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Teeth grinding


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#1 miracleseeker

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Posted 09 April 2012 - 11:04 PM

My mom kept a 25/100 Sinemet on her tongue while I thought she had swallowed it when I gave her the tablet as a booster dose at 3:00 am. By 4:30 she was mumbling non-stop and her limbs were stiff and tight. She made a fist that she wouldn't release. She also peed out of her diaper so I knew she had not swallowed it. I tried to scoop out as much as I could with my finger because by 6:00 am she would be taking her dose of 150mg Stalevo with .75 Mirapex. I then gave her some water and this time she gulped it down along with the pill.

The problem is she began grinding her teeth all day long. This happened to her once before when she was on 200mg Stalevo 3 times a day and I thought it probably meant she was taking too much. Now in this case it is because she still had lots of Sinemet left in her system when I gave her the Stalevo so again she had too much in her system? If that is true then why would she be grinding all day? I would think the Sinemet would have left a long time ago and all she was on was her regular strength of stalevo. Any thought?

#2 MComes RPH

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Posted 15 April 2012 - 11:32 AM

The grinding of theeth is a big issue in todays society. It usually jappens at night, but some people experience it during the day. Here are a few issues that can cause theeth grinding:
1-Anxiety
2-Feelings of aggression
3-Frustration
4-Stress
5-Suppressed anger
6-Tension
Now this is with people who do not have PD. As you know, any or all of these issues will exacerbate PD symptoms, including dyskensia in some situations.
Grinding of the teeth in PD patients is usually due to too much Dopamine in the system. So, here are a few posibilities that may help decrease the teeth grinding. This is a condition call oral-buccal dyskensia.
1- we know we can not eliminate sinemet, but we may be able to re-organize it. If you try a sinemet CR at the latest dose of the day, right at bedtime, this may eliminate the morning dose of the regular strength sinemet in the morning.
2- possibly a muscle relaxer at bedtime or a low dose muscle relaxer a couple times a day may help decrease the grinding.
3- Vitamin B-5 (pantothenic acid) has also been known to help with the grinding of teeth. It works with the nervous sysyem to diminish muscle cramping of the smooth muscle, which is in the jaw area.
Let me ask, has your mom been taking any benzodiazapines for any length of time? Examples of benzodiazapines are:
Generic Name (Brand Name)
______________________________________
Alprazolam (Helex, Xanax, Xanor, Onax, Alprox, Restyl, Tafil)
Bromazepam (Lectopam, Lexotanil, Lexotan, Bromam)
Brotizolam (Lendormin, Dormex, Sintonal, Noctilan)
Chlordiazepoxide (Librium, Risolid, Elenium)
Cinolazepam (Gerodorm)
Clonazepam (Rivotril, Klonopin, Paxam)
Clorazepate (Tranxene, Tranxilium)
Clotiazepam (Veratran, Clozan, Rize)
Cloxazolam (Sepazon, Olcadil)
Delorazepam (Dadumir)
Diazepam (Antenex, Apaurin, Apzepam, Apozepam, Hexalid, Pax, Stesolid, Stedon, Valium, Vival, Valaxona)
Estazolam (ProSom)
Etizolam (Etilaam, Pasaden, Depas)
Flunitrazepam (Rohypnol, Fluscand, Flunipam, Ronal, Rohydorm)
Flurazepam (Dalmadorm, Dalmane)
Flutoprazepam (Restas)
Halazepam (Paxipam)
Ketazolam (Anxon)
Loprazolam (Dormonoct)
Lorazepam (Ativan, Lorenin, Temesta, Tavor, Lorabenz)
Lormetazepam (Loramet, Noctamid, Pronoctan)
Medazepam (Nobrium)
Midazolam (Dormicum, Versed, Hypnovel, Dormonid)
Nimetazepam (Erimin)
Nitrazepam (Mogadon, Alodorm, Pacisyn, Dumolid, Nitrazadon)
Nordazepam (Madar)
Oxazepam (Seresta, Serax, Serenid, Serepax, Sobril, Oxabenz, Oxapax)
Phenazepam (Phenazepam)
Pinazepam (Domar)
Prazepam (Lysanxia, Centrax)
Premazepam (Premazepam)
Quazepam (Doral)
Temazepam (Restoril)
Tetrazepam (Mylostan)
Triazolam (Halcion)

I know the list is long, but I wanted t make sure I covered ALL OF THEM. any of these medications, taken even at low doses, for a LONG period of time can cause teeth clinching or grinding. I know from working behind the counyer how many elderly people depend on these types of medications.
I know it seems like over kill, but I would rather give you too much than too little information. Hope it helps.





