Assessment of self-reported and clinically reported bruxism in studies on selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors use

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BACKGROUND: The authors critically evaluated whether evidence supports an association between selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors and reported bruxism, and they analyzed possible causal inferences. TYPES OF STUDIES REVIEWED: The authors appraised published case reports, case series, and cross-sectional studies in which antidepressant use and bruxism outcomes were investigated. Study selection included reports in which bruxism onset or prevalence among users of selective serotonin reuptake inhibitor and serotonin-norepinephrine reuptake inhibitor were described. Assessment methods, timing relative to drug initiation, differentiation between awake and sleep bruxism, and presence of comparison groups were critically analyzed. RESULTS: Evidence was predominantly observational and based largely on self-reported or clinically reported bruxism. Data were available for 41 patients in case reports, 17 patients in case series, and 2,655 patients in cross-sectional studies. Polysomnography was used in only 1 study. No researchers prospectively assessed bruxism before and after antidepressant initiation while adequately controlling for psychological confounding variables. Inconsistent differentiation between awake and sleep bruxism and heterogeneous diagnostic approaches contributed substantially to interstudy variability. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Dentists should interpret reports of antidepressant-related bruxism cautiously. Overreliance on subjective assessment may lead to misattribution of symptoms to medication rather than underlying psychological or sleep-related factors. The protocol was registered in the Open Science Framework on November 22, 2025 (doi:10.17605/OSF.IO/6X27Y).

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