Bruxism therapy with botulinum toxin
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 serious consequences, ranging from tooth damage to headaches, neck pain and even the onset of tinnitus. Conventional therapy for bruxism includes muscular relaxation exercises and grinding splints at night. It often brings patients little relief. 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:
Teeth grinding at night, pain during the day
what is bruxism?
In medicine, “bruxism” is the unconscious clenching and grinding of the teeth. This 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 biting, thumb sucking or fingernail biting. Bruxism is divided into 2 principal types according to the nature of its occurrence:
Sleep bruxism
In sleep bruxism, teeth grinding occurs at night during sleep. Often, no cause can be determined for this, and it is then referred to as “primary bruxism.” In contrast, “secondary bruxism” is diagnosed when nocturnal teeth grinding is presumed to be the result of a disease. Finally, “iatrogenic bruxism” is when teeth grinding occurs at night as a side effect of a medication.
Wake bruxism
Waking bruxism, unlike sleep bruxism, occurs during the day, when the patient is fully conscious. Waking bruxism mostly has 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 people do not directly notice teeth grinding at night, bruxism can often only be detected 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. A wide range of 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 the 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 not only in the immediate vicinity of the jaws, but also further away throughout the body, for example in the back or legs. Physical ailments are often accompanied by psychological ones: sleep disorders, nervous tension and general malaise are typical.
Conventional therapies for bruxism
The first port of call for bruxism should always be the dentist or oral surgeon. They are best qualified to diagnose bruxism in a medically correct manner, to isolate the causes of teeth grinding and to suggest appropriate treatment.
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 called a “bite splint”). Such a splint tries to counteract the wear of the teeth due to the constant mechanical stress; however, it does not eliminate the cause as such.
Masseter inject with Botox
Botox against bruxism
If conventional therapy recommendations are ineffective or cannot be followed through by the patient (this is referred to as “lack of compliance”), it has recently become possible to relax themasseter muscle with the help of botulinum toxin. The main contributor to teeth grinding is thus specifically eliminated for several months. Relief is often quick and dramatic.
How Botox weakens the masseter muscle
The injection of Botox into the great masseter muscle makes it relax and the teeth grinding stops at night. The muscle is not completely paralyzed, but only weakened. After all, his important roles in chewing and facial expressions should be preserved.
Therefore, Botox can be used to treat teeth grinding directly at the causes without accepting major risks. The masticatory muscle retains its full function and there are no impairments in speaking, 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 additional benefit of Botox for bruxism
Another aspect of Botox for bruxism that is not of immediate medical importance, but in a sense represents 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 particularly 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.
Botox Masseter in a few minutes
Treatment video botox Masseter
Masseter treatment lasts only a few minutes
how does the bruxism therapy with botox work?
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 risks and side effects have been explained. A detailed patient self-disclosure is therefore essential, followed by a detailed interview. A central role is played by existing medications, any existing pregnancy or ongoing breastfeeding.
Dosage and injection regimen
In BOTOX for teeth grinding, usually 50-60 units of the toxin are distributed in 4-6 injection points on both halves of the face. Injections are made into the deeper regions of the masseter muscle. The 4 points into which I distribute the toxin with a very thin needle are located in the anatomical representation at the points marked in black:
When does the effect start and how long does it last?
The toxin begins to act about 1-2 days after treatment and develops its full effect after about 10 days. At the latest, you should experience noticeable relief. If not, then the dosage must be increased.
As a rule, 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 happens in individual cases depends on individual factors and cannot be predicted exactly. But on average, you should expect to have to refresh the treatment every 4-6 months initially.
In the long term, treatment results in a slight regression of the masseter muscle (atrophy). This opens up the realistic prospect that treatment intervals can be extended with increasing treatment duration.
Botox against teeth grinding – side effects
Are there any risks or side effects?
Expected side effects of Botox treatment are redness and minor hematomas in the treated areas. Botox into the masseter muscle may also cause dry mouth and a slight feeling of tightness in the jaw area for a short time. 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 for bruxism?
An often expressed fear with Botox for teeth grinding relates to the alleged weakening of the 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, prolonged injection of Botox into the lower third of the masseter muscle resulted in a measurable reduction in mandibular volume. On closer inspection, however, this is neither alarming nor surprising. This is because 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 conducted 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 muscles were active again and the joint was loaded.
What does it mean? Complete inhibition is by no means intended with Botox for bruxism. According to the therapy protocol, the relaxation of the masseter muscle affects only the lower part of the muscle, so that the temporomandibular joint is still loaded, during chewing and various facial expressions.
Only positive own experience 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 are from South Korea and have had Botox in the masseter muscle there for years. I have not been aware of any problems from Botox treatment in these or any other patients.
Botox for bruxism – costs and reimbursement
what is the cost of botox for teeth grinding?
The cost of Botox for bruxism is 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 for bruxism are currently not (yet) reimbursed by statutory health insurance. Individual private health insurance companies cover the costs upon application. You should therefore clarify with your insurance company in advance whether they are prepared to reimburse you in full or at least on a pro rata basis. I will be happy to assist you with the necessary documentation.