My mom kept a 25/100 Sinemet on her tongue while I thought she had swallowed it when I gave her the tablet as a booster dose at 3:00 am. By 4:30 she was mumbling non-stop and her limbs were stiff and tight. She made a fist that she wouldn't release. She also peed out of her diaper so I knew she had not swallowed it. I tried to scoop out as much as I could with my finger because by 6:00 am she would be taking her dose of 150mg Stalevo with .75 Mirapex. I then gave her some water and this time she gulped it down along with the pill.

The problem is she began grinding her teeth all day long. This happened to her once before when she was on 200mg Stalevo 3 times a day and I thought it probably meant she was taking too much. Now in this case it is because she still had lots of Sinemet left in her system when I gave her the Stalevo so again she had too much in her system? If that is true then why would she be grinding all day? I would think the Sinemet would have left a long time ago and all she was on was her regular strength of stalevo. Any thought?


Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#3 miracleseeker

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Posted 15 April 2012 - 07:40 PM

No she doesn't take any of those medications listed. She took Ativan once and she wired up so we had to stop.
I had a feeling it was too much meds that's causing her teeth grinding. What I don't understand is how can that be if she's been taking her pills the same time everyday for the past 5 months now and just a week ago she started to grind her teeth? I would like to decrease Stalevo by .25 for the afternoon where she does it most often and see if it will help. But if she gets rigid from having less of it then I can't do that. She's also been moaning and groaning in her sleep in the afternoon. Is that too much meds as well? She's the one that gets her Stalevo crushed so maybe it's too much all at once?

I tried having her take Sinemet instead but it's not as strong as Stalevo.

#4 MComes RPH

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Posted 02 May 2012 - 05:07 AM

That is what I was talking about before when crushing the stalevo. It goes from a long release to a short release. Which in turn will cause higher levels quickly instead of an even rate over a longer time period. That is probably what is causing her to grind her teeth.
Also, maybe a sinemet CR in the late evening may stop, or slow down some of this.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#5 miracleseeker

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Posted 02 May 2012 - 08:19 AM

It's been over 10 days since I decreased the Stalevo by 25mg at night. She's still grinding on and off. The only way to stop this repetitive cycle is to give her something crunchy to chew on and then she stops. She takes 25/100 Sinemet at 2 am and still grinds from that too so it's not just the Stalevo being crusheds that's causing the problem. Besides I have been crushing for over 7 months now so why would the grinding start now? I don't want to keep decreasing because I know she will get worse movement wise. I was hoping it was a phase but I dunno now...

#6 MComes RPH

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Posted 08 May 2012 - 07:07 AM

I am also stumped. It seems like we tried every possible answer. I guess if we saw a little improvement in the last change we made, maybe moving the one at night a little later may help a little more.
Keep me updated.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#7 miracleseeker

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Posted 09 May 2012 - 02:31 PM

What I notice is she grinds when she's feeling relaxed and that happens when the pill kicks in usually 30 minutes to an hour after she takes it. I then give her something to crunch on and then she stops. It's like she has an itch for this repetitive motion and after she actually gets to bite down on something she then stops.

#8 MComes RPH

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Posted 13 May 2012 - 06:45 PM

Is she aware she is doing it? I guess that is the biggest question. It could just be a psycoseematic response after she is given that pill. Almost like a habit
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#9 miracleseeker

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Posted 13 May 2012 - 11:10 PM

No my mom's dementia prevents her from knowing much of anything. I once put my finger in her mouth to see what exactly is she biting on and she bit me hard. So i know it's not something she has help doing. it's just a reflex but only started a month ago after getting her teeth cleaned.

#10 MComes RPH

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Posted 15 May 2012 - 11:14 AM

When people have dementia, as you know, a routine makes the difference between a good day and a bad day. It could just be the sensation of how clean they feel or the smoothness as to the reasin she is doing it. It may be that simple.
Give it another month or so and let me know. And no more fingers in her mouth. JK:-)
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#11 miracleseeker

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Posted 06 June 2012 - 12:18 PM

Well guess what? I replaced 150mg Stalevo for 1.5 tablets of regular sinemet 25/100 at bedtime and..... no more grinding for the night. I then give her 1 tablet of 25/100 sinemet at 2 am and then it's 150mg Stalevo at 6am then 125mg Stalevo at 1:30pm

She doesn't grind with the 150mg Stalevo in the morning but she does with the 125mg Stalevo in the afternoon. I lessened it from 150mg hoping the decrease would stop it but it didn't.

The reason I won't switch her to sinemet completely is because Stalevo is a stronger drug for my mom so I make her stay with it in the mornings and afternoon where she needs to be awake and active. Taking Sinemet at night while she's sleeping and not moving is ok. I just want her comfortable then.

