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Bruxism is the jaw clenching or grinding of teeth that usually occurs during sleep. 1–5 It is synonymous with trismus when referring to tonic jaw clenching, and considerable jaw pain and tooth ischemic pain in particular can be generated by this form. Lifetime occurrence of at least some orofacial pain from a night of bruxing or daytime episodes of clenching or grinding, particularly at a time of unusual stress, approaches 100%. Point prevalence is estimated at 5–10% of the adult population, 5 6 and a minority of these individuals develop

to fewer adverse effects such as sedation, dry mouth, and orthostatic hypotension. However, when sleep is poor and nocturnal bruxism is present, a tertiary amine (amitriptyline, imipramine) can be used at bedtime. TCAs are useful for most COP, including musculoskeletal pains, neuropathic pains, migraine, and tension-type headache. The newer SNRIs, venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq), are used increasingly for chronic pain, and particularly neuropathic pain. Cymbalta and Pristiq are FDA-approved for certain neuropathic

, Uziel N, Lisha T, Goldsmith C, Eli I. Self-reported bruxism: associations with perceived stress, motivation for control, dental anxiety and gagging . J Oral Rehab . 2011 ; 38 : 3 – 11 . 10 Bassi GS

the reactivation of the autonomic-cardiac sympathetic dominance, expressed as a rapid rise in heart rate, which is normally seen (Okura et al, abst Sleep 2005). Between 30% and 65% of patients with sleep bruxism/tooth-grinding complain of morning headaches, a condition that is commonly caused by airway collapse (Upper airway resistance syndrome/limitation of airflow or Sleep Apnea/cessation of breathing). The cause and effect relationship between sleep respiratory disturbances and the maintenance of chronic pain remains to be demonstrated. Management