Botox against bruxism

Botox helps with teeth grinding

Botox also helps against teeth grinding. And teeth grinding, medically called “bruxism,” plagues more people than you might think. Whether during the day or at night, some people grind their teeth regularly. Bruxism can have quite serious consequences, ranging from tooth damage to head and neck pain and even the onset of tinnitus. Conventional therapy for bruxism involves muscular relaxation exercises and grinding splints at night. It often provides little relief to patients. A promising new therapy consists of relaxing the large masseter muscle with Botox. This article is about this new therapy and what you need to know about it.

These are the topics:

  • What is bruxism
  • Botox against bruxism
  • How does the treatment work?
  • What are the risks and side effects?
  • What is the cost of Botox for bruxism?

What is bruxism?

In medicine, “bruxism” refers to unconscious clenching and grinding of the teeth. It is not a “bad habit”, but unconscious and uncontrollable movements. Teeth grinding belongs to the so-called “parafunctions”, which also include lip biting and tongue chewing, thumb sucking or fingernail biting. Bruxism is divided into 2 principal types according to the way it occurs:

Sleep bruxism

In sleep bruxism, teeth grinding occurs at night during sleep. Often, no cause can be determined for it, and it is then referred to as “primary bruxism.” In contrast, “secondary bruxism” is diagnosed when nighttime teeth grinding is presumed to be the result of a disease. Finally, “iatrogenic bruxism” is when teeth grinding at night occurs as a side effect of a medication.

Waking Bruxism

Waking bruxism, unlike sleep bruxism, occurs during the day, while fully conscious. Waking bruxism is mostly due to psychological causes such as stress or anxiety, but can also be the result of sleep disturbances, increased consumption of alcohol, caffeine or nicotine, and as a side effect of medication.

Bruxism Symptoms

Since one does not directly notice teeth grinding at night, bruxism can often only be recognized through its typical consequences. These include in particular pain in the teeth and jaw joints. Muscular tension is also typical, especially in the head and neck area. Bruxism even plays a role as a cause of migraine. Many other symptoms are also conceivable, depending on the specific causes of teeth grinding. One of my patients in Munich, for example, suffered from tinnitus without even being aware of her nocturnal bruxism. She was correspondingly relieved and exuberantly pleased when I relieved her of her suffering.

Bruxism can have serious consequences

The health effects of bruxism can therefore be quite serious and have a massive impact on quality of life. If the masticatory muscles are traumatized to the point of chronic tension, then individual muscle areas can harden and lead to chronic pain. And this not only in the immediate vicinity of the jaws, but also further away throughout the body, for example in the back or legs. The physical ailments are often accompanied by psychological ones: sleep disturbances, nervous tension and general malaise are typical.

Conventional therapies for bruxism

The first port of call for bruxism should always be a dentist or oral surgeon. They are in the best position to diagnose bruxism in a medically correct way, to isolate the causes of teeth grinding and to suggest appropriate therapies.

Often, their first recommendation will be to learn certain relaxation techniques, and in the case of teeth grinding at night, often to wear a “grinding splint” (also known as a “bite splint”). Such a splint attempts to counteract the wear of the teeth as a result of the constant mechanical stress; however, it does not eliminate the cause as such.

Botox against bruxism

When conventional therapy recommendations are of no avail or cannot be followed through by the patient (this is referred to as “lack of compliance”), there is recently the possibility of using the masseter muscle (Musculus masseter) with the aid of botulinum toxin. The main muscle involved in teeth grinding is thus specifically eliminated for several months. The relief of discomfort is often rapid and dramatic.

These wrinkles can always be treated very well if they are not yet too deep. Therefore, there is actually such a thing as preventive Botox injections, which can be envisaged from the late 20s.

How Botox weakens the chewing muscle

BOTOX for teeth grinding is administered with 4-6 injections into the lower part of the masseter muscle.

Injection of Botox into the greater masseter muscle causes it to relax and stop teeth grinding at night. The muscle is not completely paralyzed, but only weakened. After all, its important roles in chewing and facial expressions should be preserved.

Thus, Botox can be used to treat teeth grinding directly at its causes without accepting major risks. The masticatory muscle retains its full function, and there is no impairment of speech, chewing or laughing. It is still strong enough for voluntary movements, but no longer receptive enough to involuntary stimuli that cause teeth grinding at night.

Cosmetic added benefit of Botox in bruxism.

There is another aspect of Botox for bruxism that, although not of immediate medical importance, is in a sense an additional cosmetic benefit: The longer-term relaxation of a hypertrophied (overly stressed) masseter muscle narrows the facial contour and the youthful “V-shape” reappears more clearly.

