakopoulos G, Tsaltas E, Kollias K.
Low-dose aripiprazole in the treatment of SSRI-induced bruxism. J Neuropsychiatry Clin Neurosci
2012;24:E39. [PubMed] [Google Scholar]33. Pavlovic ZM.
Buspirone to improve compliance in venlafaxine-induced movement disorder. Int J Neuropsychopharmacol
2004;7:523–524. [PubMed] [Google Scholar]34. Ranjan S. S chandra P, Prabhu S.
Antidepressant-induced bruxism: need for buspirone?
Int J Neuropsychopharmacol
2006;9:485–487. [PubMed] [Google Scholar]35. Romanelli F, Adler DA, Bungay KM.
Possible paroxetine-induced bruxism. Ann Pharmacother
1996;30:1246–1248. [PubMed] [Google Scholar]36. Sabuncuoglu O, Ekinci O, Berkem M.
Fluoxetine-induced sleep bruxism in an adolescent treated with buspirone: a case report. Spec Care Dentist
2009;29:215–217. [PubMed] [Google Scholar]37. Soyata AZ, Oflaz S.
Gabapentin treatment in bruxism associated with fluoxetine. J Clin Psychopharmacol
2015;35:481–482. [PubMed] [Google Scholar]38. Stahl SM.
Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 4th ed
Cambridge: Cambridge University Press; 2013. [Google Scholar]

Bruxism: Teeth Grinding at Night

Clenching and grinding your teeth is a common involuntary reaction to anger, fear, or stress. In some people, this reaction plays out repeatedly through the day, even if they aren’t responding to an immediate stressor. This involuntary teeth grinding is known as bruxism.

Bruxism can happen while awake or asleep, but people are much less likely to know that they grind their teeth when sleeping. Because of the force applied during episodes of sleep bruxism, the condition can pose serious problems for the teeth and jaw and may require treatment to reduce its impact.

What Is Sleep Bruxism?

Sleep bruxism is teeth grinding that happens during sleep. Sleep bruxism and bruxism while awake are considered to be distinct conditions even though the physical action is similar. Of the two, awake bruxism is more common.

A key challenge with sleep bruxism is that it is much harder for people to be aware that they are grinding their teeth while sleeping. Relatedly, a sleeping person doesn’t realize their bite strength, so they more tightly clench and grind their teeth, employing up to 250 pounds of force.

How Common Is Sleep Bruxism?

Sleep bruxism is more common in children, adolescents, and young adults than middle-aged and older adults. Exact numbers of how many people have sleep bruxism are hard to come by because many people are not aware that they grind their teeth.

Statistics about sleep bruxism in children are the hardest to pin down. Studies have found anywhere from around 6% to up to nearly 50% of children experience nighttime teeth grinding. It can affect children as soon as teeth come in, so some infants and toddlers grind their teeth.

In adolescents, the prevalence of sleep bruxism is estimated to be around 15%. It becomes less common with age as around 8% of middle-aged adults and only 3% of older adults are believed to grind their teeth during sleep.

What Are the Symptoms of Sleep Bruxism?

The main symptom of sleep bruxism is involuntary clenching and grinding of the teeth during sleep. The movements resemble chewing but generally involve more force.

People with sleep bruxism don’t grind their teeth throughout the night. Instead, they have episodes of clenching and grinding. People may have very few episodes per night or up to 100. The frequency of episodes is often inconsistent, and teeth grinding may not occur every night.

Some amount of mouth movement is normal during sleep. Up to 60% of people make occasional chewing-like motions known as rhythmic masticatory muscle activities (RMMA), but in people with sleep bruxism, these occur with greater frequency and force.

The majority of sleep bruxism takes place early in the sleep cycle during stages 1 and 2 of non-REM sleep. A small percentage of episodes can arise during REM sleep.

It’s normal for people who grind their teeth at night to not be cognizant of this symptom unless they are told about it by a family member or bed partner. However, other symptoms can be an indication of sleep bruxism.

Jaw pain and neck pain are two frequent signs of teeth grinding. These occur because of the tightening of these muscles during episodes of bruxism. Morning headaches that feel like tension headaches are another potential symptom. Unexplained damage to teeth can also be a sign of nighttime clenching and grinding of teeth.

What Are the Consequences of Sleep Bruxism?

Long-term consequences of sleep bruxism can include significant harm to the teeth. Teeth may become painful, eroded, and mobile. Dental crowns, fillings, and implants can also become damaged.

Teeth grinding can increase the risk of problems with the joint that connects the lower jaw to the skull, known as the temporomandibular joint (TMJ). TMJ problems can provoke difficulty chewing, chronic jaw pain, popping or clicking noises, locking of the jaw, and other complications.

Not everyone with sleep bruxism will have serious effects. The extent of symptoms and long-term consequences depend on the severity of the grinding, the alignment of a person’s teeth, their diet, and whether they have other conditions that can affect the teeth like gastroesophageal reflux disease (GERD).

Nighttime teeth grinding can also impact a bed partner. The noise from clenching and grinding can be bothersome, making it harder for a person sharing the bed to fall asleep or stay asleep as long as they would like.

What Causes Sleep Bruxism?

Multiple factors influence the risk of sleep bruxism, so it’s usually not possible to identify one single cause for why people grind their teeth. That said, certain risk factors are associated with a greater probability of sleep bruxism.

Stress is one of the most significant of these risk factors. Clenching the teeth when facing negative situations is a common reaction, and that can carry over to episodes of sleep bruxism. Teeth grinding is also believed to be connected to higher levels of anxiety.

Researchers have determined that sleep bruxism has a genetic component and can run in families. As many as half of people with sleep bruxism will have a close family member who also experiences the condition.

Episodes of teeth grinding appear to be connected to changing sleep patterns or microarousals from sleep. Most teeth grinding is preceded by increases in brain and cardiovascular activity. This may explain the associations that have been found between sleep bruxism and obstructive sleep apnea (OSA), which causes temporary sleep interruptions from lapses in breathing.

Numerous other factors have been associated with sleep bruxism including cigarette smoking, alcohol consumption, caffeine intake, depression, and snoring. Further research is needed to better understand possible causal connections and whether and how these factors affect sleep bruxism.

How Is Sleep Bruxism Diagnosed?

Sleep bruxism is diagnosed by a doctor or a dentist, but the diagnostic process can vary depending on the type of health professional providing care.

An overnight study in a sleep clinic, known as polysomnography, is the most conclusive way to diagnose sleep bruxism. However, polysomnography can be time-consuming and expensive and may not be necessary in certain cases. Polysomnography can identify other sleep problems, like OSA, so it may be especially useful when a person has diverse sleep complaints.

For many people, the presence of symptoms like tooth damage and jaw pain combined with reports of teeth grinding from a bed partner may be sufficient to determine that a person has sleep bruxism.

Home observation tests can monitor for signs of teeth grinding, but these tests are considered to be less definitive than polysomnography.

What Are the Treatments for Sleep Bruxism?

There is no treatment that can completely eliminate or cure teeth grinding during sleep, but several approaches can decrease episodes and limit damage to the teeth and jaw.

Some people who grind their teeth have no symptoms and may not need treatment. Other people may have symptoms or greater risk of long-term problems, and in these cases, treatment is usually necessary.

The best treatment for sleep bruxism varies based on the individual and should always be overseen by a doctor or dentist who can explain the benefits and downsides of a therapy in the patient’s specific situation.

Stress Reduction

High levels of stress contribute to bruxism when awake and asleep, so taking steps to reduce and manage stress may help naturally decrease teeth grinding.

Reducing exposure to stressful situations is ideal, but of course, it’s impossible to completely eliminate stress. As a result, many approaches focus on combating negative responses to stress in order to reduce its impact.

Techniques for reframing negative thoughts are part of cognitive behavioral therapy for insomnia (CBT-I), a talk therapy for improving sleep that may address anxiety and stress as well. Improving sleep hygiene and employing relaxation techniques can have added benefits for falling asleep more easily.


Medications help some people reduce sleep bruxism. Most of these drugs work by altering brain chemicals to reduce muscle activity involved in teeth grinding. Botox injections are another way of limiting muscle movement and have shown effectiveness in more severe cases of sleep bruxism.

Most medications have side effects that may make them inappropriate for some patients or difficult to use over the long-term. It is important to talk with a doctor before taking any medication for sleep bruxism in order to best understand its potential benefits and side effects.


Various types of mouthpieces and mouthguards, sometimes called night guards, are used to reduce damage to the teeth and mouth that can occur because of sleep bruxism.

Dental splints can cover the teeth so that there is a barrier against the harmful impact of grinding. Splints are often specially designed by a dentist for the patient’s mouth but are also sold over-the-counter. They may cover just a section of teeth or cover a wider area, such as the whole upper or lower teeth.

Other types of splints and mouthpieces, including mandibular advancement devices (MAD), work to stabilize the mouth and jaw in a specific position and prevent clenching and grinding. MAD work by holding the lower jaw forward, and they are commonly used to reduce chronic snoring.

Symptom Relief

Another component of treatment is relieving symptoms to better cope with sleep bruxism.

Avoiding gum and hard foods can cut down on painful movements of the jaw. A hot compress or ice pack applied to the jaw may provide temporary pain relief.

Facial exercises help some people reduce the pain in their jaw or neck. Facial relaxation and massage of the head and neck area may further reduce muscle tension. A doctor or dentist may be able to suggest specific exercises or make a referral to an experienced physical therapist or massage therapist.

  • Was this article helpful?
  • YesNo

Bruxism and hypertonicity of the chewing muscles

Preparations of botulinum toxin type A are better known in our country as botox and are consistently associated with getting rid of early wrinkles. But there are a number of inaccuracies here. Firstly, botox is not a group of drugs and not an active substance, but the trade name of a very specific drug, which, nevertheless, has become a household name, that is, it is used to refer to all such drugs in general. And secondly, the range of tasks for such funds is much wider!

What are the advantages of botulinum therapy “Botulax” in the treatment of bruxism?

