Oral-Facial Dyskinesia: Symptoms, Types, Causes and Treatment

Oral-facial dyskinesia is an umbrella term for a group of involuntary, abnormal movements affecting the muscles of the face, mouth, jaw, and tongue. Though these disorders are relatively rare, they can have a profound impact on quality of life—affecting speech, eating, dental health, and even safety. Dentists, neurologists, psychiatrists, and other healthcare providers should be attuned to the signs of these movement disorders, as early recognition and tailored management can make a significant difference for patients 1 4.

In this article, we’ll explore the defining symptoms, key types, known causes, and modern treatment options for oral-facial dyskinesia. Each section is supported by current clinical research and expert consensus, ensuring a well-rounded, evidence-based overview.

Symptoms of Oral-Facial Dyskinesia

Recognizing the symptoms of oral-facial dyskinesia is essential for timely intervention and appropriate care. These symptoms often present as repetitive, involuntary movements of the mouth and facial muscles, but the specific manifestations can vary widely between individuals and underlying causes. Early detection is especially important as it can prevent complications such as oral trauma, speech difficulties, and nutritional issues 1 2 4 7.

Symptom	Description	Complications	Sources
Chorea	Rapid, jerky, involuntary mouth/facial moves	Speech, eating impairment	1 2 4
Dystonia	Sustained, twisting muscle contractions	Jaw dislocation, muscle pain	4
Stereotypies	Repetitive, purposeless movements	Oral injuries, self-inflicted	1 7
Bruxism	Teeth grinding/jaw clenching	Tooth wear, jaw pain	1 4
Oral Trauma	Lip, cheek, tongue biting or lacerations	Bleeding, infection, tooth loss	6 7

Table 1: Key Symptoms

Chorea and Rapid Movements

One of the hallmark symptoms is chorea—rapid, unpredictable, and involuntary movements of the mouth, lips, or tongue. These movements may interfere with speech and make eating difficult. Patients may also experience sudden grimacing, lip smacking, or tongue protrusion 1 2 4.

Dystonia and Sustained Contractions

In some cases, individuals develop oromandibular dystonia, characterized by prolonged, involuntary muscle contractions that result in twisting or abnormal postures of the jaw and lower face. This can result in jaw dislocation, difficulty swallowing, or muscle pain 4.

Stereotypies and Repetitive Movements

Oral-facial stereotypies are repetitive, purposeless movements such as lip pursing, tongue chewing, or jaw opening and closing. When severe, these can cause self-inflicted injuries, particularly in vulnerable populations such as patients with encephalitis or those who are edentulous (without teeth) 1 7.

Bruxism and Tooth Grinding

Bruxism, or the grinding and clenching of teeth, is another possible manifestation, often leading to dental complications like tooth wear and jaw pain 1 4.

Oral Trauma

In some cases, especially those involving severe dyskinesia or underlying neurological disease, the involuntary movements can result in significant oral or facial trauma—including lacerations, tooth avulsion, and bleeding. These complications may require urgent intervention to prevent lasting damage 6 7.

Types of Oral-Facial Dyskinesia

Oral-facial dyskinesia is not a single disorder but a spectrum of related movement disorders, each with distinct features and underlying mechanisms. Understanding these types helps clinicians tailor diagnosis and management strategies more effectively 1 2 4.

Type	Distinct Features	Typical Onset	Sources
Tardive Dyskinesia	Drug-induced, repetitive oral movements	Months-years post drug	1 2 5
Orofacial Dystonia	Sustained muscle contractions, jaw spasms	Middle-older adults	1 4
Spontaneous Dyskinesia	No clear cause, rare	Older adults	2 3
Stereotypic Movements	Habitual, often in edentulous elderly	Elderly, psychiatric	1

Table 2: Types of Oral-Facial Dyskinesia

Tardive Dyskinesia

Tardive dyskinesia is the most commonly recognized form, most frequently resulting from long-term use of neuroleptic (antipsychotic) drugs or certain antihistamines. It typically involves repetitive, involuntary movements of the lips, tongue, jaw, and face, often emerging months or years after exposure to the triggering medication 1 2 5.

Orofacial Dystonia

Orofacial dystonia is characterized by sustained or intermittent muscle contractions, leading to abnormal, often painful postures or repetitive movements of the jaw and lower face. Dystonia may be primary or secondary to other neurological or dental conditions, and often presents in adults 1 4.

Spontaneous Oral-Facial Dyskinesia

This rare subtype occurs without clear precipitating factors such as medication or underlying disease. It is most often reported in older adults, and its causes and progression remain poorly understood. Pathological studies suggest unique patterns of neuronal loss in specific brain regions, differentiating it from other movement disorders 2 3.

Stereotypic Movements in the Elderly

Stereotypic oral movements—such as repetitive lip or tongue movements—are sometimes observed in elderly individuals, especially those without teeth (edentulous). Ill-fitting dentures can trigger or worsen these movements, which may be mistaken for more serious disorders 1.

Causes of Oral-Facial Dyskinesia

A thorough understanding of the causes helps guide prevention and therapy. Oral-facial dyskinesia can arise from a range of sources, including medications, neurological diseases, structural brain changes, and dental factors 1 2 3 4 5 6 7.