This purely aesthetic effect is especially popular in South Korea; according to surveys, half to two-thirds of the botulinum toxin administered there for cosmetic purposes is used for this one indication only. In fact, I also have some patients of South Korean origin in Munich for whom the cosmetic aspect of Botox for bruxism is in the foreground and any medical indication would only be of secondary importance.

How does the treatment with BOTOX for bruxism proceed?

Botox for bruxism in off-label use

Botox does not (yet) have approval for the treatment of teeth grinding in Germany. Doctors therefore treat bruxism with BOTOX in so-called “off-label use”. This means that an approved drug is used for a different treatment than the one for which it was approved. The treatment of teeth grinding consists of the following phases:

Self-disclosure and patient interview

As with any other therapy, BOTOX is administered in the treatment of bruxism only after any contraindications have been clarified and the patient has been informed of the risks and side effects. A detailed patient self-disclosure is therefore indispensable, followed by a detailed discussion. Existing medications, a possible pregnancy or ongoing breastfeeding play a central role.

Dosage and injection regimen

In BOTOX for teeth grinding, 50-60 units of the toxin are usually distributed into 4-6 injection points on both halves of the face. Injections are made into the deeper regions of the masseter muscle. The 4 points where I distribute the toxin with a very thin needle are located in the black marked places in the anatomical illustration:

Bruxism -Botox-Munich
Treatment of bruxism with BOTOX is performed by 4-6 injections of 25-30 units of toxin bilaterally into the deeper regions of the masseter muscle.

When does the effect start and how long does it last?

The toxin begins to work about 1-2 days after treatment and takes full effect after about 10 days. By then, at the latest, you should experience noticeable relief. If not, then you need to re-dose.

Usually, Botox will noticeably reduce teeth grinding for about 3-6 months. During this period, it is gradually broken down by the body. How quickly or slowly this occurs in individual cases depends on individual factors and cannot be accurately predicted. But on average, one should expect to have to refresh the treatment initially every 4-6 months.

In the long term, treatment results in a slight regression of the masseter muscle (atrophy). This opens the realistic prospect that treatment intervals can be extended with increasing treatment duration.

Are there any risks or side effects?

Expected side effects of Botox treatment include redness and minor hematomas in the treated areas. When Botox is applied to the masseter muscle, dry mouth and a slight feeling of tightness in the jaw area may also occur briefly. Both phenomena usually disappear after 24 hours.

Botox without great risks

Bruxism therapy with Botox is extremely low-risk if all contraindications are clarified and observed and an experienced therapist performs the treatment. All the repeatedly heard fears regarding the toxicity of botulinum toxin or rumored long-term damage do not stand up to the continuously updated study results.

Bone loss due to Botox in bruxism?

An often expressed fear with Botox for teeth grinding relates to the alleged weakening of bone substance. And indeed, studies show that long-term treatment of the masseter muscle with botulinum toxin can cause bone changes in the mandible. In a Korean study of 20 patients, long-term injection of Botox into the lower third of the masseter muscle resulted in a measurable reduction in the volume of the mandible. On closer inspection, however, this is neither alarming nor surprising. After all, it is perfectly normal for a bone to react by reducing its size and thickness when not in use or when the load is reduced.

Other studies on the same topic indicate bone loss in the temporomandibular joint after Botox treatment. However, these studies were performed on animals rather than humans. Moreover, not only was the masseter muscle partially weakened, but the entire musculature that moves the temporomandibular joint was completely disabled. And even then, the effect on the bone substance of the temporomandibular joint was reversible, i.e. the thickness increased again as soon as the musculature became active again and the joint was loaded.

What does this mean? After all, complete inhibition is by no means intended with Botox for bruxism. According to the therapy protocol, the relaxation of the masseter muscle only affects the lower part of the muscle, so that the temporomandibular joint is still loaded during chewing and various facial expressions.

Only positive own experiences with Botox for bruxism

I can only say that I now frequently perform Botox injections in the masseter muscle in my practice in Munich, for medical as well as purely cosmetic indications. Some of my patients come from South Korea and have been treated there for years with Botox into the masseter muscle. Problems caused by Botox treatment have not been known to me, neither in these nor in other patients.

What is the cost of Botox for teeth grinding?

The costs for Botox against bruxism are determined and billed individually according to the German Medical Fee Schedule (GOÄ). As an approximate guideline, I can give you about 270-320 euros for the treatment in my practice in Munich. The mentioned price range refers to the treatment with a total of 50-60 units of botulinum toxin A.

The costs of Botox against bruxism are currently not (yet) reimbursed by public health insurance. Some private health insurances cover the costs upon request. You should therefore clarify with your insurance company in advance whether they are willing to reimburse you in full or at least in part. I will be happy to assist you with the necessary documents.