Teeth grinding in the day is present in 4% in people living with dementia. Clinical management in awake bruxism can be challenging as most cases do not respond well to medical treatment. Does Galantamine have a role in this condition? To cite this poster: Lai MM. Managing oral symptoms in dementia. The 16th Asia Pacific Regional Conference of Alzheimer’s Disease International (ADI), December 2013. The scientific publication can be found in: Awake bruxism in a patient with Alzheimer’s dementia. Geront & Geriatr Int. Oct 2013; 4(13). doi: 10.1111/ggi.12086 http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CB8QFjAB&url=http%3A%2F%2Fwww.researchgate.net%2Fprofile%2FMichelle_Lai3%2Fpublication%2F257888467_Awake_bruxism_in_a_patient_with_Alzheimer's_dementia%2Flinks%2F54190c5b0cf203f155adc06d&ei=7h0tVMGiNs798AWCooGwCg&usg=AFQjCNEfWnQeATmFzjGtPeby-w5TXP-v-Q&sig2=UQ-jkruNxneG9w_UO50JtQ&bvm=bv.76477589,d.dGc

1. Managing
Oral
Symptoms
in
DemenAa:
A
Case
of
Awake
Bruxism
in
Alzheimer’s
disease
1,
2
Michelle
M.
Y.
Lai
1Eastern
Health
Clinical
School,
Monash
University
2Department
of
Aged
Care,
Caulfield
Hospital,
Alfred
Health,
Melbourne,
Australia
CASE
DISCUSSION
• A 79-year old Italian man presented to a
memory clinic with 2-year history of progressive
short-term memory loss, apathy, hallucinations
and constant teeth grinding in the day. He did
not use neuroleptics or any medications.
• His debilitating oral symptom had partial
remission during eating and speaking, impacting
on his social activities.
• Examination revealed extensive teeth damage,
phasic teeth grinding but no extrapyramidal
features. MMSE was 20 out of 30.
• Neuropsychological testing was consistent with
moderate dementia of Alzheimer’s type,
although a diagnosis of Lewy body dementia
was possible. Computer Tomography of the
brain showed generalised atrophy.
• His visual hallucination resolved with
risperidone 1mg daily. Subsequently, his teeth
grinding responded favourably to galantamine
at 16mg daily.
• The complex interactions of various
neurotransmitters in awake bruxism is poorly
understood, but a central role of the
dopaminergic system has been suggested.(2)
• A favourable response to galantamine, a
cholinesterase inhibitor that potentiates
acetylcholine, might affect dopamineacetylecholine balance and have an inhibitory
effect on dopamine-induced oral dyskinesia.
Furthermore, relief of anxiety is an alternative
explanatory of the favourable response in this
patient.
• The lack of prior neuroleptic use excluded the
diagnosis of orofacial tardive dystonia.
• The use of risperidone needs to be cautious, as
its dopamine blockage may worsen patient’s
teeth grinding.
BRUXISMS
and
DEMENTIA
• Approximately 4% of people with Alzheimer’s
disease have oral movement disorder of tooth
grinding or clenching while awake.(1)
• They present with stereotyped movement of
mouth, causing tooth damage, pain, headache
and depression.
• Awake bruxism is a separate entity from
nocturnal bruxism during sleep. The former may
sometimes follow prolonged anti-psychotic use
but it is also associated with central nervous
system (CNS) diseases, such as Parkinson’s
disease, stroke and dementia.(1)
• Most patients with dementia present to dentists
with poor tolerance to mouth guards and have a
low remission rate.
The 16th Asia Pacific Regional Conference of ADI 2013, Hong Kong Convention Centre
RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
CONCLUSIONS
- This case of debilitating awake bruxism that
developed during the course of Alzheimer’s,
unrelated to anti-psychotic use, highlights that
galantamine may have dual benefit in
modulating cognition and bruxism symptoms.
- Pharmacological management may have a role
in managing awake bruxism in patients with
dementia, who have poor tolerance to mouth
guards, or botulinum toxin injection of muscles
of mastication.
REFERENCES
Kwak YT, Han IW, Lee PH et al. Associated conditions and clinical significance of awake bruxism. Geriatr Gerontol Int
2009; 9:382-390.
Chen WH, Lu YC, Lui CC et al. A proposed mechanism for diurnal/norcturnal hypersensitivity of presynaptic dopamine
receptors in the frontal lobe. J Clin Neurosci 2005; 12:161-163.
Contact: Dr Michelle Lai
Lecturer, Consultant Geriatrician
& Clinical Epidemiologist
E: Michelle.Lai@monash.edu
This case report is recently published in Geriatrics and Gerontology
International:
Lai MM. Awake bruxism in a patient with Alzheimer's dementia. Geriatr
Gerontol Int. 2013 Oct;13(4):1076-7. PubMed PMID: 24131760