Bruxism – Botox for the jaw muscles
Botox treatment for bruxism is a botulinum toxin procedure that reduces excessive activity in the chewing muscles (masseter and temporalis). Botulinum toxin acts at the neuromuscular junction and weakens muscle activation. This reduces the strain on the muscles.
In some cases, this treatment can be used to supplement the primary treatment for bruxism, namely a bite splint.
Botulinum toxin treatment for bruxism at a glance:
- Botox treatment reduces overactivity of the masticatory muscles at the neuromuscular junction
- This treatment is used as part of a comprehensive treatment plan for bruxism
- Complements orthodontic treatment
- It does not address the underlying causes of bruxism, such as stress or lifestyle factors. However, repeated botulinum toxin treatments may lead to a reduction in the tendency to grind one’s teeth.
- The effects usually last 3–6 months
- Since bruxism also affects your teeth, it’s best to have the problem addressed by a dentist.
Bruxism —the grinding and clenching of teeth—places significant strain on the masticatory muscles. As a result of bruxism, the masticatory muscles may enlarge, and associated symptoms may worsen.
In some cases, botulinum toxin (Botox) is used to reduce the activity of the jaw muscles. The goal of the treatment is not to eliminate bruxism entirely, but to reduce muscle strain and the associated symptoms of bruxism.
The suitability of the treatment is assessed on an individual basis during the appointment. The dentist assesses the suitability of the treatment.
How does botulinum toxin affect the masticatory muscles in bruxism?
Bruxism, or teeth grinding, places particular strain on the masseter muscles. In cases of chronic bruxism, muscle activity increases significantly.
Botox treatment reduces the activity of the jaw muscles in a controlled manner. As tension in the jaw muscles decreases, the strain on the jaws also decreases.
Treatment does not eliminate the various causes of bruxism, but it significantly reduces the symptoms.
Botox treatment for bruxism – when is it used?
Teeth grinding, jaw clenching, and tension in the jaw muscles can affect daily life more than many people realize. Most often, bruxism affects people at night, but some of us grind our teeth even when we’re awake. Nighttime grinding often goes unnoticed and undiagnosed, whereas daytime bruxism is much easier to detect.
If left untreated for a long time, bruxism can cause facial pain, persistent, vague headaches, daytime fatigue, and tooth wear.
Botulinum toxin treatment—more commonly known as Botox—can, in some cases, be an effective and safe way to relieve symptoms caused by bruxism. However, it is important to remember that treatment for bruxism almost always begins with a mouthguard. For this reason, you should first consult a dentist about this issue.
When treating occlusal problems, the first line of treatment is usually a bite splint. Botulinum toxin therapy is used as a complementary treatment when overactive masticatory muscles cause pain and other symptoms that interfere with daily life.
Source: Current Care Guideline: Bruxism
Botox treatment complements the effectiveness of a mouthguard by reducing the activity of the jaw muscles and alleviating the intensity of teeth grinding. Together, the mouthguard and Botox form an effective comprehensive solution:
- A bite guard protects teeth from wear.
- Botox reduces teeth grinding.
"I perform botulinum toxin treatments for bruxism every day at all of my clinics. I also train doctors and dentists in the use of botulinum toxin to treat masticatory problems. I am currently working on my doctoral thesis, which focuses, among other things, on botulinum toxin treatments for the masticatory muscles," says Ville Männistö.
What is bruxism, or teeth grinding?
Bruxism refers to involuntary and repetitive clenching and grinding movements. These occur either during sleep (nocturnal bruxism) or while awake (waking bruxism). Both sleep-related and waking bruxism can cause similar unpleasant symptoms. However, many people are unaware that they suffer from bruxism until they notice the consequences of grinding.
Bruxism is associated with increased activity in the masticatory muscles, which can be influenced by factors such as stress and central nervous system regulation.
👉 Learn more about the causes of bruxism.
Temporomandibular disorders (TMD) are the most common cause of pain in the mouth and face after toothache. According to estimates, up to about half of the population experiences symptoms of temporomandibular disorders from time to time, and about 10% suffer from significant symptoms. (Source: research literature on temporomandibular disorders)
Sometimes nocturnal bruxism isn’t diagnosed until a dental checkup, when the dentist notices damage to the teeth caused by grinding.
– Ville Männistö
Symptoms of bruxism – what are the signs of bruxism?
The symptoms of bruxism can range from mild jaw stiffness to severe pain in the jaw muscles and recurring headaches. In cases of chronic bruxism, teeth grinding can wear down the teeth and put strain on the jaw joints.
