Bruxism as a consequence of chemotherapy

Introduction Bruxism is a syndrome with uncertain etiology but with proposed factors: psychosocial, peripheral and central. Treatment is also controversial and one of the options focuses in GABA theory and regularization of ion channels. Xelox (capecitabine + oxaliplatin) and bevacizumad is indicated for metastatic colorectal cancer, being oxaliplatin the most neurotoxic agent (acute syndrome and/or a chronic sensory neuropathy). Acute neurotoxicity is very frequent and it is a sensory and/or a motor toxicity (as tongue tingling or jaw spams). The proposed pathogenesis – neuronal hyperexcitability due to alterations of voltage-gated ion channels – is supported by mechanism of action of some treatments. Objectives and Aims Review different causes of bruxism. Methods Description of a clinical case. Results This is a story of 76-years-old man in treatment for metastatic colon cancer that developed toxicity: nauseas (treated with haloperidol), bruxism and gingival atrophy. He was referred to psycho-oncology by involuntary movements of mouth and trunk. The patient complained of sadness, anhedonia and insomnia since recurrence of cancer and related the movements with CT. At observation he was anxious, tearfulness and agitated. He was treated for a depressive episode, but the doubt remained about involuntary movements: haloperidol was a confounding factor for oxaliplatin acute neurotoxicity, also aggravated by psychic and peripheral factors. Conclusions The authors believe that bruxism is linked to CT in a very complex relation that includes psychic, peripheral and central factors. Psychiatrists need to keep attention to the patient as a whole, not being seduced by easy answers like psychosocial factors.