Extrapyramidal Reactions Induced by Dopamine Antagonists: Clinical Management and the Protective Role of Clear Aligners: A Case Report

Objective: Extrapyramidal Syndrome (EPS) encompasses a range of movement disorders caused by dysfunction of the extrapyramidal system, often as an adverse effect of dopamine antagonist drugs. Severe dystonic reactions can lead to involuntary muscle contractions, posing significant risks to oral health, particularly through traumatic injuries to the dentition and facial structures. This case report explores the protective role of clear aligners in preventing dental trauma during an acute dystonic crisis, highlighting their potential as a preventive measure in at risk patients. Method: A 25-year-old female patient presented to the emergency room with acute dystonia affecting her facial musculature, characterized by involuntary jaw contractions, blurred vision and severe pain. The episode occurred after recent administration of dopamine antagonists (Levosulpiride and Metoclopramide). Clinical examination, imaging and laboratory tests ruled out other neurological conditions. During the crisis, the patient was wearing invisalign clear aligners, which incidentally provided protection against severe dental trauma. Diazepam was administered as a treatment, leading to symptom resolution. Results: The patient’s dystonic symptoms resolved completely following diazepam administration. Despite significant involuntary jaw contractions, no dental fractures or soft tissue injuries were observed, likely due to the protective effect of the clear aligners. This case underscores an underrecognized benefit of orthodontic aligners beyond their intended orthodontic function, suggesting their potential role in mitigating dental trauma during EPS-related dystonic crises. Conclusion: EPS-induced dystonia presents substantial risks to oral health, particularly in patients prone to in-voluntary jaw movements. While occlusal splints are commonly used in managing oromandibular dystonia and bruxism, this case highlights the unexpected protective function of clear aligners in preventing dental injuries. Given the potential severity of EPS-related dystonic episodes, clear aligners could serve as a practical and preventive measure for patients at risk. Future research should explore their role in interdisciplinary approaches to managing EPS-related complications.