Common symptoms of bruxism:
- headaches, especially in the morning
- pain in the face and temples
- jaw tension or tenderness
- jaw clicking, grinding, and other noises
- tooth wear or chipping
- in some cases, changes in the shape of the lower face (enlargement of the masseter muscle)
In cases of chronic bruxism, the strain can extend beyond the jaws and masticatory muscles to the neck and shoulder area. In such cases, the symptoms may become more complex and prolonged.
Severe bruxism
Sometimes bruxism can be particularly severe and cause significant damage to the teeth and jaw joints.
Botulinum toxin treatment (Botox) can help in these situations. Botulinum toxin reduces the strength of the jaw muscles and, through this mechanism, alleviates many of the symptoms associated with bruxism.
How does botulinum toxin affect the masticatory muscles in bruxism?
In the treatment of bruxism, botulinum toxin is often injected into the masseter muscles at the corners of the mouth, among other areas. For this reason, the treatment is sometimes also referred to as " masseter Botox."
On the other hand, the term " masseter Botox " is also often used to refer to facial slimming performed for cosmetic reasons.
The masticatory muscles play a major role in chewing and closing the jaw. In cases of prolonged bruxism, these muscles can grow, sometimes significantly.
Bruxism puts strain on the masticatory muscles (the masseter muscles at the corners of the mouth and the temporalis muscles at the temples). Constant clenching and tension can cause pain in the facial area, headaches, and many other ailments. Frequent grinding may eventually become visible to others as well.
When the masticatory muscles are constantly being exercised, they grow just like any other muscles. A dentist can spot a severe bruxist as soon as they see the patient’s face at the door of the examination room. The well-exercised masseter muscles make the lower face wider and more robust than normal. At the latest when looking inside the mouth, the dentist can make the correct diagnosis, as the consequences of grinding are visible on the teeth, the tongue, and even the inner surfaces of the cheeks, Ville explains.
Can botulinum toxin reduce overuse of the masticatory muscles?
In some cases, botulinum toxin treatment (Botox) can safely and effectively reduce the overactivity of the masticatory muscles. Small, precisely targeted doses of botulinum toxin are used to treat bruxism. In some cases, the muscles of the base of the skull and the neck and shoulder area may also be treated. Botulinum toxin relaxes the masticatory muscles, thereby reducing bite force and alleviating symptoms.
Of course, the treatment does not completely paralyze the bite. Eating, speaking, and other functions remain normal.
– Ville Männistö
Botulinum toxin treatment for bruxism is not the only medical use for botulinum toxin. Botulinum toxin is also used to treat migraines, excessive sweating, and various neurological conditions.
The Use of Botulinum Toxin Treatment for Bruxism
Botulinum toxin treatment for bruxism is always tailored to each individual based on facial muscle function and the patient’s symptoms.
Botulinum toxin treatment for the masticatory muscles is used particularly in cases where bruxism—or teeth grinding—causes pain, muscle tension, or strain in the jaw area.
This treatment is not suitable for everyone, and the need for it is always assessed during the consultation. Ultimately, the decision regarding treatment is made by the dentist.
How does botulinum toxin treatment for bruxism work?
Botulinum toxin treatment for bruxism is a quick but carefully planned procedure in which safety and individualized assessment play a key role. The typical treatment process proceeds as follows:
- Assessment. The patient’s condition and symptoms are assessed. The function of the masticatory muscles is examined, and the size and activity of the masseter muscles are evaluated. The condition of the teeth is also taken into account.
- Treatment decision. If Botox treatment is the appropriate solution, the injection sites are carefully planned.
- Procedure. Botulinum toxin is injected in small, targeted doses primarily into the chewing muscles: the masseter and temporalis muscles. The treatment usually takes only a few minutes.
- Follow-up. We will go over the aftercare instructions, and a follow-up visit can be scheduled if necessary.
Botox treatment is not suitable for everyone who grinds their teeth; rather, it is used as a carefully considered part of a comprehensive treatment plan for bruxism.
The effects of Botox treatment usually begin within a few days and peak after about two weeks. The effects of the treatment typically last for about 3 to 6 months.
In addition to bite splints and Botox, comprehensive treatment may also include massage of the masticatory muscles or self-guided stretching and relaxation exercises.
The mechanism of action of botulinum toxin in bruxism
In chronic bruxism, the masticatory muscles are easily overloaded. This constant state of tension can affect other parts of the body as well—even the entire body—although symptoms are usually concentrated in the head area.
Constant teeth grinding can lead to hypertrophy (muscle growth) of the masseter muscles. This manifests as a more pronounced jawline and a wider lower face, explains Ville.
