Jaw Clenching Associated with Sertraline Use

Mechanism and Incidence

The American Academy of Child and Adolescent Psychiatry notes that SSRIs, including sertraline, can cause motor side effects through serotonergic modulation of dopaminergic pathways, leading to extrapyramidal symptoms like bruxism, jaw clenching, and teeth grinding 1.
Motor symptoms like jaw clenching represent less commonly discussed but clinically significant side effects of SSRIs, according to the American Academy of Child and Adolescent Psychiatry guidelines 1.
These symptoms can occur at any dose but may worsen with dose escalation, as higher doses of SSRIs are associated with increased frequency of adverse effects 1, 2.

The American Academy of Child and Adolescent Psychiatry recommends reducing the sertraline dose to the lowest effective level (typically 25-50 mg daily) to reduce the frequency and severity of adverse events, including jaw clenching 1, 2.
When switching to an alternative SSRI, the American Academy of Child and Adolescent Psychiatry suggests tapering sertraline gradually over 1-2 weeks to avoid discontinuation syndrome 1.
Consider adding a dental night guard to prevent tooth damage from nocturnal bruxism while addressing the underlying medication cause, as recommended by the American Academy of Child and Adolescent Psychiatry 1.

Assess for additional serotonin syndrome features, including mental status changes, neuromuscular hyperactivity, and autonomic instability, as jaw clenching alone is typically an isolated motor side effect, but if accompanied by these other features, immediately discontinue sertraline and provide supportive care 4.
Review all concomitant medications for serotonergic agents, which increase serotonin syndrome risk, according to the American Academy of Child and Adolescent Psychiatry 4.
Sertraline interacts with drugs metabolized by CYP2D6, which may increase adverse effects if the patient is taking multiple medications through this pathway 1.

Do not simply increase the dose assuming the jaw clenching will resolve with time—motor side effects typically persist or worsen with higher doses, as noted by the American Academy of Child and Adolescent Psychiatry 1, 2.
Do not abruptly discontinue sertraline without tapering, as this will cause discontinuation syndrome with symptoms that may be confused with relapse of the underlying anxiety disorder, according to the American Academy of Child and Adolescent Psychiatry 1.