All four patients described by Ellison and Stanziani as well as our patient were under significant stress and experiencing anxiety when bruxism symptoms occurred. None of the patients had been aware of jaw clenching and teeth grinding. Our patient was under stress from marital difficulties. His anxiety level could also have increased due to the stress of being alone for the upcoming holiday. These two factors could increase the frequency and intensity of teeth clenching and grinding. Thus the incident of bruxism and the sertraline therapy could merely be coincidental.
Sertraline may have induced bruxism given that it was the only new medicine added to the patients’ drug therapy. No patient was reported to have had an increase in the serum concentration of sertraline. Furthermore, in our patient, the adverse event occurred three days after sertraline administration, and he had never received any SSRIs or neuroleptic agents before this adverse event.
However, there may not be association between bruxism disease, hypertension, hyperlipidemia, peripheral vascular disease, atrial flutter and impotence. Medications included glyburide 5 mg orally bid, enalapril 5 mg bid, digoxin 0.25 mg/day, propafenone 150 mg tid, enteric-coated acetyl-salicylic acid 325 mg/day and lovastatin 20 mg at bedtime. He denied alcohol use and had quit cigarette smoking two years previously. Past surgical history included two femoral bypass surgeries in 1977 and 1987, a pacemaker insertion in 1992 and a penile prosthesis.
Depression treatment was initiated with sertraline 50 mg at bedtime. Three days later the patient began to complain of a sudden onset of jaw clenching and teeth grinding. He denied any similar experience before receiving sertraline. Because these symptoms were not debilitating sertraline therapy was continued. Over the next seven days his jaw pain increased in intensity and duration. While awake he was able to control the jaw clenching and teeth grinding voluntarily. However, at night the symptoms would recur. The symptoms made chewing and yawning very difficult and became so intense that he broke two left lower premolars, necessitating a dental visit. Sertraline was discontinued after 14 days of treatment.