Botox relaxes the jaw muscles
Botox treatment affects nerve transmission in the muscles, which results in the relaxation of the masticatory muscles. In some cases, it has been reported that muscle relaxation may continue to affect the function of the masticatory muscles even after the effects of Botox have worn off, but this is quite rare. The response to treatment varies from person to person.
Of course, botulinum toxin does not eliminate the underlying causes of bruxism, such as stress.
In most cases, maintaining the results of treatment requires follow-up sessions, for example, 2–3 times a year. In the best-case scenarios, after a few botulinum toxin treatments, the jaw muscles seem to “forget” their tendency to clench.
– Ville Männistö
Botulinum toxin treatment for bruxism – what does the research evidence say?
Botulinum toxin has been studied for the treatment of masticatory muscle pain and temporomandibular disorders (TMD). In several clinical studies, botulinum toxin treatment has been found to reduce masticatory muscle pain and muscle hyperactivity.
- In a clinical trial involving 149 patients, pain levels decreased on average from 8/10 to 3/10 on the VAS pain scale during a six-week follow-up period.
- Some studies have reported that botulinum toxin treatment also reduces the frequency of headaches and tenderness in the masticatory muscles.
However, the research evidence is somewhat mixed, and everyone responds to botulinum toxin treatment at least somewhat differently.
I participated in a study that examined the effects of botulinum toxin treatment on masticatory muscle-related temporomandibular disorders. The study was published in the peer-reviewed Journal of Craniofacial Surgery and is available in the PubMed database:Temporomandibular disorders and masticatory muscle dysfunction – research publication
Although botulinum toxin is an unparalleled treatment for bruxism, it is important to note that, according to current treatment guidelines, botulinum toxin therapy is not considered the primary treatment for disorders of the masticatory system. Treatment is generally based on a bite splint and other conservative treatments. These can be supplemented with botulinum toxin treatment if necessary.
Temporomandibular disorders (TMD) are the most common cause of pain in the mouth and face after toothache. It is estimated that up to about half of the population experiences symptoms of TMD from time to time, and about 10% suffer from significant symptoms.
– Ville Männistö
Patient experiences with botulinum toxin treatment for bruxism
- Many patients report feeling more relaxed after botulinum toxin treatment: their headaches decrease, jaw muscle tenderness eases, and their sleep quality improves. Read about Matilda’s experience. *
- Some patients also notice aesthetic changes: as the masticatory muscles relax, they may shrink in size and the lower face may take on a more streamlined appearance.
- Based on Ville’s clinical experience, botulinum toxin treatment is a significant help for some patients in managing the symptoms of bruxism.
* Individual experiences may vary. Not all patients will experience the same benefits from treatment.
“Botox injections have been a huge help to me. The symptoms caused by bruxism have decreased significantly.”
– Patient Feedback, Helsinki 2024
Can the jaw muscles shrink after Botox treatment?
Yes, the masticatory muscles can shrink as a result of botulinum toxin treatment, as the load on them decreases and muscle activity declines.
Changes in muscle size occur because a muscle that has been in constant use loses some of its load and may, over time, atrophy slightly.
The effects of Botox treatment can be seen in the facial area. The result is not—nor is it intended to be—merely aesthetic. The greatest benefit of the treatment is that it reduces the constant tension, tightness, and pain experienced in daily life.
Treating bruxism is important. Early treatment reduces tooth wear and other changes caused by stress on the masticatory system. Untreated bruxism can sometimes cause serious damage to the teeth. All dentists are certainly aware of this.
– Ville Männistö
An Oral and Maxillofacial Surgeon's Perspective on the Treatment of Teeth Grinding
Botulinum toxin is used in some cases to help treat teeth grinding. Botox treatment is typically very well tolerated. However, successful treatment requires medical expertise, knowledge of facial anatomy, and experience with botulinum toxin treatments.
The masticatory muscles are located near other facial muscles whose function may be affected by botulinum toxin if the injection is administered in a suboptimal location. In such a situation, the treatment outcome may be less than optimal. In addition, side effects may also manifest in the appearance or even the function of the face.
At the same time, it is important to remember that botulinum toxin treatment is generally considered a safe procedure. Serious complications are rare, and any aesthetic changes, such as facial asymmetry, are temporary. Even in the worst-case scenarios, side effects and aesthetically unsatisfactory treatment results last only a few months.
Aesthetic changes in the facial area are often noticeable. That is why planning and administering Botox treatments require a solid understanding of anatomy and experience with facial muscle function, Ville emphasizes.
What is known about Botox treatment for bruxism?
