Management of Bruxism with Muscle Relaxants

First-Line Treatment Approach

The British Medical Journal recommends conservative approaches, including reassurance and education about the condition, avoidance of wide mouth opening or aggravating activities, soft diet to reduce jaw muscle strain, heat and/or cold therapy for muscle relaxation, and bite plate or oral appliance in the presence of bruxism, as the initial treatment for bruxism 1
Physiotherapy and jaw exercises, cognitive behavioral therapy for stress management, mindfulness, yoga, or meditation to reduce anxiety, and acupuncture may be considered as adjunctive therapies alongside muscle relaxant therapy, as recommended by the British Medical Journal 1

Methocarbamol can be considered for acute muscle spasms related to bruxism, according to Praxis Medical Insights 2
Atracurium/cisatracurium may be considered in patients with renal/hepatic failure, as stated in Anaesthesia 3

Monitor for excessive sedation, especially when combining muscle relaxants with other CNS depressants, as advised by Praxis Medical Insights 4
Suxamethonium is contraindicated in patients with primary muscle damage (myopathies) or up-regulation of nicotinic acetylcholine receptors, and muscle relaxants should be used with caution in patients with neuromuscular diseases, according to Anaesthesia 5

The British Medical Journal recommends starting with conservative measures, such as oral appliance, soft diet, and heat/cold therapy, and initiating cyclobenzaprine 5 mg TID for 7-14 days if there is an inadequate response, with assessment of response after 3-4 doses 1
For patients with hepatic/renal impairment, consider benzylisoquinoline muscle relaxants like atracurium, as stated in Anaesthesia 3