Objectives: The effects of a nightly dose of Pergolide, a dopamine D1 and D2 receptor agonist, were assessed in a patient who suffered from extreme sleep-related bruxism. Methods: A 51-year-old man had received three 3I implants in the left upper jaw. Shortly after the placement of the supra-structure, two out of the three implants broke below abutment level. The apparent reason for this failure was extreme sleep-related bruxism. To evaluate various treatment options, a total of five all-night polysomnographic recordings (PSGs) were performed over a half-year period. Both the number of bruxism episodes per hour of sleep (EpiH) and the bruxism time index (BTI; the total time spent in bruxing divided by the total sleep time, times 100%) were determined as outcome variables. Results: The first baseline PSG showed an EpiH of 25.4. The total time in bruxing was 31.1 minutes. This resulted in a BTI of 8.2%. With respect to baseline and after treatment with a splint for one month, the results of the second PSG showed a decrease in EpiH of 6% as well as in BTI of 58%. Two months later, the administration of Pergolide (0.30mg) was started. Another two months later, a third PSG showed a remarkable decrease in EpiH of 82% and in BTI of 91%, both relative to baseline. A higher dose of Pergolide (0.50mg), administered for yet another month, did not further improve the bruxism results: with respect to baseline, the fourth PSG showed a decrease in EpiH of 62% and in BTI of 84%. One month after termination of all therapy, a fifth PSG demonstrated that compared to baseline, the EpiH and BTI were still decreased with 77% and 90%, respectively. Conclusion: The results of this single-patient open-label study suggest that the use of a nightly dose of Pergolide might be useful in reducing extreme sleep-related bruxism.

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