Cause	Mechanism/Context	Population Affected	Sources
Drug-Induced (Tardive)	Neuroleptics, antihistamines	Adults, psychiatric	1 2 5
Basal Ganglia Disorders	Hereditary/acquired neurological disease	All ages	2 3 4
Autoimmune Encephalitis	NMDA receptor antibodies	Children, young adults	6 7
Dental/Prosthetic Issues	Ill-fitting dentures, dental procedures	Elderly, post-dental	1
Idiopathic	Unknown	Older adults	2 3

Table 3: Causes of Oral-Facial Dyskinesia

Drug-Induced Dyskinesia

The most prevalent cause is chronic exposure to dopamine-blocking medications, especially antipsychotics and certain antihistamines. Tardive dyskinesia, for example, arises after prolonged use, with some cases linked to non-phenothiazine antihistamines as well 1 2 5.

Basal Ganglia and Neurological Disorders

Involvement of the basal ganglia—a brain region controlling movement—can result in dyskinesias. This may occur in hereditary conditions (such as Huntington’s disease) or acquired diseases affecting these brain areas. Unique patterns of neuronal cell loss and gliosis have been observed in some rare cases 2 3 4.

Autoimmune Causes: Anti-NMDA Receptor Encephalitis

Recent reports highlight anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis as a cause, particularly in pediatric and young adult populations. This autoimmune disease frequently manifests with severe orofacial dyskinesias, sometimes leading to significant oral trauma 6 7.

Dental and Prosthetic Triggers

Dental factors—such as poorly fitting dentures or recent dental procedures—may trigger or exacerbate oral-facial dyskinesias, especially in elderly or edentulous individuals. Addressing these factors can sometimes resolve or reduce symptoms 1.

Idiopathic and Spontaneous Forms

Some cases occur without a clear cause, especially in older adults. These idiopathic dyskinesias may have unique brain pathology but are still not fully understood 2 3.

Treatment of Oral-Facial Dyskinesia

Managing oral-facial dyskinesia requires a tailored, multidisciplinary approach, as the best therapy depends on the underlying cause, severity, and individual patient factors. Treatment goals include reducing involuntary movements, preventing injury, and improving quality of life 1 4 6 7.

Treatment	Approach/Indications	Effectiveness/Notes	Sources
Medication Adjustment	Discontinue/replace causative drugs	Often improves symptoms	1 2 5
Botulinum Toxin (BoNT-A)	Direct muscle injection (masseter, etc.)	Reduces severe movements	6
Oral Appliances	Custom-fitted mouthguards, fixation	Prevents trauma, aids function	7
Immunotherapy	For autoimmune (e.g., anti-NMDAR)	Treats underlying disease	6 7
Prosthodontic Care	Adjust dentures, dental interventions	Reduces stereotypies, improves fit	1 7
Sedation/Muscle Relaxants	Temporarily reduce movement severity	Symptomatic, ICU settings	7
Multidisciplinary Care	Neurology, psychiatry, dentistry input	Optimizes outcomes	1 4

Table 4: Treatment Options

Medication Review and Withdrawal

For drug-induced dyskinesias, reducing or discontinuing the offending medication is the first-line strategy. In many cases, symptoms improve once the drug is stopped, though some may persist or even worsen temporarily 1 2 5.

Botulinum Toxin (BoNT-A) Injections

Botulinum neurotoxin injections directly into affected facial muscles (such as the masseter) can provide significant relief for severe, refractory cases. This approach is especially valuable in preventing self-inflicted oral injury in patients with autoimmune encephalitis or other difficult-to-treat forms 6.

Oral Appliances and Prosthodontic Interventions

Custom-made oral appliances (such as acrylic guards) or adjusting ill-fitting dentures can both reduce the risk of injury and improve oral function. Recently, appliance-based therapy has shown promise in managing severe dyskinesias when other measures fail 7 1.

Immunotherapy for Autoimmune Causes

When dyskinesia is associated with autoimmune conditions like anti-NMDAR encephalitis, immunotherapy (e.g., corticosteroids, rituximab) is essential. Treating the underlying disease often results in gradual improvement of movement symptoms 6 7.

Sedation and Muscle Paralysis

In cases of life-threatening oral trauma due to severe dyskinesia, temporary use of sedatives or neuromuscular blockers may be necessary in intensive care settings. These are short-term measures to prevent further injury while definitive therapy takes effect 7 6.

The Importance of Multidisciplinary Care

Effective management often involves collaboration between neurologists, psychiatrists, dentists, and other specialists. This team-based approach ensures all aspects of the disorder—and its impact on daily life—are addressed 1 4.

Conclusion

Oral-facial dyskinesia is a complex group of movement disorders with diverse symptoms, causes, and management strategies. Awareness and early intervention can significantly improve patient outcomes, reduce complications, and enhance quality of life.

Key Takeaways:

• Symptoms: Involuntary, often repetitive oral and facial movements—including chorea, dystonia, bruxism, and risk of oral trauma 1 2 4 6 7.
• Types: Includes tardive dyskinesia (drug-induced), orofacial dystonia, spontaneous dyskinesia, and stereotypic movements in the elderly 1 2 3 4 5.
• Causes: Range from medications and neurological diseases to autoimmune conditions and dental factors 1 2 3 4 5 6 7.
• Treatment: Requires a tailored, multidisciplinary approach—including drug adjustment, botulinum toxin injections, oral appliances, immunotherapy, and dental care 1 4 6 7.

Empowering healthcare providers and patients with knowledge of oral-facial dyskinesia is vital for timely diagnosis and effective care. With continued research and collaboration, outcomes for those affected by these challenging disorders will continue to improve.