- Botulinum toxin reduces muscle activity at the neuromuscular junction
- Many studies have found that pain symptoms are alleviated
- Botulinum toxin treatment is rarely the first-line treatment for bruxism
- The response to botulinum toxin treatment varies from person to person
Bruxism & Botox Treatment for Masseter Muscles – Frequently Asked Questions
Does Botox treatment hurt?
The injection usually feels like a slight pinch on the skin, but the actual pain is usually mild and short-lived. The procedure takes only a few minutes, and anesthesia is generally not needed. If necessary, an anesthetic cream can be used.
When do the effects of Botox treatment begin?
The effects of botulinum toxin (Botox) treatment are not immediate. Botulinum toxin blocks the release of acetylcholine at the neuromuscular junction, causing muscle contraction to gradually weaken.
How long does Botox affect the jaw muscles?
The effects of Botox treatment usually last about 3–6 months. The duration varies from person to person. In some cases, the tendency to grind one’s teeth can be eliminated permanently after just a few Botox treatments.
Can Botox treatment replace a mouthguard?
No. A bite splint is the primary treatment for bruxism. The splint protects the teeth from wear. Botulinum toxin treatment complements splint therapy by reducing overuse of the masticatory muscles and alleviating symptoms associated with bruxism, such as facial pain and headaches.
Is Botox treatment safe?
Botox treatment is generally considered safe when performed by a trained doctor or dentist. However, the treatment is not suitable for everyone. Contrary to popular belief, the medical use of botulinum toxin is actually a fairly old invention. And that is why there is already a wealth of scientifically valid data on the long-term effects of botulinum toxin.
The side effects of Botox treatment are mild and temporary. If the injection is not administered correctly, it may affect facial muscle function or appearance. These issues are unpleasant but temporary.
Why is the treatment of bruxism primarily the responsibility of a dentist?
Bruxism, or teeth grinding, is related to the functioning of the mouth and masticatory system. The dentist evaluates the condition of the teeth, bite, and masticatory muscles as a whole.
Since bruxism can cause tooth wear and other changes in the oral cavity, treatment is primarily based on a bite splint and other conservative methods. In some cases, botulinum toxin treatment can complement this approach. Botox is rarely the first-line treatment, and patients should not be left to rely on botulinum toxin alone. A dentist understands bruxism as a phenomenon and can design the most effective comprehensive treatment plan tailored to each individual.
– Ville Männistö
Patient experience with botulinum toxin treatment for bruxism
The following video describes a patient's experience with botulinum toxin treatment for bruxism.
Bruxism, or teeth grinding and clenching, caused headaches, among other symptoms. According to the patient, the effects of the botulinum toxin treatment began within a few days: muscle tension eased, grinding decreased, and associated symptoms improved.
The treatment was also found to have aesthetic effects, such as a slight slimming of the lower face.
The treatment does not work the same way for all patients. For some, botulinum toxin provides significant relief, while for others, the effect is disappointingly modest.
In this video, a patient shares their experience with botulinum toxin treatment for bruxism. Botulinum toxin treatment can reduce excessive activity in the chewing muscles—particularly the masseters— and alleviate symptoms associated with teeth grinding.
Where are Botox treatments for bruxism performed?
Botulinum toxin is used to treat bruxism in many healthcare facilities. The treatment is based on an assessment of the function of the masticatory muscles and an individualized treatment plan.
The safety and outcome of the treatment depend in particular on the practitioner’s experience, knowledge of anatomy, and injection technique.
Comprehensive Treatment for Bruxism
Bruxism, or teeth grinding, can cause a variety of symptoms: facial pain, headaches, tooth wear, and even temporomandibular joint problems.
In some cases, Botox treatment is used to alleviate excessive activity in the jaw muscles. However, the most common treatment involves a mouthguard, which protects the teeth and reduces stress on them.
When used together, Botox and a mouthguard can help manage bruxism and reduce symptoms associated with teeth grinding. The response to treatment varies from person to person, and bruxism cannot always be completely eliminated.
Medical uses of botulinum toxin
Botox treatment helps with bruxism by reducing excessive activity in the jaw muscles at the neuromuscular junction.
In addition to bruxism, botulinum toxin is also used for, among other things,
- for the treatment of migraines
- to reduce excessive sweating
- for the treatment of white finger disease
Botulinum toxin treatments for migraine and bruxism share some of the same principles and injection sites. Although the mechanisms of action are not entirely the same, there are significant similarities in the practical implementation of the treatment.
Does Botox treatment help with bruxism?
Botulinum toxin treatment often reduces bruxism by reducing excessive activity in the jaw muscles.
The response to treatment varies from person to person, and the first Botox treatment should be viewed as a trial. Even the most experienced dentist cannot guarantee that Botox will definitely work.