  • Myorelaxation Complete relaxation of tight chewing muscles and elimination of painful spasm.
  • Long lasting effect After one treatment, the relaxing effect lasts for several months.
  • Fast relief from pain The drug begins to act immediately and gently relieves stress and discomfort.
  • Point effect The drug is injected at strictly defined points and does not affect the work of other facial structures.
  • Getting rid of a bad habit You will imperceptibly lose the habit of clenching your jaws and aggravating the effects of bruxism.
  • Maximum safety The drug does not cause addiction and is completely eliminated from the body.

There is a solution for every case!

Botulinum therapy can help if you have a habit of clenching your jaws tightly and grinding your teeth, you suffer from increased abrasion of enamel and destruction of crowns.

Symptoms of masticatory muscle hypertonicity and bruxism

  • the chewing surfaces of the teeth become worn out and flat (the incisal edges disappear),
  • the enamel of the teeth is chipping, wedge-shaped defects appear, fillings fly out, the teeth are quickly destroyed, loosened, the gums hurt,
  • you experience discomfort when opening your mouth, while eating or yawning – there are clicks, crunching,
  • you or your loved ones notice that you are grinding your teeth – the characteristic grinding occurs mainly at night (the so-called “night bruxism”), when it is difficult for a person to control himself in a dream,
  • reduces the jaw – you cannot fully open or close your mouth, the jaw seems to be blocked,
  • it is difficult for you to keep your mouth open for a long time, overexertion and pain appear with bruxism,
  • when talking or while chewing, you feel that the facial muscles are “clogged”, tired,
  • when you are angry, tense, or just working with concentration – your mouth is tightly closed, lips are pursed, teeth are closed, you are literally clenching your jaws,
  • there are problems with the bite – the teeth do not close properly, the jaws are displaced relative to each other, which is why you bite your cheeks or tongue,
  • After concentrated work or under stress, you often have a pressing sensation in the temples, pain and dizziness,
  • you notice ringing and tinnitus,
  • Over time, the lower half of your face has visually become square, heavy,
  • there are problems with posture – you are slouching, your lower back hurts, your neck is numb, one shoulder is higher than the other.

If you find one or more signs in yourself, then this is a reason to consult a specialist for medical help. And the first step is a comprehensive diagnosis and search for the causes of hypertension.

We approach the treatment of bruxism in a complex way!

We carry out in-depth diagnostics, find the exact cause of facial muscle spasm and eliminate it using advanced methods – safely and with high results.

Free consultation

The main causes of bruxism in adults and overexertion of the jaws

  • psycho-emotional reasons: nervous tension, prolonged stress, difficult experience of situations,
  • dental reasons: prolonged absence of teeth, malocclusion, diseases of the temporomandibular joint, complete or almost complete absence of teeth, uncomfortable and poorly manufactured crowns and prostheses, too high fillings, injuries of the dentition,
  • disorders of the musculoskeletal system: injuries and curvature of the spine, posture disorders, asymmetry in the work of the muscles of the body,
  • neurological causes: epilepsy, birth trauma, brain and central nervous system damage,
  • Other reasons: taking certain medications, smoking, abuse of caffeinated beverages.

“We always approach the solution of the problems of hypertonicity of the facial muscles in a complex manner. First of all, we look for causes from the maxillofacial apparatus – we carry out a complete diagnosis and examination, evaluate the work of the chewing muscles, identify the patient’s characteristic habits and collect the medical history. If necessary, we refer the patient to specialized specialists – a neurologist, a psychotherapist, etc. It is very important to cure hypertonicity – at least so that the patient in the future can start high-quality dental restoration without risks: implantation, prosthetics or treatment. “

Dzhutova Aida Vladimirovna,
implant surgeon, periodontist,
work experience over 9 years make an appointment

Botulinum therapy as one of the methods of treating hypertonicity and bruxism

Botulinum toxin type A, which is used in medicine and cosmetology, is able to relieve spasms and relax overstrained muscles, reducing their activity pointwise or completely immobilizing them. But not forever, but only for a certain period – during this time the body adapts to new circumstances and ceases to overstrain a certain area.That is, the therapeutic effect for such a diagnosis as “bruxism” persists for a long time, which is confirmed by numerous patient reviews.

How does it work?

Botulinum toxin type A is a neurotoxin produced by the bacteria Clostridium botulinum. It blocks nerve impulses from the central nervous system to muscle fibers. That is, in fact, the drug paralyzes a certain muscle without transmitting motor commands from the brain to it.

In medicine and cosmetology, it is used in ultra-small and highly purified forms – that is, it is not poisonous or toxic to the body!

The drug is injected at clearly defined points in order to affect only a specific muscle and not affect the work of others.The dosages are harmless and the blockage is reversible. Over time, the drug is completely eliminated from the body – it usually takes 5 to 7 months. Gradually, neuromuscular conduction in the area is restored, and mobility returns to the muscle – but since it was “resting”, the spasmodic fibers are smoothed out, and the body adapts and normalizes the load.

Botulinum toxin only relieves hypertonicity and allows the muscle to relax. This is the basis of its well-known cosmetological effect – smoothing of wrinkles by blocking the work of facial muscles.That is, it is wrong to think that botulinum toxin preparations can be “pumped up” – they do not increase the volume of soft tissues in any way.

To relieve excessive tension of the masticatory muscles, we use Botulax for intramuscular administration with 99% of the active substance content, thereby increasing the onset and duration of the therapeutic effect. And due to the high degree of purification of the drug, the risk of adverse reactions is minimized. The dosage and course are selected by the doctor strictly individually!

Indications and contraindications for botulinum therapy of masticatory muscles


  • soreness in the temporomandibular joint area,
  • limited mouth opening,
  • clicks, crunching, discomfort when moving the lower jaw,
  • pathological abrasion of enamel,
  • overexertion of the chewing muscles, their soreness and heaviness,
  • preparation for implantation, classical prosthetics (especially veneers), orthodontic treatment.


  • pustular skin lesions, ulcers, acute infection in the area of ​​the chewing muscles,
  • acute viral and infectious diseases,
  • neuromuscular diseases (myasthenia gravis),
  • constant intake of certain drugs and antibiotics,
  • pregnancy and lactation,
  • bleeding disorders,
  • diabetes,
  • allergic reactions to the components of the preparation,
  • Oncology and severe mental disorders.

The main stages of treatment

Step 1. Preparation for the procedure

A doctor, for example, an implant surgeon or an orthopedic surgeon, may refer you to botulinum therapy for comprehensive preparation before installing implants or dentures. But you can also go to the dentist yourself with complaints about the symptoms of dental bruxism. On the recommendation of a doctor, after consultation and diagnosis, you can start an injection course.

No complicated preparation required.2-3 days before the procedure, it is advisable to eliminate alcohol and reduce the consumption of tea, coffee and energy drinks, as well as stop taking blood-thinning drugs and antibiotics.

Experienced doctors who follow safety precautions!

Our specialists have undergone appropriate training, have certificates and accurately calculate the dosage of the drug. We carry out the treatment carefully, safely and with results!

Sign up

Step 2. Drug administration

The procedure itself takes an average of 20 minutes.The doctor conducts a control examination and marks the points for the injection of the drug.

The doctor takes the ampoule out of the refrigerator and opens the disposable syringe with the medicine with you – this way you will make sure that the storage conditions and the sterility of the medicine are observed. How many units of Botox do you need for bruxism? The specialist will calculate the dose individually, based on the severity of the symptoms, and divide it into 3-4 parts – that is, you will be given several small injections in different parts of the muscle. Disposable sterile syringes with thin needles are used for injections, so the procedure is almost painless.But for more comfort, the injection site can be numbed.

Step 3. Rehabilitation period

The drug begins to act immediately, but gains maximum strength gradually – approximately within 10-14 days, during which there is a complete relaxation of the spasmodic area. At this time, it is undesirable to overheat and overcool the problem area: that is, you will have to limit physical activity, trips to the bathhouse and sauna, as well as to the pool.

It is also important in the first days to touch the face to a minimum, not to steam or massage the injection sites.

The effect of the drug lasts up to 7 months, but may subside faster depending on individual characteristics. The doctor will tell you whether you need a second course at a follow-up appointment.

Cons of treatment of bruxism with Botulax

It is important to choose an experienced certified doctor who has been trained and has an official admission to injection therapy with botulinum toxin – this is a rather complicated procedure with its own subtleties. If the rules of storage, selection of dosage and administration technique are not followed, there may be complications.And if hematomas, bruises or slight swelling, in principle, go away on their own, then difficulties with swallowing and chewing should already be eliminated together with a doctor.

Our doctors have been trained and certified – it is completely safe to treat hypertonicity with botulinum therapy in our clinic

Why is botulinum therapy not enough to eliminate hypertonicity?

It should be understood that botox treatment in dentistry, as well as orthopedic treatment of bruxism (that is, the manufacture of special protective mouth guards for teeth with bruxism), is only an additional, not an independent method.Botulinum therapy protects against the effects of muscle overstrain – that is, visible relief will really come after the administration of the drug. The spasm will go away, the muscles will relax, you will stop involuntarily clenching your jaws and injuring your teeth. But as soon as the effect of botulinum toxin effect wears off, the problem may return, albeit to a lesser extent.

Of course, if it was just a formed habit on a nervous basis, and the causes of bruxism in psychosomatics or neurology, then during the treatment you have a good chance to completely get rid of it.But if the source lies in other pathologies and disorders, then you need to deal with their elimination as well: do your posture, solve occlusion problems, restore damaged teeth, replace low-quality dentures, etc. Botulinum therapy will be an effective complex measure.

Why are mouthguards needed for bruxism?

Another additional method of treating hypertonicity of the masticatory muscles in adults is wearing a special protective mouthguard (they are also called “kappa” or “trainer for bruxism”).These are plastic and dense onlays on the teeth, which are worn mainly at night, and in case of severe symptoms, they are worn during the day. They are made from hypoallergenic materials in the dental laboratory individually for the patient or at the factory, if we are talking about mass production.

