Masseter Botox for Bruxism And Facial Slimming

Does Nocturnal Teeth Grinding Bother You?

Discover the surprisingly effective method of using Botox to alleviate teeth grinding in the masseter muscles.

Masseter Botox At A Glance

Botox is a neurotoxin that relaxes the major chewing muscle (masseter) and can therefore alleviate or eliminate teeth grinding.

In addition to its use for teeth grinding, Botox in the masseter muscles is also employed for aesthetic purposes such as facial slimming.

Since Botox is metabolized by the body, its effects are temporary. The results typically last for 4–6 months. Thereafter, Botox needs to be injected into the masseter muscles again.

Botox injections in the masseter muscles usually do not require anesthesia.

Typical side effects of Botox injections in the masseter muscles include redness, swelling, and bruising. They usually subside within 2–3 days.

Masseter Botox does not require any downtime. You can resume your normal activities immediately after the procedure.

The initial appointment for Masseter Botox treatment typically lasts 30–45 minutes, while follow-up appointments typically take 15 minutes.

Bild, dass eine Patientin zeigt, die von Fraur Dr. Strobl mit Botox Masseter behandelt wird.  Die Einstichpunkte für die Injektionen werden gerade eingezeichnet.

What is Bruxism?

Bruxism is the medical term for the unconscious clenching and grinding of teeth. It is not a bad habit but rather an involuntary process. Teeth grinding falls under the category of para functions, which also includes lip biting or tongue chewing.

Bruxism is divided into two main types based on when it occurs: sleep bruxism and awake bruxism.

Sleep Bruxism

Sleep bruxism refers to teeth grinding that occurs during sleep. Often, no specific cause can be identified, and this is referred to as primary bruxism. Secondary bruxism is diagnosed when nocturnal teeth grinding is believed to be a result of an underlying condition. Iatrogenic bruxism is the term used when nighttime teeth grinding is a side effect of medication.

Awake Bruxism

On the other hand, awake bruxism occurs during the daytime when a person is fully conscious. Awake bruxism is frequently caused by psychological factors such as stress or anxiety. It can also be a result of sleep disorders, increased alcohol consumption, caffeine or nicotine intake, or medication side effects.

Symptoms of Bruxism

Since teeth grinding during sleep is not consciously perceived, bruxism is typically recognized by its typical consequences. These include pain in the teeth and jaw joints. Muscular tension, particularly in the head and neck area, is also common. Even migraines can be caused by bruxism.

One of my patients in Munich suffered from tinnitus without being aware of her nighttime bruxism. She was relieved when I was able to relieve her of her suffering.

Bruxism Can Have Serious Consequences

The health effects of bruxism can be quite severe and significantly impact one’s quality of life. If the jaw muscles become traumatized to the extent that chronic tension develops, individual muscle areas can harden and lead to chronic pain. This can occur not only in the immediate vicinity of the jaw but also in other parts of the body, such as the back or legs. Physical ailments are often accompanied by psychological ones, including sleep disorders, nervous tension, and a general feeling of discomfort.

Conventional Treatments for Bruxism

The first point of contact for bruxism should always be a dentist or oral surgeon. They are best equipped to diagnose bruxism accurately, determine the causes of teeth grinding, and propose appropriate treatment options.

Their initial recommendation frequently focuses on learning relaxation techniques. These exercises aim to relax the jaw muscle and subsequently reduce teeth grinding. In principle, this is a promising approach, although it requires patience.

Wearing a “night guard” or “bite splint” is also recommended for nocturnal teeth grinding. Such a device aims to protect the teeth from wear caused by constant mechanical strain. However, it does not address the underlying muscular cause.

Masseter Botox for Bruxism

When conventional treatment recommendations prove ineffective or the patient is unable to adhere to them (referred to as non-compliance), a new therapeutic approach involves using Botulinum toxin to relax the masseter muscle.

Relief Can be Dramatic, But is Not Guaranteed

The goal of this therapy, now known as Masseter Botox, is to specifically target the main contributor to teeth grinding and provide relief for several months. The treatment is not successful for all patients, but for those who respond positively, relief from symptoms can be experienced within a few days. In successful cases, the improvement can be remarkable:

One day later, the right-sided tinnitus was gone, the left-sided tinnitus significantly reduced, and the annoying modulation of the sound was also noticeably reduced.

(Patient on Jameda, 09/2020)

Unlike conventional therapies, the use of Botox aims to treat teeth grinding directly at its source. However, it is important to note that the masseter muscle should not be completely paralyzed, but rather have its overactivity reduced. Its essential roles in chewing and facial expressions need to be preserved. Unlike forehead or frown lines, an unintentional overdose of Botox in the masseter muscle could have significant consequences.

In successful therapy, there are no impairments in speaking, chewing, or laughing. The muscle remains strong enough for voluntary movements, but no longer responds to involuntary stimuli that lead to teeth grinding during sleep. However, it must be emphasized once again: The therapy does not work for all patients. Even in my practice, there are cases where despite a high dosage, no relief is achieved.

Cosmetic benefits of Masseter Botox

Masseter Botox also offers a cosmetic effect that is utilized in facial slimming. The prolonged relaxation of the overactive masseter muscle helps narrow the facial contour. The face appears more harmonious, and the youthful “V-shape” becomes more prominent.

The treatment, also known as facial slimming or jaw Botox, can be used as a standalone therapy for purely aesthetic purposes as well. The approach does not differ significantly from the medical application for teeth grinding. It is injected directly into the masseter muscle to relax it. The dosage and location of the injection points may vary slightly, depending on aesthetic goals.

