Bruxism is a common orofacial problem, which affects a large number of people all around the world. It presents as chronic teeth clenching, grinding, and temporal headaches. While not yet widely recognized or employed by most dentists, bruxism can be successfully with Botox injections.
I have found Botox to be tremendously effective at masseter muscle hypertrophy and symptomatic teeth clenching. Bruxism or chronic grinding of teeth can cause the jaw muscles to become stronger and achieve a square shape, while simultaneously causing damage to the back premolar and molar teeth.While dental splints and appliances are the standard of care currently, they do not treat the source of the problem (muscle) but rather are primarily protective of ongoing damage to the teeth. Conversely, Botox achieves muscle relaxation or stops muscle spasm which are triggered by the muscles of the jaw.
The part of the masseter muscle that is injected is the lower part which is easy to feel bulging when one clenches. This is in front of the parotid gland and above where the marginal mandibular nerve passes along the lower jawline. It is essentially at the jaw angle area. While other parts of the masseter muscle can be injected, this lower area is the easiest with essentially no risk of any complications. By using a very small 30 gauge long needle and a 1cc syringe, Botox can be near painlessly injected in multiple areas of the bulging muscle.
Many people have a symptomatic facial side, and often that side is visibly larger than the non-or less symptomatic side. In these patients, I will inject only the larger side with about 25 units. When both sides are involved, I will put more on the larger side. On average, it takes about 25 units per side injected into the thickest and most protruding masseter muscle. (when the patient clenches) At a cost of around $12 to $14 per unit, cost estimates per side would be about $350. Botox will not work immediately, on average it takes 3 to 5 days to begin working.
Most patients that I have treated get significant relief with Botox injections. For some, it is a complete ‘cure’ (albeit temporary) and for others it is about reduction in their symptoms. I have yet to see a a patient who gets no relief with an identified large masseter muscle bulging. Pain and clenching relief will last around 4 months which is typical for how long Botox lasts in the face for expression reduction. Interestingly, one will usually see the size of the muscle reduce over time, often within the first treatment cycle. While not fully explained, this muscle shrinking is seen consistently.
How long does one need Botox for clenching symptom relief? That is going to vary per each patient. Some may only need one or two treatments and then the cycle is broken. Others may need consistent treatment every 4 months for a year or two. It is not possible to predict for anyone how long one may need or want this injection therapy.
Dr. Barry Eppley
Indianapolis, Indiana