Pharmacologic Management of Sleep Bruxism in Adults: A Systematic Review and Meta-Analysis of Polysomnographic Outcomes.

backgroundSleep bruxism (SB) is a sleep-related movement behaviour with potential dental and orofacial consequences. Pharmacologic treatment remains controversial because evidence of benefit is limited and its clinical value in dental practice is unclear.

objectivesTo evaluate the efficacy, safety and clinical relevance of pharmacologic interventions for SB in adults, and to consider their implications for dental management.

methodsPubMed, Embase and Web of Science were searched through March 2025. Clinical trials in adults were eligible when they evaluated pharmacologic interventions for polysomnography-confirmed SB or rhythmic masticatory muscle activity (RMMA). Randomized studies were synthesized quantitatively where appropriate, and non-randomized studies were summarized qualitatively. Risk of bias and certainty of evidence were assessed using standard review methods.

resultsNine studies involving 116 adults were included, six of which were randomized crossover trials. Five pharmacologic classes were identified. Overall certainty of evidence ranged from low to very low. Clonidine showed the most consistent, but modest, reduction in SB frequency. Benzodiazepines, dopaminergic agents and beta-blockers showed no reproducible benefit. Gabapentin reduced RMMA and improved sleep efficiency in one non-randomized study. No serious adverse events were reported, but most studies evaluated only single-night or short-term exposure.

conclusionsCurrent evidence suggests that pharmacological interventions provide, at most, limited short-term benefits for SB. For dental practice, pharmacotherapy should not replace established first-line approaches such as patient counselling, behavioural strategies and occlusal appliances. At present, no medication can be recommended for routine management of SB. PROSPERO REGISTRATION: CRD420251168064.