But this is also an auxiliary measure – the mouth guard helps the muscles to relax, protects against abrasion of teeth and the consequences of bruxism, but does not remove the cause of hypertonia.

  • protection of enamel from cracks, chips, increased abrasion during involuntary compression of teeth,
  • protection of artificial crowns, prostheses (including those on implants) or braces from damage,
  • relieve tension and pain in the chewing muscles and joints,
  • protection against movement and displacement of teeth due to constant pressure on them,
  • Gradual return of the jaws and joints to the correct position in the event of their displacement (of course, this is how only individual mouthguards for bruxism made by a doctor work).

Choosing a mouth guard for bruxism: types and prices

Firstly, we distinguish between universal and individual options: finished products are manufactured in factories according to standard templates, and custom-made mouth guards are made exactly according to your size.

Also, as we mentioned, mouthguards are not only for night ones. The vast majority of patients suffer from teeth grinding during sleep, but a number of people cannot control the compression of their jaws during the day – for such cases, there are options for day linings that are more invisible and do not affect pronunciation.

A mouthguard for teeth against bruxism, especially a night one, can also be bought at a pharmacy (even in Moscow, at least in any other city). It costs about two to three times cheaper than a custom made one. The quality depends on the manufacturer, and even the universal options have limitations in size and shape, so they simply may not fit the dentition. But the most important limitation, which patients often forget, is that a ready-made patch should be bought on the recommendation of a dentist, and not self-medicate.Alas, without diagnostics and searching for the causes of spasm of the masticatory muscles, a ready-made mouthguard will do more harm than good.

Therefore, it is better if the mouthguard is made individually – according to the impression from your jaws. Individual mouthguards for bruxism, made during sleep, take into account the anatomical features to the smallest detail and do not overload the teeth. And if you need to wear the pad during the day, then it must correspond to the shape of the teeth in order to really be invisible during communication. You can order such a mouth guard for bruxism in dentistry by contacting a doctor with this problem.

Also, the doctor will give recommendations for how long a day it is better to put on the mouthguard, how to take care of it and when the product should be replaced.

What will happen if the hypertonicity of the masticatory muscles is not treated?

The chewing muscle, which drives the lower jaw, is the most powerful in the group of facial muscles. Reducing, it is capable of creating an effort of up to 80-100 kg (compare – in order to chew food efficiently, we use hardly 10% of this force).

Chronic spasm and overstrain of such strong chewing muscles creates excessive pressure on teeth, periodontal tissues and temporomandibular joints.From here, many unpleasant consequences for the jaw system and health in general develop along the chain:

  • enamel erasure and tooth height reduction,
  • chips and cracks, various defects of enamel,
  • frequent caries,
  • Overload of periodontal tissues and the development of gum disease – in particular, dangerous periodontitis,
  • Failure of fillings, crowns and prostheses,
  • threat to implants, the possibility of overloading and loosening,
  • swelling and inflammation of the chewing muscles,
  • temporomandibular joint dysfunction, pain and discomfort when chewing,
  • deterioration of blood circulation and tissue nutrition in the area of ​​muscle spasm,
  • intensification of headaches, dizziness, noise and pain in the ears,
  • overexertion of the muscles of the neck and back, development of problems with posture,
  • violation of facial aesthetics: angular jaw, deep wrinkles around the nose and lips, sunken face and reduction of the lower third.

Is it possible to undergo implantation for bruxism?

Only on condition that an integrated approach is applied to the implantation and subsequent installation of the prosthesis. In order for new teeth to serve you for a long time, we carefully plan the entire course of treatment from and to: we carry out in-depth diagnostics, identify related problems that may affect the result, take measures to eliminate them and work out the entire course of the operation and prosthetics step by step.

For example, often bruxism and problems with the temporomandibular joints in our patients are due to the fact that the dentition worked incorrectly for a very long time – the teeth were destroyed, the load was distributed unevenly.In itself, the return of all teeth through complex implantation is already a treatment for such conditions, since we think over prostheses taking into account the correct functioning of muscles and joints, normal closure of the dentition, etc. But the body will take time to adjust to normal work. And that is why, for cases of bruxism, we take additional measures – we increase the number of implants installed on the entire jaw, we make prostheses reinforced with a frame and made of more durable materials, we make protective soft mouth guards.

But if bruxism in adults cannot be cured only by dental methods, since the problem is not on the part of the jaw system, but in the same psychosomatics, then we refer the patient for treatment to a specialized specialist – and return to the restoration of teeth afterwards. We care about your health and do our best to ensure that the achieved treatment results are preserved not for a couple of years, but throughout your life.

Prevention of bruxism: how to help yourself on your own

By prevention, we mean measures that prevent hypertonicity and bruxism of teeth in adults, because without looking for the cause and monitoring a specialist, their treatment at home is an unsafe occupation, as for any disease.So if you notice alarming symptoms, your first step is to get diagnosed and get a comprehensive plan to fix this problem.

You may need the help of several specialists (neurologist, dentist, gastroenterologist, ENT doctor, psychotherapist), because bruxism occurs in different people for very different reasons. You may be prescribed courses of physiotherapy, taking certain medications (for example, magnesium preparations), but all this, of course, is very individual.

Self-help measures are helpful if you have agreed with your doctor.For example, you can do a light relaxing massage for bruxism in the chin and temples. There are also a number of exercises that can help relieve muscle spasms – it is helpful to repeat them regularly before bed. Relieve general stress: Sleep enough hours, walk more outdoors, reduce coffee and strong tea, take relaxing herbal baths, and avoid anxious situations.

All this will help consolidate the result of complex professional treatment and forget about unpleasant symptoms.

90,000 Capa for bruxism in Moscow

Bruxism is involuntary clenching of the jaws and grinding of teeth during sleep. A person suffering from bruxism does not interfere with sleep, but it creates discomfort for others.

The problem is that bruxism is fraught with consequences – damage to tooth enamel, crowns and prosthetic bridges, as well as inflammation of the jaw joints.

Getting rid of bruxism is not easy. But there is an effective way to avoid damage to health – mouthguard, special protective pad on the teeth.

Kappa for bruxism: indications for wearing

Bruxism is not a serious health threat, but given that the gripping force of the jaws during an attack is ten times the normal chewing pressure, this condition is very unsafe for your teeth, jaws, crowns and bridges.

The cause of bruxism has not yet been established. There are several theories about the onset of the disease: psychological, neurological, dental.There is still no consensus on this issue – scientists agree that the reason is a complex of various unfavorable factors to provoke bruxism: alcohol, smoking, stress, taking stimulants, mental and neurological disorders, gastrointestinal problems.

Kappa for bruxism: effect

Bruxism in a dream is a negative phenomenon, because a sleeping person is not able to control himself. Kappa does not cure bruxism, but protects against the effects of seizures.

Well-Fitted Kappa:

  1. Provides protection of tooth enamel from abrasion, chips, cracks, and crowns and other structures in the oral cavity from damage.
  2. Eliminates pain in the jaw during seizures, as it significantly reduces the pressure on the jaw.
  3. Allows you to avoid loosening of the teeth, their displacement, changes in bite.
  4. Improves sleep and the state of the nervous system.

Uncontrolled muscle contraction during an attack of bruxism can cause insomnia, headaches, and pain in the cervical muscles.The mouthguard will allow your jaw muscles to relax. An additional effect of wearing a mouthguard is to relieve apnea symptoms (cessation of breathing during sleep for more than 10 seconds, which is often accompanied by snoring).

Varieties of dental aligners

According to the period of wearing, mouthguards are divided into day and night, according to the method of wearing – into single and double jaw. The choice of mouthguards depends on the condition of the teeth, the nature of the attacks – their frequency, severity.

Day mouthguards

For some people, bruxism symptoms appear not only at night, but during the day.They need day kappa (tire) . It is made individually and is practically invisible from the outside. Such a mouthguard does not interfere with chewing or speaking, although unpleasant sensations are possible in the first days after installation.

Kappa for bruxism night

Night guards are put on the upper jaw only before going to bed. Such a mouthguard prevents tight compression of the teeth of the upper and lower jaw during uncontrolled muscle contraction, redistributing the pressure on itself.Some types of nightguards are visible, but this does not really matter, because they are only worn at night.

Making mouthguards for bruxism

The mouthguards are made from modern biopolymer materials that do not cause allergies. In most cases, they are transparent. The material of the mouthguards withstands significant loads and does not create discomfort when worn.

Kappa varieties according to the manufacturing method

According to the method of manufacturing, mouthguards are divided into the following types:

  1. Standard .They can be bought ready-made. Standard aligners can be uncomfortable when worn.
  2. Thermoplastic mouthguards . They are made of transparent plastic material – medical grade silicone. This material changes shape when exposed to heat. The thermoplastic mouthguard is placed in hot water, then put on – it takes the shape of the dentition and hardens. In the process of formation, the thermoplastic mouthguard needs some correction by the dentist, after which it can be used.It is not suitable for everyone, but its cost is low compared to custom-made aligners.
  3. Individual aligners are made for each patient individually. An individual mouthguard is ideally suited to the peculiarities of the structure of the jaw, the shape and position of the teeth. Its production requires taking an impression.

Manufacturing steps

Making an individual mouthguard includes:

  1. Taking an impression of the jaw.
  2. Making a model from plaster.
  3. Kappa making.
  4. Installation and adjustment of the mouthguard on the jaw.

If the custom mouthguard is made correctly, wearing it does not cause discomfort, you can take it off and put it on yourself. The main thing is that it should fit snugly enough to the teeth.

Individual mouthguards are made of special plastic by molding. Recently, the process of making mouthguards has been simplified thanks to the methods of computer 3D modeling, which makes it possible to make a mouthguard that perfectly matches the dentition.Customized mouthguards are the most expensive ones.