Facial slimming is particularly popular in South Korea, where Masseter Botox is predominantly used for aesthetic purposes. According to surveys, half to two-thirds of the Botulinum toxin administered for cosmetic purposes in South Korea is used for this indication. In my practice in Munich, I also have Korean patients who I treat with Masseter Botox for facial slimming. They often combine facial slimming with Skin Botox to achieve the popular “glass skin” look in Korea.

Treatment Video Botox Masseter


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The video showcases Masseter Botox being administered to a patient with significantly hypertrophied masseter muscles. The patient has been suffering from nocturnal teeth grinding for years, experiencing distressing symptoms such as headaches, jaw pain, and daytime fatigue. I inject 30 units of Botulinum toxin on both sides, using 5 injection points each.

The Treatment Process

In Germany, Masseter Botox does not have an official approval. Therefore, doctors use Botox for the treatment of bruxism in a practice known as off-label use. This means that an approved medication is used for a different treatment than what it was specifically approved for. It is important for patients to know that doctors have an extended duty to inform them about off-label treatments.

Self-disclosure and patient consultation

As with any other therapy, Botox treatment for bruxism is administered only after clarifying any potential contraindications and providing information about risks and side effects. A detailed self-disclosure from the patient is therefore essential, followed by an extensive conversation. Existing medications, possible pregnancy, or ongoing lactation play a central role in these discussions.

Dosage and injection scheme

For Botox against teeth grinding, typically 50–60 units of the toxin are distributed into 4-6 injection points on both sides of the face. The injections are targeted at the deeper regions of the masseter muscle. The 4 points where I administer the toxin using a very thin needle are located at the anatomical areas marked in black:

Onset of action and duration

The toxin begins to take effect approximately 1–2 days after the treatment and reaches its full effect after about 10 days. By then, you should experience noticeable relief. If not, a supplemental dose may be necessary.

Typically, Botox for teeth grinding reduces symptoms for about 3–6 months. During this period, it gradually breaks down in the body. The speed at which this happens varies depending on individual factors and cannot be precisely predicted. On average, it is expected that the treatment will need to be refreshed every 4–6 months.

Long-term effects of the treatment include slight regression or atrophy of the masseter muscle.

Are There Risks and Side Effects?

Expected side effects of Masseter Botox include minor bruises at the injection sites. Temporary dryness of the mouth and a mild sensation of tension in the jaw area are also possible. Both of these effects usually disappear within 1–2 days.

Manageable Risks

Masseter Botox is exceptionally low-risk when all contraindications are identified and considered. However, this is only the case when the treatment is performed by an experienced and competent therapist. Concerns about the toxicity of botulinum toxin or rumored long-term damage do not hold up against continuously updated study findings.

Bone Loss After Masseter Botox?

One commonly expressed concern about Masseter Botox relates to the alleged weakening of bone structure. Indeed, studies have shown that long-term weakening of the masseter muscle can lead to changes in bone structure. For example, a Korean study with 20 patients found that long-term Botox injections resulted in a measurable reduction in jaw volume.

However, upon closer examination, this is neither alarming nor surprising. It is completely normal for bones to respond with a reduction in size and thickness when they are not in use or when the load on them is reduced.

Other studies on the same topic have indicated bone loss in the temporomandibular joint after Botox treatment. However, these studies were conducted on animals, not humans. Moreover, in these studies, not only the masseter muscle was partially weakened, but the entire musculature responsible for moving the temporomandibular joint was completely immobilized. Even then, the effect on the bone structure of the joint was reversible, meaning the thickness increased again once the muscles became active and the joint was stressed.

What does this mean? Complete inhibition is by no means intended with Botox for bruxism. According to the treatment protocol, relaxation of the masseter muscle only affects the lower part of the muscle, so the temporomandibular joint is still subject to load during chewing and various facial expressions.

Positive Personal Experiences

In my practice in Munich, I regularly perform Botox injections in the masseter muscle for both medical and purely cosmetic purposes. Some of my patients come from South Korea and have previously received Masseter Botox treatment there for several years. I am not aware of any problems or long-term effects in these patients or others.

What Is the Cost of Masseter Botox?

The costs for Botox treatment for bruxism are determined and billed individually according to the German Medical Fee Schedule (GOÄ). As an approximate guideline, I can provide you with a range of €280-€360 for Masseter Botox in my practice in Munich. This price range is based on the treatment with a total of 50–60 units of Botulinum toxin A.

The costs of Botox for bruxism are currently not covered by statutory health insurance providers. Some private health insurance companies may reimburse the costs upon request. Therefore, it is advisable to clarify with your insurance provider in advance whether they are willing to provide full or partial reimbursement.

Portrait von Dr. Eva Maria Strobl von Lips and Skin München

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About the Author:

Dr. med. univ. Eva Maria Strobl is the owner of LIPS and SKIN Aesthetic Medicine practice in Munich. She is a trained specialist in general medicine (MedUni Vienna) and has over 10 years of specialization in non-surgical aesthetic procedures. Dr. Strobl is a member of the German Society for Aesthetic Botulinum Therapy e.V. (DGBT), the German Society of Anti-Aging Medicine e.V. (GSAAM) and of Network Global Health. She publishes regularly on her blog and on DocCheck.

Sources of This Article:

Sommer et al, Botulinumtoxin in der ästhetischen Medizin, Thieme
Long et al, Efficacy of botulinum toxins on bruxism: an evidence-based review, Link

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