Does Amitriptyline Stop Bruxism? An Examination of the Clinical Evidence

October 8, 2025 •

4 min read

Bruxism affects millions worldwide, with some studies indicating up to 10% of adults experience sleep-related teeth grinding. While various treatments exist, the question, "Does amitriptyline stop bruxism?" is a common one, though the clinical evidence suggests this tricyclic antidepressant is largely ineffective for the motor symptoms of grinding and clenching.

Quick Summary

Studies show that low-dose amitriptyline has no significant effect on jaw muscle activity related to sleep bruxism. While it may reduce associated pain and stress perception, it is not a primary treatment. More effective alternatives include oral appliances, botulinum toxin injections, and other medications like clonazepam or gabapentin.

Key Points

Limited Efficacy for Grinding: Numerous studies and systematic reviews have concluded that low-dose amitriptyline does not significantly reduce nocturnal jaw muscle activity, the primary symptom of bruxism.
Does Not Stop the Act of Clenching: The medication does not reliably prevent the physical act of grinding or clenching teeth, and its effects on jaw muscle activity can be unpredictable.
May Reduce Stress Perception: Some limited evidence suggests that amitriptyline might help reduce the perception of stress associated with bruxism, but this does not equate to stopping the physical action.
Consider More Effective Alternatives: For treating bruxism, alternatives with stronger clinical evidence include occlusal splints, botulinum toxin injections, and other medications like clonazepam or gabapentin.
Consult a Professional: Due to its side effect profile and limited efficacy for bruxism, you should not take or stop amitriptyline for this condition without a healthcare provider's guidance.
Less Likely to Cause Bruxism: Unlike some SSRI/SNRI antidepressants, TCAs like amitriptyline are less commonly associated with inducing bruxism.

The Clinical Evidence on Amitriptyline and Bruxism

Clinical trials have investigated the efficacy of amitriptyline, a tricyclic antidepressant (TCA), as a treatment for sleep bruxism. However, the evidence consistently points to limited effectiveness in reducing the actual grinding and clenching.

Multiple double-blind, randomized, placebo-controlled studies have demonstrated that low-dose amitriptyline (e.g., 25 mg/night) does not significantly reduce nocturnal masseteric electromyographic (EMG) activity, which measures jaw muscle activity. A Cochrane systematic review of pharmacotherapy for sleep bruxism also found that amitriptyline did not reduce the activity of the jaw muscles. Some studies even reported that the intake of amitriptyline was unpredictably associated with either an increase or a decrease in masseteric activity, making it an unreliable treatment.

Potential Effect on Associated Symptoms

Despite its lack of efficacy on the motor activity of bruxism, amitriptyline may offer some secondary benefits. One pilot study found that while 4 weeks of low-dose amitriptyline did not significantly reduce pain intensity in bruxers, it did significantly reduce their perception of stress. Since stress is a known contributing factor to bruxism, this could indirectly help manage the condition for some individuals, though it doesn't address the physical action itself.

Contrasting with Other Antidepressants

It is important to differentiate amitriptyline from other classes of antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). Studies have shown a link between SSRIs and SNRIs and the induction or worsening of bruxism. In contrast, TCAs like amitriptyline are not typically associated with inducing bruxism. This might explain why some clinicians consider it, but it does not mean it is a suitable treatment for pre-existing bruxism. A rare case report did show some success with amitriptyline treating duloxetine-induced bruxism, but this finding is considered less scientifically valuable than controlled trials.

Potential Side Effects of Amitriptyline

Even when used in low doses, amitriptyline has a side effect profile that needs consideration. Some common side effects include:

Daytime sedation or drowsiness
Dry mouth (xerostomia)
Dizziness or lightheadedness
Constipation
Blurred vision
Weight gain

Dry mouth, in particular, can be a dental health concern, as it increases the risk of tooth decay. Higher doses carry more significant risks, and suddenly stopping the medication without professional guidance can be dangerous.