Care of a dental tray

Caring for your mouthguard is simple and does not take much time. Certain rules must be followed:

  1. The mouthguard, like teeth, must be brushed daily with a toothpaste brush. Remove the tray, carefully, without applying force, clean its surface. Then rinse with warm water. The kappa is ready to use again.
  2. It is best to store (and carry) your mouthguard in a specially designed case with air holes.Such a case will protect the mouthguard from accidental damage, provide the necessary ventilation and temperature inside. Remember, mouthguards are afraid of heat.
  3. If you experience any discomfort while using your aligner, consult your doctor. He will examine the mouthguard to see if it needs a replacement.

Depending on the individual situation and the severity of the manifestations of bruxism, the kappa lasts up to one year, after which it must be replaced.


What you need to know before you take Azaleptin

If any of the above applies to you, contact your doctor and stop taking Azaleptin.

Azaleptin should not be used by people in an unconscious state or in a coma.

Special instructions and precautions

The safety measures mentioned in this section are very important. You must follow them to minimize your risk of serious, life-threatening side effects.

Before starting treatment with Azaleptin, tell your doctor if you have or have ever been observed:

  • Family history of blood clots or blood clots, because drugs in this group promote blood clots,
  • glaucoma (increased intraocular pressure),
  • diabetes mellitus. Increased (sometimes significantly) blood sugar levels are observed in healthy patients or patients with a history of diabetes mellitus (see.section 4),
  • prostate problems or difficulty urinating,
  • any diseases of the heart, kidneys or liver,
  • Chronic constipation or if you are taking medications that cause constipation (such as anticholinergics)
  • galactose intolerance, lactase deficiency or malabsorption of glucose-galactose,
  • controlled epilepsy,
  • colon disease,
  • if you have ever had abdominal surgery,
  • if you had a family history of heart disease or heart conduction disorder, in the form of “Prolongation of the QT interval”,
  • if you are at risk of a stroke, for example if you have high blood pressure, cardiovascular problems, or problems with the blood vessels in the brain.

Tell your doctor immediately before taking Azaleptin tablets if:

  • You have symptoms of a cold, fever, flu-like symptoms, sore throat, or any other infection. You need to have an urgent blood test to check if your symptoms are related to the drug you are taking.
  • you have a sudden rapid increase in body temperature, muscle stiffness that can lead to loss of consciousness (neuroleptic malignant syndrome), this is a very serious side effect that requires urgent treatment.
  • You have a fast and irregular heartbeat even when you are at rest, palpitations, trouble breathing, chest pain, or unexplained fatigue. In this case, your doctor needs to check the functional state of the heart and, if necessary, immediately contact a cardiologist.
  • You are experiencing nausea, vomiting and / or loss of appetite. Your health care provider should monitor your liver.
  • You have severe constipation. Your health care provider should treat the constipation to avoid further complications.

Medical examinations and blood tests

Before you start taking Azaleptin, your healthcare provider needs to review your medical history and perform blood tests to make sure your white blood cell count is normal. It is important to be aware of this as the body needs white blood cells to fight infections.

Periodic blood tests should be performed before starting treatment, during treatment, and after stopping Azaleptin.

  • Your doctor will decide when and what tests to do. Azaleptin can only be taken if your blood cell count is normal.
  • Azaleptin can lead to a severe decrease in the number of leukocytes in the blood (agranulocytosis). Only regular blood tests can reveal the risk of developing agranulocytosis.
  • During the first 18 weeks of treatment, tests are performed once a week. Between weeks 18 and 52, tests should be performed at least every 2 weeks.Later tests should be done at least once a month.
  • If the number of leukocytes in the blood falls, it is necessary to stop treatment with Azaleptin immediately. After that, the number of leukocytes in the blood should return to normal.
  • You will need to have blood tests for an additional 4 weeks after your Azaleptin treatment ends.

Your healthcare professional may also conduct physical examinations before starting treatment. To check the condition of the heart, he can do an electrocardiogram (ECG), but only if necessary or if you have an indication for this.

If you have impaired liver function, you should have regular liver function tests during the entire course of taking Azaleptin. If you have high blood sugar (diabetes mellitus), your doctor will need to monitor your blood sugar regularly.

Azaleptin can cause changes in blood lipids. Azaleptin can lead to weight gain. Your healthcare provider should monitor your weight and blood lipids.

If dizziness or weakness occurs while taking Azaleptin, gently get up from a sitting or lying position.

If you have planned surgery or if for some reason you are unable to walk for a long period of time, consult your doctor about taking Azaleptin, as there may be a risk of thrombosis (venous thrombosis).

Children and adolescents under 16 years old

If you are under the age of 16, you should not take Azaleptin as there is insufficient data on its use in this age group.

Elderly (aged 60 and over)

Elderly people (aged 60 years and older) may more often experience the following side effects during treatment with Azaleptin: weakness or dizziness after changing body posture, fast heartbeat, difficulty urinating, and constipation.

Tell your doctor or pharmacist if you have dementia.

Other medicines and Azaleptin

Tell your doctor or pharmacist if you are using, have recently taken or must take any other drugs.This includes over-the-counter or herbal medicines. You may need to change your dosage or take other medications.

Do not take Azaleptin at the same time as medications that inhibit bone marrow function and / or reduce the number of blood cells, such as:

  • carbamazepine, a drug used to treat epilepsy.
  • Certain antibiotics: chloramphenicol, sulfonamides such as Co-trimoxazole.
  • Certain pain relievers: Pyrazolone derivatives such as phenylbutazone.
  • penicylamine, used to treat rheumatoid arthritis.
  • cytotoxic drugs used in chemotherapy.
  • depot injections of long-acting antipsychotic drugs.

These drugs increase the risk of developing agranulocytosis (low leukocyte count in the blood).

The use of Azaleptin concomitantly with other medicines that may affect the effects of Azaleptin and / or other medicines.Tell your doctor if you plan to take, are taking (even if the course of treatment ends) or if you have recently had to stop using any of the following drugs:

  • Medicines for the treatment of depression such as lithium, fluvoxamine, tricyclic antidepressants, MAO inhibitors, citalopram, paroxetine, fluoxetine and sertraline,
  • other antipsychotic drugs for the treatment of mental disorders,
  • benzodiazepines and other drugs used to treat anxiety or sleep disorders,
  • narcotic analgesics and other drugs that can depress breathing,
  • medicinal analgesics used to treat epilepsy, such as phenytoin and valproic acid,
  • medicines for the treatment of high or low blood pressure, such as epinephrine and norepinephrine,
  • warfarin, a drug used to prevent thrombosis,
  • Antihistamines used to treat colds or allergies such as hay fever
  • Anticholinergics for the relief of stomach cramps and cramps and motion sickness,
  • drugs for the treatment of Parkinson’s disease,
  • Digoxin, used to treat heart failure,
  • drugs used to treat heart rhythm disorders,
  • Certain medicines used to treat stomach ulcers, such as omeprazole or cimetidine,
  • Certain antibiotics such as erythromycin and rifampicin,
  • Certain drugs used to treat fungal infections (such as ketoconazole) or viral infections (such as protease inhibitors used to treat HIV infections)
  • atropine, a medicine used in some eye drops or medicines for coughs and colds,
  • epinephrine, emergency drug,
  • hormonal contraceptives (contraceptives).

This list is not complete. Your doctor and pharmacist may have more information about medicines that you should be careful about or avoid taking Azaleptin. They can also tell you if the drugs you are taking belong to the groups listed above or not. Please consult with them.

Azaleptin with food and drinks

Avoid drinking alcohol while using Azaleptin.

Tell your doctor if you smoke and how often you drink caffeinated drinks (coffee, tea, cola). Sudden changes in smoking or caffeinated beverages may also affect the effects of Azaleptin.

How to take Azaleptin

In order to minimize the risk of a drop in blood pressure, seizures and drowsiness, it is necessary that your doctor gradually increase the dose of the drug. You should always take Azaleptin exactly as prescribed by your healthcare professional.If in doubt, you should consult your doctor or pharmacist.

First of all, it is important not to change the dosage or stop taking Azaleptin without notifying your doctor. Continue taking the drug for as long as your doctor tells you to. If you are 60 years of age or older, your doctor may start treatment at a lower dosage and increase it gradually, as patients in this age group are more likely to develop some unwanted side effects.”What you need to know before using Azaleptin”).

If the dosage that you have been prescribed cannot be reached by this dose, there are other doses of this drug, with which you need to achieve the desired dosage of the drug.

Azaleptin tablets can be divided into equal doses.

Schizophrenia treatment

The recommended starting dose is 12.5 mg (half a 25 mg tablet) once or twice on the first day, then 25 mg once or twice on the second day.Swallow the tablet with water. If this dose is well tolerated, your doctor may gradually increase the dose in increments of 25 to 50 mg over the next 2-3 weeks until the dose reaches 300 mg per day. Thereafter, if necessary, the daily dose can be increased in increments from 50 to 100 mg at half a week, or preferably at weekly intervals.

The recommended daily dose is 200 to 450 mg, divided into several single doses per day.Some people may need a higher dose. The permissible daily dose can be up to 900 mg. Frequent side effects (in particular, convulsions) are possible with daily doses of more than 450 mg. Always take the individually set minimum effective dose for you. Most people take part of the dose in the morning and another part in the evening. Your healthcare professional will advise you on how to properly divide your daily dose. If your daily dose is only 200 mg, then you can take it once in the evening.During a certain period of time when you are taking Azaleptin and you see positive results, your doctor may reduce the dose. You must take Azaleptin for at least 6 months.

Treatment of severe thinking disorders in patients with Parkinson’s disease

The recommended starting dose is 12.5 mg (half a 25 mg tablet) in the evening. Swallow the tablet with water. Your doctor may then gradually increase the dose in 12.5 mg increments, but no faster than two increments per week, up to a maximum dose of 50 mg by the end of the second week.Increasing the dosage should be stopped or postponed if you feel faint, dizzy, or confused. In order to avoid these symptoms, blood pressure should be measured during the first weeks of treatment.

The recommended daily dose is 25 to 37.5 mg taken once in the evening. The dose of 50 mg per day should only be exceeded in exceptional cases. The maximum daily dose is 100 mg. Always take the lowest effective dose of the drug individually tailored to you.

