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References

NICE guidelines on antidepressants. http://www.NICE.org.uk/guidelines
Wrobel S. Science, serotonin and sadness: the biology of antidepressants. A Series for the public. FASEB Journal. 2007; 21:(13)3404-3417
Pavone BW. Bruxism and its effect on the natural teeth. J Prosthet Dent. 1985; 53:(5)692-696
Stahl SM. Mechanism of action of serotonin selective reuptake inhibitor: serotonin receptors and pathways mediate therapeutic effects and side effects. J Affect Disord. 1998; 51:(3)215-235
Mukherjee S, Sen S, Biswas A, Chaterjee SS, Tripathi SK. Escitalopram induced bruxism: a case report. Schol J Appl Med Sci. 2014; 2:(3D)1162-1163

Depression, selective serotonin reuptake inhibitors and bruxism

From Volume 42, Issue 10, December 2015 | Page 979

Authors

Roya Hazara

BDS

Central and North West London NHS Foundation Trust

Articles by Roya Hazara

Article

Depression is one of the most common mental disorders that affects 1 in 6 people in the UK at some point in their life. The cause or the causes of depression is not set in stone, it is multifactorial, and is known to be triggered by certain occasions or events in life, such as bereavement, illness etc.1 One of the most recent biological explanations of the causes of depression is thought to be related to a decrease in the secretion of the neurotransmitter serotonin in the brain.2

For treatment of depression, there are three classes of antidepressants:

  • The monoamine oxidase inhibitors (MAOIs);
  • Tricyclic antidepressants (TCAs);
  • Selective Serotonin Reuptake Inhibitors (SSRIs).

    • Currently, the most commonly prescribed antidepressants are SSRIs. They are applauded for their fewer side-effects. However, there are numerous case reports available in the literature, some dating back to 20 years ago, that link increased bruxism with SSRIs, making it relevant to dentistry. Currently, to the best of my knowledge, there is no scientific evidence to prove or disprove this.

    Bruxism is defined as involuntary movement of jaw musculature and is characterized by grinding and clenching of teeth and affects 8–31% of the population; it is a complex and destructive dental functional disorder.3 Increased bruxism can cause multiple orofacial problems, such as toothwear, jaw pain and sensitive teeth, broken restorations and general discomfort for the afflicted individuals. Bruxism can be subdivided into two types; nocturnal bruxism and awake bruxism.

    SSRIs, as the name suggests, selectively inhibit the reuptake of serotonin (5-hydroxytryptamine, 5HT).2 They act as competitive antagonists with serotonin and target the post-synaptic 5 HT receptors. SSRIs bind to the receptors and this allows the free floating of serotonin in the synaptic cleft for longer.4 The theory is that the higher the level of serotonin in the synaptic cleft, the increased improvement in depressive symptoms. It is proposed that an increase in movement of jaw muscle can be due to low levels of dopaminergic neurons that are caused as a result of increased serotoninergic action on the mesio-cortical neurons that are situated in the ventral tegmental part of the brain.5 Dopamine is the main neurotransmitter that is associated with motor activity and a deficiency in this, especially in the mesio-cortical tract, can cause increased muscle movement, as exhibited in Parkinsonism.

    In our clinic, as a specialist service, we treat a large volume of patients with moderate or severe learning difficulties who are on SSRI antidepressants. Clinically, the majority of these patients display some form of toothwear consistent with increased teeth clenching and grinding. Although most of these patients are non-verbal and unable to answer any questions regarding their habits, their family members, carers and support workers report these habits during sleep. This letter highlights the side-effects of SSRIs that is relevant to dentistry and the importance of its awareness amongst dental professionals.