Accutane, Bruxing and TMJ

Recently, a patient presented with “clicking” that has progressed to having a locked left jaw in the morning.  They can “unlock” it easily at this point. The clicking symptoms started when they were taking Accutane for acne and the clicking seemed to resolve when Accutane was discontinued.

Did Accutane have anything to do with this?

Yes and no.  Accutane side effect profile shows that very few people who take Accutane “brux” or “grind their teeth” after 6 months of taking it (.4% of sample of 30,000 who reported it).  Bruxing seems to subside for a few months and then re-appears after another 6 months of use, but at much lower rates.  Bruxing significantly increases the pressure in the TMJ and if there is an underlying misalignment or subtle problem, it could “push it over the edge” to become symptomatic. It would have anyway…the increased pressure just hastened it’s onset.

Women report bruxing almost 3X as often as males.

The #1 reason that TMJ problems develop (regardless of bruxing) is due to the jaw joints (condyles) being “out of center in the sockets”.  This is a growth/imbalance between the upper and lower jaws that can only be seen with a 3d radiograph.  Up to 90 % of people have some “misalignment” of their TMJ, but not all develop signs (clicking, locking, limited opening or sideways movement, bite change) or symptoms (jaw pain, headaches, clenching or grinding teeth).

Many factors trigger the TMJ symptoms to appear and, once they start they don’t “go away” on their own, despite what you read and are told…the symptoms just change.

If your TMJ starts clicking, if your bite changes or feels uneven, your ability to open changes, etc…You have a TMJ problem.

It won’t “go away” on its own. The symptoms do change as the damage progresses, depending on what structures are being affected.  The sooner you can be evaluated by a credentialed dentist the better outcome you will have.  Adjusting the bite, “Equilibrating the Teeth” or using an NTI appliance or anterior bite appliance to “get the jaw in the right place” may temporarily decrease symptoms but will accelerate the orthopedic damage in your jaw.  They are the wrong devices for any type of TMJ condition and should only be used a week or so.

FDA Reports, Who have Bruxism with Accutane.

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