If you take more Azaleptin than recommended

If you think you have taken a large number of Azaleptin tablets or if someone else has taken your tablets, you should immediately contact your doctor or emergency medical help.

Overdose symptoms include:

Drowsiness, fatigue, loss of strength, loss of consciousness, coma, confusion, hallucinations, agitation, incoherent speech, stiffness of the limbs, tremors in the hands (tremors), seizures (convulsions), increased salivation, dilated pupils, blurred vision, low blood pressure , collapse, fast or irregular heartbeat, shallow or shortness of breath.

If you forget to take Azaleptin

If you forget to take the next dose of the drug, take it as soon as you remember. If it is time for your next dose, skip the missed dose and take the next dose at the usual recommended time. Do not take a double dose to make up for a missed appointment. Contact your healthcare professional as soon as possible if you have not taken Azaleptin at all for more than 48 hours.

If you stop taking Azaleptin

Do not stop taking Azaleptin without the advice of your healthcare professional, as you may develop withdrawal symptoms. It includes sweating, headache, nausea, vomiting, and diarrhea.

If you have any of the above symptoms, notify your doctor immediately. These symptoms can be followed by more serious side effects if not treated immediately.

Symptoms of underlying disease may reappear. A gradual dose reduction in 12.5 mg increments over one to two weeks is recommended if treatment is to be discontinued. Your doctor will tell you how to reduce the daily dose of the drug. If you have to suddenly stop treatment with Azaleptin, you will need to consult your doctor for this.

If your doctor decides to resume treatment with Azaleptin and the last dose of Azaleptin was taken more than two days ago, then the recommended starting dose should be 12.5 mg.

If you have any other additional questions related to the use of this drug, consult your doctor, pharmacist.

Meperidine and Promethazine | Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.


  • This medicine is a strong pain reliever that can be addictive, abuse or misuse. Misuse or abuse of this drug can lead to overdose and death. Please consult your doctor.
  • Do not give this drug to children under 2 years of age. It can cause very bad, sometimes deadly, breathing problems.
  • Use with caution in children 2 years of age and older.Consult your doctor.
  • You will be closely monitored to avoid misuse, abuse or dependence on this drug.
  • This drug may cause very bad and sometimes deadly breathing problems. Call a doctor right away if breathing is slow, shallow, or difficult.
  • The risk of serious, sometimes fatal, respiratory distress may be increased when this drug is started or if the dose is increased.
  • Even one dose of this drug, taken by another person or by mistake, can be deadly, especially in children. If this drug has been taken by another person or by mistake, get medical help right away.
  • Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
  • Long-term use of this drug during pregnancy may cause withdrawal in newborns.This can be life threatening. Consult your doctor.
  • This medicinal product contains an opioid. Serious side effects have occurred with the use of opioid drugs with benzodiazepines, alcohol, marijuana, or other forms of cannabis, as well as prescription or over-the-counter drugs that can cause drowsiness or slow action. These effects include slowed down or labored breathing and death. Benzodiazepines include drugs such as alprazolam, diazepam, and lorazepam.Benzodiazepines can be used to treat many health conditions such as anxiety, sleep disturbances, or seizures. If you have any questions, please consult your doctor.
  • Many drugs interact with this drug, which can increase the risk of side effects, such as deadly breathing problems. Check with your doctor and pharmacist to make sure this drug is safe to use with all your other drugs.
  • Avoid drinking alcohol while taking this drug.
  • Get immediate medical attention if you feel very sleepy, dizzy, or pass out. Caregivers or others should seek immediate medical attention if the patient does not respond, does not respond, or does not respond in the usual way, or if he is asleep and does not wake up.

What is this drug used for?

  • Used to relieve pain.

What do I need to tell my doctor BEFORE taking this drug?

  • In case of an individual allergic reaction to meperidine, promethazine or any other component of this medicine.
  • If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
  • If you have taken a drug for depression or Parkinson’s disease in the past 14 days.These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

  • Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
  • Avoid driving or performing other tasks or work requiring attention or sharp eyesight until you know how this drug is affecting you.
  • To reduce the risk of dizziness or loss of consciousness, get up slowly from a lying or sitting position. Use caution when climbing and descending stairs.
  • Do not take this drug with any other strong pain reliever or with a pain reliever patch without first consulting your doctor.
  • Do not take the drug in higher doses than the doctor prescribed. Taking more than the prescribed amount of the drug increases the risk of serious side effects.
  • If this drug is taken for a long time or in high doses, its effectiveness may be reduced and a higher dose may be needed to obtain the same effect. The so-called drug tolerance develops. Talk to your doctor if this drug stops working.Do not take the drug in higher doses than your doctor prescribed.
  • Long-term or regular use of opioid medications like this can lead to dependence. Reducing the dose or stopping suddenly from this drug can cause a serious risk of a withdrawal reaction or other serious impairment. Talk to your doctor before lowering the dose or stopping this drug. Follow your doctor’s instructions. Tell your doctor if you experience severe pain, mood changes, suicidal thoughts, or any other side effects.
  • You can burn quickly. Avoid direct sunlight, sun lamps and tanning beds. Use sun umbrellas, long clothing, and sunglasses.
  • If you have or have ever had seizures, talk to your healthcare professional.
  • Occasional use of this type of opioid can cause very severe adrenal dysfunction. Call your doctor right away if you experience very severe dizziness or fainting, very severe nausea or vomiting, decreased appetite, feeling very tired or weak.
  • Long-term use of an opioid drug can lead to a decrease in sex hormone levels. If you have a decreased interest in sex, impaired fertility, missing menstrual periods, or trouble ejaculating, see your doctor.
  • If you are 65 years of age or older, use this drug with caution. You may have more side effects.
  • Tell your doctor if you are pregnant or planning to become pregnant. The benefits and risks of taking this drug during pregnancy will need to be discussed.
  • Tell your doctor if you are breastfeeding. It is necessary to consult if the drug poses any risk to the child.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can cause serious and sometimes deadly side effects. Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

  • Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blisters or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
  • Severe dizziness or fainting.
  • Rapid or slow heartbeat.
  • Feeling of an abnormal heartbeat.
  • Fever or chills.
  • Sore throat.
  • Hallucinations (a person sees or hears something that is not in reality).
  • Mood swings.
  • Confusion of consciousness.
  • Severe constipation.
  • Severe drowsiness.
  • Chest pain.
  • Convulsions.
  • Difficulty, slow or shallow breathing.
  • Shiver.
  • Any unexplained bruising or bleeding.
  • Change of vision.
  • Yellowness of the skin or eyes.
  • A very serious, sometimes fatal, disorder – neuroleptic malignant syndrome (NMS) – can occur. Call your doctor right away if you have a fever, muscle cramps or stiffness, dizziness, severe headache, confusion, changes in thinking, tachycardia, an abnormal heartbeat, or excessive sweating.
  • Some people taking this drug experience uncontrolled muscle contractions. Call your doctor right away if you experience uncontrolled body movements or muscle problems in your tongue, face, mouth, or jaw, such as having difficulty sticking out your tongue, puffing out your cheeks, clenching your lips or chewing.
  • A serious and sometimes deadly condition called serotonin syndrome can develop when this drug is used with certain other drugs.Call your doctor right away if you develop agitation, imbalance, confusion, hallucinations, fever, tachycardia or irregular heartbeat, flushing, muscle twitching or stiffness, seizures, tremors or tremors, excessive sweating, severe diarrhea, nausea or vomiting , severe headache.

What are some other side effects of this drug?

Any medicine can have side effects.However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

  • Nausea or vomiting.
  • Constipation.
  • Dizziness.
  • Sleepiness.
  • Dry mouth.
  • Excessive sweating.

This list of potential side effects is not exhaustive.If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner.Read all the information provided to you. Follow all instructions strictly.

  • Take with or without food. Take with food if the medicine causes nausea.

What should I do if a dose of a drug is missed?

  • If you are taking this medication regularly, take the missed dose as soon as you can.
  • If it’s time to take your next dose, do not take the missed dose and then return to your normal dose schedule.
  • Do not take 2 doses at the same time or an additional dose.
  • In most cases, this drug is used as needed. Do not take this medicine more often than prescribed by your doctor.

How do I store and / or discard this drug?

  • Store at room temperature, protected from light. Store in a dry place. Do not store in the bathroom.
  • Store this medication in a protected place, out of the reach of children, and out of the reach of other people.A box or room, which is locked with a key, can act as a protected storage location for the drug. Keep all medicines out of the reach of pets.
  • Dispose of unused or expired drugs. Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

General information on medicinal products

  • If your health does not improve or even worsens, see your doctor.
  • You should not give your medicine to anyone and take other people’s medicines.
  • Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
  • Some medicines may have different patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
  • A drug called naloxone can be used to treat an overdose with this drug. Your doctor may prescribe naloxone to keep you with you while you are taking this drug.If you have any questions about buying or using naloxone, ask your doctor or pharmacist. If you think an overdose has occurred, seek immediate medical attention, even if you are using naloxone. Be prepared to tell or show which drug you took, how much and when it happened.

Use of information by consumer and limitation of liability

This information should not be used to make decisions about taking this or any other drug.Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient. This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug.This information should not be construed as a guide to treatment and does not replace the information provided to you by your healthcare professional. Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.


© UpToDate, Inc.and its affiliates and / or licensors, 2021. All rights reserved.

90,000 First aid for ACS – City Clinical Emergency Hospital No. 2

Brief recommendations for the provision of medical care for patients with acute coronary syndrome

The Recommendations set out the basic principles of medical care and the algorithm of actions of a doctor, paramedic in patients with acute coronary syndrome. In each case, if necessary, correction is possible depending on the characteristics of the course of the disease.

The recommendations are intended for doctors and paramedics working in medical organizations providing primary health care * and emergency medical doctors / paramedics.

The term “acute coronary syndrome” is used to denote an exacerbation of coronary artery disease. This term includes such clinical conditions as myocardial infarction (MI) (all forms) and unstable angina pectoris. ACS is distinguished with ST segment elevation and without ST segment elevation.

