Injections containing Botulinum Toxin or neurotoxin- known more commonly as Botox - are perhaps the most widely known treatments in the anti-ageing field.

However, they are also excellent treatment options for a range of other conditions such as jaw-grinding, excessive sweating or increased muscle tone or bulk.

It is in this context that they are suitable for treating the masseter muscles, a pair of powerful muscles located on either side of the jaw, responsible for jaw clenching.

Exploring Bruxism

Bruxism is a condition characterised by persistent grinding of the teeth that often occurs while the sufferer is asleep. Consequently, it is extremely difficult to stop this unconscious habit.

We can often link it to stress and anxiety (which is why it is practically at pandemic levels amongst young, hardworking and ambitious professionals), sleep disorders such as obstructive sleep apnoea, the use of medications such as SSRI antidepressants, as well as the consumption of caffeine and recreational drugs.

Bruxism then leads to a vicious cycle, whereby the constant use of those muscles responsible for chewing and grinding can cause them to enlarge and bulk out, and in turn, this makes them even more powerful which only leads to more grinding. This condition is known as Masseter Hypertrophy and so it is often the case the hypertrophy and bruxism coexist.

As a consequence, this often leads to a series of problems, including erosion of the teeth’s surfaces, pain within the TMJ (the joint connecting the lower jaw to the skull) as well as tension headaches, and waking up feeling uncomfortable and not well-rested.

In aesthetic terms, bruxism also leads to a squaring off and wideset bulky appearance of the jaw which especially in female faces can lead to an unwanted masculinising and widened appearance. This can lead to a disruption of the harmony of the lower half of the face.

In patients with a suspected or known history of bruxism, I would always strongly encourage you to visit a dentist in the first instance in order to rule out any underlying problems with your dentition or joints, which would need to be addressed first. It is important to be assessed for tooth erosion and in the first instance your dentist may recommend a mouthguard to help protect your tooth surfaces from any more wear and tear.

Although this is a very useful measure, most patients, however will continue to grind against their mouthguard and so even though their teeth will be protected, they are likely to continue suffering with discomfort, tension and muscle bulkiness.

Introducing Neurotoxin (BoTox) Interventions

This is where neurotoxin injections (aka Botox or muscle relaxing injections) can play a valuable role in the management of Bruxism.

By causing a gradual weakening of the muscles responsible for chewing and grinding, the power and intensity of the grinding motion will diminish over time. From a medical/dental point of view, this will lead to a reduction in pain, tension and tooth and joint damage and from an aesthetic point of view this will lead to a reduction (atrophy) of the muscle bulk allowing for a slimming down effect of the lower face.

Tailored Treatment Strategies for Bruxism

Before undergoing muscle relaxing injections you must undergo a thorough consultation to determine the extent and severity of your symptoms. Your healthcare professional should take a holistic approach to management and that often involves a multi-factorial treatment plan which includes.

Ongoing use of your mouthguard until symptoms subside to ensure your dentition is protected
Muscle-relaxing injections to alleviate the grinding action
Encourage you to explore stress-reducing activities to help reduce the risks of ongoing persistence of the root cause of the problem.
Avoid chewing gum or excessively chewing crunchy goodies such as nuts (guilty as charged!)

Anatomical depiction of the Masseter and Temporalis Muscles. (Click on image for source webite!)

Treatment involves 3 - 5 small injections into the masseter muscle (the powerful muscles that are located on either side of the lower jaw), which are over in a matter of minutes. Patients find that they are able to then continue their day as normal with no restrictions.

It takes around 7 days before the effect of the treatment starts to become apparent and usually you will be able to feel (and see, in the case of jaw-slimming) the effects of treatment by around 4 weeks. This is longer than with Botox injections for anti-wrinkle purposes, purely because we are dealing with a much stronger muscle.

In first time treatments it is not unusual to require a small top-up dose, due to the fact that we are dealing with such a powerful muscle, however most patients report a significant improvement in their symptoms by the first week. This improvement then continues for several weeks afterwards as the muscle continues to weaken over time.

We have 3 other muscle pairs that assist our masseters with chewing and clenching and so even when the masseters are weakened we are still able to chew. However, your practitioner will assess the most appropriate dose for you and administer the neurotoxin accordingly to ensure a good effect but minimal side-effects.

Especially with first time patients, I always advise we start you at a “sensible” dose and review you in a few weeks to assess if a touch-up is needed, rather than weaken you drastically.

In severe cases that are unresponsive or minimally responsive to masseter neurotoxin, patients may also require neurotoxin in the temporalis muscles (located on either side of the temple), as these muscles are also associated with action of chewing and may be co-culprits in the grinding tendency.

Mitigating The Risks Of Masseter Injections

The main risks associated with injections to the masseter include weakness in bite strength and a potential weakness/asymmetry of the muscles responsible for smiling (this effect is NOT permanent). For this reason, it is always advised to seek treatment with a registered and trained healthcare professional in order to reduce this risk as much as possible.

Furthermore, in some individuals seeking masseter reduction for aesthetic purposes, if it is felt that by reducing your jaw bulk, this might result in a worsening appearance of skin excess in the jowl area, you will be advised against treatment.

Bruxism Post-treatment Guidelines

It is recommended that you avoid exercise or excessive straining for 24 hours post treatment, as well as avoiding excessive heat or rubbing and pressure to the area. It is also advisable to avoid use of make-up over the puncture sites for a minimum of 6 hours.

Neurotoxin effects tend to last around 3-4 months on average and so to maintain the optimal results it is recommended to keep your treatments regular.

At Skin Health by Dr Jenny, we offer a wide range of muscle-relaxing treatments, including those designed to combat the jaw clenching and teeth grinding commonly associated with Bruxism. So if you are one of the many thousands currently suffering from such an affliction, then why not book in for a consultation with Dr. Jenny.