Established Alternatives to Amitriptyline for Bruxism

For individuals seeking effective management of bruxism, several alternatives with stronger evidence are available:

Oral Appliances (Night Guards/Splints): These custom-fitted devices are placed over the teeth to protect them from the damage of grinding and clenching. They do not stop the action but prevent dental wear and may help with associated jaw pain.
Botulinum Toxin (Botox) Injections: For severe bruxism cases, injections of botulinum toxin into the masseter and temporalis muscles can temporarily weaken them, reducing the force of clenching and grinding. This is an effective treatment for many who do not respond to other therapies.
Other Medications with Better Evidence: Certain medications have demonstrated more promising results than amitriptyline in controlled studies. These include the benzodiazepine clonazepam, the anti-anxiety medication buspirone (especially for antidepressant-induced bruxism), and the anticonvulsant gabapentin. However, all these options require careful medical supervision due to their potential side effects and risks, such as the dependence risk associated with benzodiazepines.
Behavioral and Lifestyle Changes: Since stress and anxiety are major triggers, incorporating stress management techniques can be beneficial. These include meditation, yoga, exercise, and biofeedback, which helps individuals become more aware of their jaw muscle activity. Avoiding stimulating substances like caffeine and alcohol before bed can also help.

Comparison of Bruxism Treatments


Feature	Amitriptyline	Oral Appliances (Night Guards/Splints)	Botulinum Toxin (Botox) Injections
Efficacy in Stopping Grinding	Low to non-existent based on most studies; can unpredictably increase or decrease activity.	Does not stop grinding, but protects teeth from damage.	High for severe cases by weakening jaw muscles.
Efficacy for Pain	Limited effect on pain intensity in most bruxism studies, though can reduce pain from chronic TMD.	Can help reduce jaw pain and muscle soreness.	Effective for reducing jaw pain and muscle stiffness associated with grinding.
Mechanism	Inhibits reuptake of neurotransmitters like serotonin and norepinephrine; sedative and anticholinergic effects.	Creates a barrier between upper and lower teeth.	Blocks nerve signals to the injected muscles, causing temporary relaxation.
Side Effects	Daytime sedation, dry mouth, dizziness, weight gain.	Potential for jaw discomfort initially.	Temporary muscle weakness, injection site discomfort, potential bone loss with long-term use.
Safety for Long-Term Use	Concerns with long-term use, especially due to side effects.	Generally considered safe for long-term use.	Long-term effects, such as potential bone loss due to disuse, are still being studied.

Conclusion

Based on current clinical evidence, amitriptyline does not effectively stop bruxism. Controlled studies have repeatedly shown that it has no significant impact on the nocturnal jaw muscle activity that causes teeth grinding. While it may help with associated symptoms like stress perception and is less likely to induce bruxism than other antidepressants, it is not a recommended primary treatment for the condition. Patients with bruxism should discuss with a healthcare provider more effective, evidence-backed options such as occlusal splints, botulinum toxin injections, or targeted behavioral therapies.

It is crucial for individuals dealing with teeth grinding to seek professional medical and dental advice. Do not discontinue any prescribed medication, including amitriptyline, without consulting your doctor first.

For further information on bruxism treatments, you may consult resources from authoritative organizations like the Mayo Clinic.

Frequently Asked Questions

No, amitriptyline is not considered a reliable or effective treatment for sleep bruxism. Clinical studies have shown that it does not significantly reduce the involuntary jaw muscle activity associated with teeth grinding.

The primary effect, based on some limited studies, is a reduction in the perception of stress in bruxers, not a cessation of the teeth grinding or clenching action itself.

While not a primary treatment for bruxism, a doctor might consider amitriptyline for managing chronic orofacial pain or if stress and anxiety are major contributing factors. It is also less likely to induce bruxism compared to some other classes of antidepressants.

Yes, several medications and treatments have shown more promise. These include muscle relaxants (like clonazepam), anticonvulsants (like gabapentin), or botulinum toxin injections for severe cases.

You should only use amitriptyline as prescribed by your doctor. If you were prescribed it for another condition and also have bruxism, discuss your bruxism symptoms with your doctor to explore more effective and appropriate treatment options.

Common side effects include dry mouth (xerostomia), which can increase the risk of tooth decay, and daytime drowsiness. These can impact overall dental and systemic health.

Oral appliances like night guards are generally considered a safe and effective way to protect teeth and manage pain caused by grinding and clenching. Treatment for the root cause, such as stress management, is also highly recommended.