Acute coronary syndrome with ST segment elevation is diagnosed in patients with anginal attack or other unpleasant sensations (discomfort) in the chest and ST segment elevation or newly-onset or presumably new-onset left bundle branch blockade on ECG. In this case, a persistent rise of the ST segment persists for at least 20 minutes. ST-segment elevation myocardial infarction is characterized by the occurrence of ST elevation in at least two consecutive leads, which is estimated at the level of the J-point and is 0.2 mV in men or ³ 0.15 mV in women in leads V2-V3 and / or 0.1 mV in other leads (in cases where there is no left bundle branch block and left ventricular hypertrophy).

Acute coronary syndrome without ST segment elevation is diagnosed in patients with anginal attack and ECG changes indicating acute myocardial ischemia, but without ST segment elevation, or with ST segment elevation lasting less than 20 minutes. These patients may have persistent or transient ST depression, inversion, flattening, or pseudo-normalization of T waves. In some cases, the ECG may be normal.

Symptoms. A typical manifestation of ACS is the development of an anginal attack.The nature of pain is varied: squeezing, pressing, burning. Most typically, a feeling of constriction or pressure behind the breastbone. Irradiation of pain to the left arm and / or shoulder, throat, lower jaw, epigastrium, etc. can be observed. Sometimes patients complain of atypical pain only in the area of ​​irradiation, for example, in the left hand. With myocardial infarction, pain can be wavy in nature and last from 20 minutes to several hours.

Pain syndrome is often accompanied by a feeling of fear (“fear of death”), agitation, anxiety, as well as autonomic disorders, such as increased sweating.


with normal or elevated blood pressure and without signs of left ventricular failure

  1. The patient should immediately stop all exertion and, if possible, lie down.
  2. Give the patient 0.5 mg nitroglycerin under the tongue.
  3. After 5 minutes, reappointment of nitroglycerin 0.5 mg under the tongue.
  4. If chest pain or discomfort persists for 5 minutes after repeated nitroglycerin administration, call an ambulance immediately and re-administer nitroglycerin 0.5 mg or isosorbide dinitrate 1.25 mg spray under the tongue.
  5. Take ECG (performed simultaneously with 2-4 points).
  6. In the presence of an ambulance doctor, an intravenous infusion of nitroglycerin 1% 2 – 4 ml or isosorbide dinitrate 0.1% 2 – 4 ml in 200 ml saline intravenously begins, the initial infusion rate is 15 – 20 μg / min (5 – 7 drops per minute), the maximum injection rate of the drug is 250 μg / min. The criterion for the adequacy of the infusion rate: decrease in systolic blood pressure by 10 – 15 mm Hg.Art. and / or relief of anginal status.
  7. If the therapy is ineffective, morphine hydrochloride or sulfate 1% – 1.0 ml (10 mg), diluted in at least 10 ml of 0.9% sodium chloride solution or distilled water, is injected intravenously. Initially, 2-4 mg of this drug should be administered slowly intravenously. If necessary, the introduction is repeated every 5-15 minutes at 2-4 mg until the pain is relieved or side effects occur that do not allow increasing the dose.
  8. When the blood pressure level remains> 180/10 mm. rt. Art. – to establish an intravenous drip of nitroglycerin at a rate of 10-200 mcg / hour, depending on the level of blood pressure.
  • ! If acute coronary syndrome is suspected, the patient should immediately prescribe A cetylsalicylic acid (in the absence of absolute contraindications – hypersensitivity to the drug, active bleeding) at a dose of 250 mg, subligally chew !!!
  • Simultaneously prescribe Clopidogrel at a loading dose of 300 mg.

Mandatory 12-lead ECG:

  1. In case of suspicion of ACS during the first 10 minutes of contact with the patient
  2. In the case of a normal ECG and an increasing clinical picture, the ECG is repeated after 30 minutes and after 1 hour.

What can be seen on the ECG:

  1. Normal ECG
  2. Various rhythm disturbances
  3. left bundle branch block
  4. high positive T waves
  5. negative T waves
  6. depressed ST
  7. ST depression and negative T waves
  8. ST depression and positive pointed T waves
  9. high R and ST elevation.


against the background of arterial hypotension (systolic blood pressure <90 mm Hg)

  1. Immediately call the ambulance
  2. The patient must immediately stop all exertion, take a horizontal position
  3. Take ECG

The means of choice for relieving an anginal attack is intravenous administration of morphine hydrochloride or sulfate 1% -1.0 ml (10 mg), diluted in at least 10 ml of 0.9% sodium chloride solution or distilled water.Initially, 2-4 mg of the drug should be injected slowly intravenously. If necessary, the introduction is repeated every 5-15 minutes at 2-4 mg until the pain is relieved or side effects occur that do not allow increasing the dose.

In the absence of morphine, it is necessary to use any available parenteral analgesics, for example, analgin 3-4 ml 50%.

! If acute coronary syndrome is suspected, the patient should immediately prescribe A cetylsalicylic acid (in the absence of absolute contraindications – hypersensitivity to the drug, active bleeding) at a dose of 250 mg, subligally, chew !!!

! At the same time, appoint Clopidogrel at a loading dose of 300 mg.


flowing with acute left ventricular failure

against the background of normal or increased blood pressure

  1. Immediately call the ambulance
  2. The patient must immediately stop all exertion, take a half-sitting position
  3. Take ECG
  4. The means of choice for relieving an anginal attack is intravenous administration of morphine hydrochloride or sulfate 1% – 1.0 ml (10 mg) diluted in at least 10 ml of 0.9% sodium chloride solution or distilled water.Initially, 2-4 mg of the drug should be injected slowly intravenously. If necessary, the introduction is repeated every 5 to 15 minutes, 2 to 4 mg until pain relief or side effects occur that do not allow increasing the dose.
  5. Give the patient 0.5 mg nitroglycerin under the tongue.
  6. Intravenous infusion of nitroglycerin 1% 2 – 4 ml or isosorbide dinitrate 0.1% 2 – 4 ml in 200 ml of saline intravenous drip, initial infusion rate 15 – 20 μg / min (5 – 7 drops per minute), maximum the rate of administration of the drug is 250 μg / min.The criterion for the adequacy of the infusion rate: decrease in systolic blood pressure by 10 – 15 mm. rt. Art. and / or relief of anginal status.
  • ! If acute coronary syndrome is suspected, the patient should immediately prescribe A cetylsalicylic acid (in the absence of absolute contraindications – hypersensitivity to the drug, active bleeding) at a dose of 250 mg, subligally, chew !!!
  • ! At the same time, appoint Clopidogrel at a loading dose of 300 mg.

TREATMENT OF ANGINOUS ATTACK, proceeding with acute left ventricular failure on the background of arterial hypotension (systolic blood pressure <90 mm Hg)

  1. Immediately call the ambulance
  2. Take ECG in 12 leads
  3. The means of choice for relieving an anginal attack is morphine 1% – 0.5 ml, diluted in at least 10 ml of 0.9% sodium chloride solution or distilled water.Initially, 2-4 mg of the drug should be administered slowly intravenously. If necessary, the introduction is repeated every 5-15 minutes at 2-4 mg until the pain is relieved or side effects occur that do not allow increasing the dose.
  4. For low blood pressure (systolic blood pressure <90 mm Hg), provide intravenous administration of dopamine 200 mg in 200 ml of saline (initial rate 3 μg / min / kg, in the absence of effect, the infusion rate increases by 3 μg / min / kg, the maximum speed is 12 μg / min / kg).With persisting hypotension and the presence of clinical signs of relative hypovolemia - the absence of moist wheezing in the lungs and swelling of the neck veins - it is advisable to inject 200-250 ml of 0.9% sodium chloride solution for 5-10 minutes. While maintaining arterial hypotension, repeated injections of 0.9% sodium chloride solution to a total volume of 0.5-1.0 liters are possible. If shortness of breath or moist wheezing occurs in the lungs, the fluid infusion should be discontinued.
  • ! If acute coronary syndrome is suspected, the patient should immediately prescribe A cetylsalicylic acid (in the absence of absolute contraindications – hypersensitivity to the drug, active bleeding) at a dose of 250 mg, subligally, chew !!!
  • ! At the same time, appoint Clopidogrel at a loading dose of 300 mg.

Recommendations for reperfusion therapy in patients with acute coronary syndrome

Within 30 minutes from the first contact with a patient with acute coronary syndrome, the ambulance team, along with relieving pain and stabilizing hemodynamics (maintaining blood pressure at the proper level), must decide on reperfusion therapy – thrombolysis or percutaneous coronary intervention (PCI) in this patient:

  1. If there is a possibility and confidence that PCI (emergency stenting of the coronary artery that caused the development of ACS) will be performed within 2 hours, the patient is immediately admitted to the nearest medical organization, where high-tech interventions on the infarction-related coronary artery are performed.
  2. If PCI is not possible within these terms, thrombolytic therapy (TLT) is required, which is carried out by an ambulance team. TLT is indicated in the first 12 hours after the onset of pain and ECG criteria for ACS with segment elevation ST .

ECG criteria for initiating reperfusion therapy are persistent ST-segment elevations ≥0.1 mV in at least two adjacent ECG leads (≥ 0.25 mV in men under 40 / 0.2 mV in men over 40 and ≥0, 15 mV in women in leads V 2 -V 3 ) in the absence of left ventricular hypertrophy or (presumably) acute left bundle branch block (especially with concordant ST elevations in leads with a positive QRS complex).In the presence of ST segment depression ≥0.05 mV in leads V 1 -V 3 , especially with positive T waves, it is recommended to record an ECG in leads V 7 -V 9 (detection of ST elevations ≥0.05 mV / ≥ 0.01 mV in men younger than 40 years is the basis for reperfusion treatment).

