Polypharmacy and Self-Reported Tooth Clenching: An Electronic Health Record Analysis

Vollständiger Abstract

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Introduction: Central nervous system (CNS) medications, particularly antidepressants (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs]), stimulants for attention-deficit/hyperactivity disorder (ADHD), and antipsychotics, are commonly implicated in drug-induced bruxism, yet evidence derives predominantly from case reports. No large-scale studies have examined associations between CNS medication classes and bruxism while controlling for confounders, and potential effects of drug combinations remain unexplored. Objectives: This study aimed to investigate the associations between CNS medication use and self-reported tooth clenching, examining individual drugs, drug classes, and drug combinations. Methods: This cross-sectional study analyzed electronic health records from 14,643 dental clinic patients at a university dental college. Medications were standardized using RxNorm and classified into 14 pharmacological classes. Multivariable logistic regression estimated adjusted odds ratios (aORs) for self-reported tooth clenching, controlling for age, sex, polypharmacy, respiratory conditions, and neurologic conditions. Missing data were handled using multiple imputation, and the Benjamini–Hochberg (BH) procedure controlled the false discovery rate for exploratory analyses. A total of 66 pairwise drug class combinations were evaluated. Results: Overall self-reported clenching prevalence was 54.0%. Among 14 drug classes, SNRIs showed significantly elevated odds of clenching (aOR, 1.24; 95% CI, 1.08–1.43; BH-adjusted P = 0.036), whereas SSRIs showed no association. A graded association was observed with CNS polypharmacy: 2 drug classes (aOR, 1.26; 95% CI, 1.13–1.42) and 3 or more classes (aOR, 1.38; 95% CI, 1.20–1.59) showed progressively higher odds (P < 0.001). One of 66 drug combinations (SSRI plus SNRI) retained a significant association (aOR, 2.40; 95% CI, 1.51–3.83; BH-adjusted P = 0.015). Conclusions: In this exploratory analysis, SNRIs rather than SSRIs were associated with self-reported clenching, in contrast to the predominance of SSRIs in case-report literature. Greater CNS polypharmacy was associated with higher odds of self-reported clenching, and SSRI–SNRI coexposure emerged as a hypothesis-generating signal requiring confirmatory analysis. Knowledge Transfer Statement: Evidence linking specific central nervous system (CNS) medications to bruxism has relied predominantly on case reports. This cross-sectional study found that serotonin-norepinephrine reuptake inhibitors (SNRIs) and CNS polypharmacy, rather than selective serotonin reuptake inhibitors (SSRIs), were associated with self-reported clenching. These findings may prompt dental professionals to consider CNS medication profiles as one contextual factor when evaluating reported clenching or grinding, pending confirmation in studies with clinician-validated outcomes.