The question is what can I do about the grinding in the afternoon now? If I have her take Sinemet she will not be able to walk as freely as she does now. Can Sinemet CR be crushed? I wonder if she took that instead of regular Sinemet it will be the same as taking Stalevo but please keep in mind I crush Stalevo too.

#12 MComes RPH

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Posted 13 June 2012 - 10:12 AM

Sinemet cr should not be crushed, but since your mom reacts so much differently than most people, it may be worth a shot. Since you know her history and background so much better than i do, i would say i don't think it will hurt to try it.
Keep me posted. As always, I appreciate it.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#13 miracleseeker

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Posted 14 June 2012 - 07:59 AM

As of last week I switched my mom back to 150mg Staleveo in the afternoon and skipping the 125mg Stalevo altogether. She was losing steam very quickly even with just a 25mg decrease. The teeth grinding is back with full force but she's got more stamina. I have take 1.5 tablet of 25/100 Sinemet regular at bedtime and then 1 tablet at 2am. I don't want to give her CR because being that it's time released then it's basically taking Stalevo. The reason my mom is grinding her teeth is because she is getting too much entacapone. She is NOT grinding at the evening dose of Sinemet so that is how I know. I read that there is a high rate of dyskensia with CR vs. regular. Teeth grinding is part of the dyskensia which is what my mom has.

Or.... like you said before. By crushing it is making her absorb it too much too soon and that in itself is causing the teeth grinding. Not much I can do about that though. She won't swallow whole. Stalevo is a stronger drug so my mom needs it but the compromise is to not take for evening since there is no need for that extra ooomph. There is never an easy way to get her "normal"

The Sinemet does wear out very fast. Sometimes if I give it to her after 2am and then she gets her 150mg Stalevo at 6am she will grind her teeth. So it doesn't last long but if the dosing is close to the next dose than she's affected too. sigh! So if she takes it at 2am and then again at 6am she's out of it. No strength to even open her eyes or move her legs or arms for a comfortable position in bed.

She literally will be lifeless if the meds are not given in a timely manner. There is no reserve in her system to ride it out so the good stuff evaporates fast but the side effects stays. Not a good combo.

#14 MComes RPH

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Posted 09 July 2012 - 12:12 PM

Hope we can contnue to get her correct.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#15 miracleseeker

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Posted 10 July 2012 - 11:25 AM

She grinds with regular sinemet chewed or swallowed in addition to Stalevo. It's not the entacapone but rather Levo/carbo that's doing it then. I don't even know what she is grinding to be truthful. She has lost several teeth in the past year so her top teeth are not meeting with any teeth on the bottom to grind yet she makes these noises like she's chewing broken glass. I'm starting to suspect it is more like TMJ and it's her jaw that is making all the sounds. It is driving me up the walls.

The only time she lets up is several hours after her dose of meds but starts up again after she takes it half hour to an hour afterwards. I read someone's post that she gets it when she has too much Stalevo in her system. I thought that was the case for my mom but I'm wrong. Either one will do it.

#16 MComes RPH

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Posted 11 July 2012 - 12:20 PM

I have really been looking into this and it all points to obsessive compulsive issue, which could be from too much of almost any PD med. Which one? I am just not sure of yet.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#17 miracleseeker

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Posted 12 July 2012 - 03:58 PM

Well I have already tested it out and she does it whether it's Stalevo or Sinemet. Usually that means take less to stop it but when she goes less it also makes her less mobile. Taking more frequently in lesser dosage doesn't work for her either. She just goes to sleep more. Maybe if she gets her teeth pulled out then there will be nothing to grind anymore. Seriously I don't even know how she can make that sound. I tried grinding my own teeth and nothing comes of it.

#18 MComes RPH

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Posted 11 August 2012 - 11:54 AM

At this point, I guess we just do what is best for HER quality of life, not ours.
Keep me posted.
Best of health,
Mark R. Comes R.Ph.
"Ask The Pharmacist"
www.parkinson.org

#19 miracleseeker

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Posted 11 August 2012 - 04:40 PM

uh.... she seems to have stopped cold turkey. I have done nothing different to her medication or diet. Let's see if she can maintain this. She has been quiet for the past week.

However the moaning and groaning continues after her afternoon dose of crushed 150mg Staleo with .75 Mirapex.

The eyes closing and or water eyes starts up about 4 hours after any of her 3 doses for the day.

#20 miracleseeker

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Posted 19 August 2012 - 04:03 AM

Never mind. She's grinding once again. It was a good 2 weeks or so holiday from the noise. I don't know she might be doing it when she eats or drink anything citris related. I will test and see.




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