* According to the Order of the Ministry of Health of the Russian Federation of May 15, 2012 No. 543n Primary pre-medical health care is provided by feldshers of feldsher-obstetric points, medical outpatient clinics, health centers, polyclinics, polyclinic units of medical organizations.Primary medical health care is provided by general practitioners, district general practitioners, general practitioners (family doctors) of medical outpatient clinics, health centers, polyclinics, polyclinic units of medical organizations, offices of general practitioners (family doctors). Primary specialized medical and sanitary care in the “cardiology” profile is provided by cardiologists of polyclinics, polyclinic departments of medical organizations.

The recommendations were prepared by the staff of the Russian Cardiological Research and Production Complex of the Ministry of Health of Russia, Professor S. Tereshchenko.N., professor Ruda M.Ya., professor Staroverov I.I.

90,000 what leads to, what to do with it, what threatens and what is affected by poor closure in adults


  2. Potential consequences
  3. Influence of malocclusion on teeth
  4. Effect on soft tissues of the oral cavity
  5. Diseases of the temporomandibular joint due to bite
  6. Effect on posture
  7. Does asymmetry affect speech
  8. How the face changes due to a violation of the closing of the jaws
  9. ENT diseases and other disorders due to bite
  10. Bruxism
  11. Are they enlisted in the army with malocclusion
  12. What happens if the bite is not corrected
  13. Let’s summarize

When the baby’s first milk incisors are cut, the parents are moved and do not pay much attention to the formation of the dentition.With age, deviations in the structure appear more clearly. The consequences of malocclusion of the teeth are not at all as harmless as they seem to most people. This is a violation of speech, blood circulation, deformation of facial features. But do not panic, as a timely visit to an orthodontist will save you from these troubles. It is preferable to do the correction in childhood, when the bones and ligaments are plastic and there has not yet been a change from milk to permanent.


With the free closing of the jaws, the teeth of the upper and lower rows occupy a certain position.This is called bite. Distinguish between physiological, correct and pathological, in which there is a different kind of displacement. This phenomenon is observed in most people. It manifests itself in babies when the first teeth appear, when they change and in adulthood. There are many reasons, as well as types of pathology.

An early visit to a specialist helps to correct the deformation.

Potential consequences

A violation is said if there is a displacement of the row, a hypertrophied or underdeveloped state of the jaws, an atypical direction of the plates.The list of what a malocclusion leads to is long. Each species has its own symptoms and methods of correcting it. Anomalies lead to rather unpleasant consequences ranging from cosmetic imperfections to the development of inflammation in the ligaments. They occur at any age, can be triggered by illness, injury, or the removal of several teeth at once. The most important thing is to notice the displacement in time and seek help from a specialist for examination, consultation and restoration of the physiological form.

What threatens short-term malocclusion

We are talking about milk teeth and a period of time from 6 months to 6-7 years. It is divided into 3 main stages, where, along with heredity, bad habits have a significant weight. There are two directions of deformation:

  • The prognathic bite is characterized by a strong advancement of the lower jaw, resulting in the effect of a “Neanderthal face” with a heavy aggressive chin and a “moving” dentition;
  • The

  • mesial version looks the other way around, giving the face a limp look with an inwardly sloping bottom.

Disorders strongly affect the ability to chew food, spoil the aesthetic component, put excessive stress on the temporomandibular joint and interfere with the growth of permanent plates, deforming them at the stage of exiting the gums.

What is the effect of replaceable malocclusion of teeth

From 5 to 13 years old there is a systematic change, where milk plates are replaced with permanent ones. Nature provides for a certain frequency and periodicity. If it is disrupted by unplanned removal or growth retardation occurs, then complications are possible.Such an example is a double row, when one has not yet dropped out, and the second has come out above it or behind the main line.

Early teething shouldn’t be encouraging. On the contrary, it is worth checking the endocrine system and taking care of the examination for tumors. The late process is also not positive, since it provokes neurological pain, disrupts the position of the entire row, and deprives the adjacent teeth of support.

What does the permanent form lead to

The Hollywood smile, which has become so popular in recent years, implies the perfect ratio of the upper and lower jaw, a bad bite is a matter of close attention and a cause for concern.The completion of the replacement process is said after 13-14 years, when there is not a single milk tooth left in the mouth. Incorrect positioning provokes numerous violations, and some of them, at first glance, are completely unrelated to the position of the jaws and the degree of their closure. For example, an orthodontist will greatly surprise him by saying that persistent headaches, tension in the cervical spine and discomfort in the temple area are not an independent phenomenon, but the consequences of a malocclusion in an adult. Here lies the reason for such common disorders as:

  • Decrease in chewing activity, leading to gastrointestinal diseases;
  • the appearance of problems with the temporomandibular joint, which are very difficult to correct;
  • Uneven load on the dentition, contributing to early destruction, abrasion of enamel, chips, damage at the base of the crown;
  • violation of the integrity of bone tissue, which leads to loosening;
  • periodontitis, leading to the loss of dental plates, the appearance of inflammatory processes that require long-term treatment.

Influence of malocclusion on teeth

Initially, nature has laid a high margin of safety in all systems of the body, provided that they work at a given rhythm and pace. Incisors with canines seem to be the strongest on a par with bones, and at the same time they are very vulnerable.

A change in the natural position of the jaws provokes damage to the enamel, the appearance of cracks and chips, through which pathogenic bacteria quickly get to the inner layer, penetrating deeply, causing inflammation and tissue destruction.The entire row loses its support, falling under a gradual deformation. In addition to the aesthetic effect, such an arrangement will certainly affect the elasticity and firmness of the ligaments.

Knowing what threatens a malocclusion in adults and what consequences are possible, consult a doctor in time to correct the situation and maintain a beautiful smile.

Effect on soft tissues of the oral cavity

Incorrect position leads to microtrauma to the gums and the inner surface of the cheeks. Chips leave scratches, closing at a different angle forms non-healing small ulcers at the points of contact, which become foci of inflammation and spread throughout the oral cavity.Stomatitis, edema are becoming more frequent, complications in the form of ENT diseases are possible.

One of the disorders with permanent tissue injury is gum recession, due to which the exposed roots become defenseless against bacterial attacks.

Diseases of the temporomandibular joint due to bite

If your head often hurts, there is tension in the direction from the temple to the ear, accompanied by a soft click when yawning or a temperamental conversation, then you should not sin on meteosensitivity or look for signs of a cold.Most likely, the reason lies in the violation of the symmetry of the jaws, which gives a number of unpleasant complications that eventually become chronic. They lead to arthritis, arthrosis, dislocations due to loss of ligament tone. The appearance of the problem is indicated by regular headaches and ear pains, clicking and crunching when moving the lower jaw, restrictions in width when trying to open the mouth completely.

Important: advanced cases are difficult to treat.

Do not give up and think about how to live with a wrong bite.It needs to be corrected and only then the complications that have arisen against the background of the violation are gradually removed.

Effect on posture

The human body is a single system, where a malfunction in one area is reflected in others. The state of the skeletal complex as a whole depends on the health of each part. Jaw problems immediately make themselves felt in a change in the position of the cervical spine, which, in turn, is closely related to the thoracic region.

Correct posture is characterized by a clear vertical line.It is easy to check it on your own, it is enough to come close to the wall and check the points of contact. They should be in the back of the head, shoulder blades and buttocks.

Moving forward of the upper dentition provokes an overweight of the head, retraction of the chest. At the same time, the tone deteriorates, chronic overstrain is observed.

Oversight of the lower jaw leads to a general overturning of the upper body, disruption of the work of facial muscles, and difficulty in breathing.

Does asymmetry affect speech

Formation of clear diction depends not only on the tone of the tip of the tongue, but also on the correct position of the jaws. A skew in any direction makes the pronunciation more muffled, blurry, expressionless. In this case, you can achieve significant improvement, but you need to start with the correction of the bite.

Several missing teeth have a significant impact on speech quality. In children, this is temporary, adults need to solve the problem in a complex way, not letting it go by itself.

How the face changes due to a violation of the closing of the jaws

Natural cast depends on heredity, but some factors can distort it beyond recognition. This is a prime example of what a malocclusion can lead to:

  1. The accelerated development of the upper plate is reflected in the lower part of the face, making it limp, aided by a sunken chin. In this case, the muscles begin to pull the corners of the lips down, and the slightly open mouth complements the impression of indecision and weakness.Over time, the process grows, the enamel is erased, the chewing teeth are deformed and the upper incisors overlap the lower ones even more.
  2. Deep bite visually reduces the diameter of the oval of the face, protruding the lip forward. There is a habit of squeezing them into a thin line, which gives a disgruntled squeamish expression that repels the interlocutors. The muscles remain constantly tense, which provokes pain in the neck.
  3. The rapid formation of the lower jaw with the upper lagging makes the facial features heavier, which turns into an offended or angry mask.It is accompanied by an increased tone of the chewing and cervical muscles, deforms the posture.
  4. Open does not completely close the lips, which creates the effect of sunken cheeks.
  5. The loss of several teeth leads to visible asymmetry, which encourages disproportionate growth, interferes with the normal chopping of food, forcing it to move to one side, which leads to an aggravation of the situation.

ENT diseases and other disorders due to bite

The degree of closure of the jaws is of direct importance to the completeness of breathing and the normal functioning of the respiratory system.If the mouth is constantly open, the mucous membranes dry out, hence the activation of pathogenic bacteria, which leads to pharyngitis and sinusitis. Lost time leads to complications.

It is worth remembering that a one-time treatment of diseases of the nose and throat, if they are associated with a dental problem, is ineffective. And this is also one of the reasons why the wrong bite is bad. Until it is corrected, the ailments will return with enviable regularity.


Unpleasant gnashing of teeth cannot always be attributed to a bad habit.He has well-founded reasons such as:

  • increased emotional stress;
  • constant stress;
  • unhealthy food;
  • violation of the closing of the jaws.

If you have severe twisting and any other defects in the dentition, visit the Dentica Dental Clinic. With timely treatment, our specialists will guarantee the avoidance of problems of enamel abrasion and increased sensitivity when eating, and will also help you to normalize sleep and eliminate unpleasant external manifestations.

Are they enlisted in the army with malocclusion

Exemption is given for II and III degrees of impairment with chewing ability below 60%. In this case, each case is considered individually, and if correction is possible, the pre-conscript receives assistance, and the restriction is lifted. Actions are governed by article 56.

If there is an X-ray image, a doctor’s opinion and a copy of an extract from a medical record, then a set of documents may become a reason for a decision about unsuitability for service.

What happens if the bite is not corrected

Many are negligent about the violation of the development of the jaws, considering it a temporary phenomenon in a child or a minor cosmetic defect in adults. The opinion is deeply mistaken, since over time the situation is aggravated, acquiring a rather unpleasant and dangerous bouquet of accompanying deformations:

  • it is impossible to chew food well;
  • facial features are deformed;
  • posture is impaired;
  • there is a constant muscle strain;
  • neurological pains appear;
  • arthritis and arthrosis of the temporomandibular joint develops;
  • enamel is quickly erased, the shape of the teeth changes, they begin to loosen;
  • the risk of developing periodontitis, caries increases, the volume of gum tissue decreases;
  • facial asymmetry is formed.

Summing up

With the outward insignificance of the problem in the eyes of the layman, it is much deeper and more dangerous. The influence of an incorrect bite, which means the occurrence of an impressive number of disorders in the digestive, respiratory, and nervous systems, is very large. Unaesthetic appearance can be an obstacle to obtaining prestigious public speaking jobs. Distortion of speech interferes with communication, lowers self-esteem, and becomes the cause of the appearance of complexes.Curvature of posture, headache and a feeling of heaviness in the neck, inability to open the mouth wide are also considered secondary disorders that have appeared as a result of improper development and closing of the upper and lower jaw.

Understanding what the wrong bite of the teeth means, the question of what to do if it is installed should not arise. It is necessary to seek help from dentistry as soon as possible, since the correction of the condition is much easier in the early stages.

If a child grinds his teeth: reasons and approaches


Key recommendations for children with autism who suffer from bruxism (“squeaking teeth”)

By Debra C. Lowsky
Source: Ark Therapeutic

Many children under the age of 7 begin to grit their teeth, but this behavior usually disappears on its own and does not require medical attention. However, grinding teeth for a long time (especially if the child already has permanent teeth) can seriously worsen the condition of the teeth, leading to toothaches, muscle or headaches, and other consequences.

Bruxism is a strong clenching or rubbing of teeth against each other, which is involuntary, habitual and does not perform any function. Bruxism is a type of repetitive, “parafunctional” oral behavior, like the habit of chewing on pencils or nails or chewing on the inside of your cheeks.

Bruxism is equally common in boys and girls. Long-term bruxism is much more common in children with developmental disabilities, including children with autism, Down syndrome, and cerebral palsy.Very often, bruxism is present in children who have sleep disorders.

Loud grinding of teeth usually occurs during sleep and refers to motor sleep disorders. Bruxism in the waking state is much less common, and very often it goes away without sound, because of which it may remain undiagnosed. In children, bruxism often appears against the background of stress, psychological trauma, chronic sleep disorders, brain trauma, and often the child’s parents or other family members had a similar problem in childhood.The biggest risk factor for bruxism during sleep is apnea – difficulty breathing during sleep.

Possible causes of bruxism

Listed below are several possible causes of a child’s teeth squeaking. To establish the exact cause, consultations with specialists are necessary, often with several specialists of different profiles – a pediatrician, dentist, otolaryngologist, psychologist or behavioral analyst, and so on.

Dental problems

First of all, if the child is grinding his teeth or clenching them too much, you should consult a dentist.Sometimes the cause of bruxism is bite problems, misaligned teeth, and the like. On average, dental problems account for about 10% of bruxism cases. In any case, an examination by the dentist is necessary to establish the consequences of severe compression of the teeth, for example, damage to the teeth, which must be healed in time. In addition, it is recommended that the dentist be involved in deciding strategies to correct the problem.

Side effects of drugs

If the child is taking any medication, it is necessary to check if clenching or grinding teeth can be a side effect.For example, bruxism can occur with antipsychotics and certain antidepressants. If so, the child’s doctor should be consulted about the possibility of changing his treatment. (Also see: “What You Need to Know About Dosage Changes or Withdrawal from Psychiatric Drugs”).

Stress and / or anxiety

Many people start clenching / grinding their teeth in response to stress. Grinding teeth in a child, especially during the day, can be a reaction to the various stresses they are facing, and can also be a manifestation of severe anxiety or anxiety disorder.(Also see: Anxiety and Autism).

Self-stimulating behavior (“stimming”)

Grinding your teeth during the daytime can be just a “bad habit,” as is the habit of biting your nails. In the case of children with autism and other developmental disabilities, this is often a variant of “stimming,” a repetitive behavior that the child resorts to to calm down, cope with strong emotions, or keep himself occupied. In this case, children are usually helped by one or another variant of the “sensory diet” – providing other ways for self-regulation using sensory stimulation at a specially designated time.As with other variants of “stimming”, the problem may be that the child can no longer occupy himself with anything, that is, he does it “out of boredom.” In this case, the child first of all needs training in acceptable and full-fledged types of leisure. (See also: “How to Develop Leisure Skills in a Child with Autism”).

Reduced sensitivity of the oral cavity

Reduced sensitivity (hyposensitivity) of the oral cavity is one of the possible manifestations of impairments in the processing of sensory information, which are often found in autism and other developmental features.This may encourage the child to grind their teeth in order to receive more sensory stimulation in the mouth. People with oral hyposensitivity have difficulty understanding what is going on in their mouth, and they are characterized by “sensory search” associated with the movements of the jaw. For example, children with oral hyposensitivity often chew on clothes, their hands, inedible objects, and they may also grind their teeth.

Possible treatment for bruxism

Medical treatment

First of all, medical treatment of bruxism is aimed at treating its consequences and alleviating the unpleasant symptoms associated with it, as well as protecting teeth from mechanical damage.Because children “outgrow” bruxism in most cases, medical interventions are usually temporary. Children with developmental disabilities with long-term bruxism may need long-term treatment to relieve jaw muscle pain and other problems. Possible approaches might include:

– Warm compresses in the jaw area. The heat helps to relax the jaw muscles and relieve muscle pain. The child’s doctor can advise on how to apply this strategy.

– A doctor may prescribe pain relievers or anti-inflammatory drugs to relieve muscle pain caused by bruxism.

– A doctor may recommend a muscle relaxant to help relax the jaw muscles.

– As mentioned earlier, treatment is needed for dental problems that may be associated with bruxism.

– To protect teeth from damage, first of all, in case of nocturnal bruxism, a special mouthguard can be made for the patient – a device that is made from a dental impression and is put on the jaw.In this case, when grinding teeth, the child will wear the mouthguard, and not the teeth themselves.

– In some cases, bruxism is caused by problems with breathing difficulties, primarily during sleep, and the child may need an otolaryngologist’s consultation and treatment for problems that make breathing difficult, such as removing the adenoids.

Stress Reduction / Relaxation Training

It is very important to identify possible sources of stress in the life of a child with bruxism. Various methods are recommended to help reduce stress and promote relaxation.First of all, you should try non-drug relaxation methods – muscle relaxation, meditation, music therapy, exercise. Depending on the presence of certain diagnoses and related problems, you may need to consult with a psychiatrist or psychologist. (Also see: Relaxation Techniques for a Child with Autism).

Sensory stimulation in the oral cavity

If sensory seeking is the cause of teeth grinding, then an occupational therapist or speech therapist can choose the optimal strategy to provide your child with additional oral stimulation.It may include:

– Massage of the oral cavity. This massage is often performed by speech therapists and provides very strong sensory stimulation to the oral cavity.

– Various massagers, including vibrating massagers, can provide a wide variety of sensory stimulation. Oral vibrating massagers are very often suitable for children with bruxism, which allow varying pressure and stimulation. In addition, vibration massage helps many children to relax.

– There are all sorts of teethers and safe chews that a child can use as an alternative to grinding their teeth.In case of bruxism, it is recommended to try oblong and tubular chewing so that they can easily reach the molars – this will provide similar sensations with teeth grinding. Chewers with uneven and varying surfaces can be especially appreciated by children with “touch search”.

– To increase the stimulation of the muscles of the jaw, you can gently try the following exercise – let the child bite the “chew” in the shape of a T or a tube, and then very gently pull on the chew 3-5 times.The exercise can be repeated up to 5 times on both sides of the jaw during the day.

Nutritional assistance

If the child grinds his teeth as a stimming or sensory search, this behavior can be reduced by including more hard, crunchy and chewy foods in the child’s diet, such as raw carrots, celery, dried fruits, and the like.

Many children with autism eat extremely restricted diets or avoid solid foods. However, they may still have a need to get certain sensations in the mouth and certain movements of the jaw, and they can get them by squeaking their teeth.In this case, dietary augmentation behavioral interventions can help reduce bruxism. (Also see: “How to Expand the Diet of a Child with Autism,” “If a Child with Autism Refuses Solid Foods”).

It is important to keep in mind that chewing gum, large chunks of food, or opening the mouth wide can exacerbate muscle pain in the jaw in some people with bruxism.

It is important to ensure that your child is consuming enough fluids throughout the day – some experts believe that dehydration contributes to bruxism.

If the child is medically unable to eat solid food, then he / she may be allowed to use the sensory chew to fill in the missing sensation.

Behavioral interventions for bruxism

There are several studies on the treatment of bruxism in children with autism using methods based on applied behavior analysis, but these are mostly only case studies. As a rule, in these cases, verbal and physical prompts were successfully used to “switch” to another behavior of the child, who grinds his teeth during the day.In some cases, it was possible to reduce the grinding of teeth when the child was prompted to repeat a certain sound after an adult (for example, “ah-ah”) every time he began to grind his teeth. Sound repetition is a behavior that is incompatible with grinding teeth. Also, the behavioral analyst can use other strategies, for example, functional communication training.

We hope the information on our website will be useful or interesting for you. You can support people with autism in Russia and contribute to the work of the Foundation by clicking on the “Help” button.