Q: Dr. Eppley, I am interested in getting Botox injections to treat my severe clenching and grinding. I have tried every dental approach from teeth adjustment to splints and none of them have really done anything. I am worried about the wear on my teeth which is starting to become noticeable. You seem to be the only doctor in Indianapolis that does these type of injections for this problem. I would like to know the average cost of one treatment and average time it relieves the forceful grinding of bruxism.
A: I have done Botox injections for bruxism (grinding, clenching) for well over a decade. In the right patient, it can be tremendously effective if administered properly. As a general guideline, most patients should have 20 units of Botox injected into each masseter muscle for a total of 40 units. This would be the minimum effective dose but a good starting point to see how effective Botox may be for the bruxism. If I inject the Botox it is $16/unit, if my nurse performs the injections then it is $10/unit. The effects of Botox take up to a week to see its effect as it works by depleting the available neurotransmitter acetylcholine, so what it stored up has to be used up before the muscle fibers stop firing.
Dr. Barry Eppley
Q: Dr. Eppley, I suffer from bruxism along time. I have broken teeth from the grinding and suffer from much jaw pain. In the last month I have gotten Botox injections for it. It provided some significant relief but it only lasted just over a month. Ccan you advice me if it is possible to get another botox treatment or maybe it is not my solution. Thanks for your helping.
A: Botox injections into the masseter muscles can be tremendously effective in the treatment of refractory and very painful bruxism. In my experience it lasts about as long as it does when used for cosmetic applications on the face…about 4 months. If it only worked for one month, there are several explanations. The first possibility is that simply not enough Botox (dose) was injected. The minimum effective dose is 25 units per side and 50 units per side is more ideal. Less than this dose will either have minimal effect or it will wear off very quickly. A second possibility is that the Botox used was ‘weak’, either being reconstituted days or weeks before injection, or being reconstituted with an overdilution of saline. Both can result in minimal or a very short duration of any benefit. Since you had some significant symptomatic improvement, I would repeat the Botox injections with these issues in mind. Unfortunately being the patient, the only one of these you have any control over is the actual dose.
Dr. Barry Eppley
Q: I’ve done Botox injections on my frown line and crow’s feet. Thinking about having Botox to treat TMJ pain and maybe some on my face. Please let me know if he accepts insurance for the Botox treatments.
A: The use of Botox to treat “TMJ’ problems is done by numerous practitioners with variable degrees of success. Botox is a very specific treatment for muscle spasms and tightness or overactive muscles. The term TMJ, however, is a broad term that actually is a collection of different pain sites that is not really a unified diagnosis. For this reason, so called TMJ patients are being injected who may not be ideal candidates for a muscle treatment.
The best orofacial pain patients, in my experience, to get relief from Botox injections are the bruxism or clenching patient. This is a very specific masseter muscle problem that can be localized in most cases to the part of the masseter that is near the bony jaw angle. This is also a perfectly safe area to treat without causing any complications. The tight and painful muscle can be easily felt and the most painful part of the muscle specifically injected. These are also patients that have either been through or are currently undergoing some form of traditional mouth splint therapy. Often this treatment has failed or its effectiveness has decreased…as this is why they are seeking Botox injections.
Because the use of Botox for bruxism or as any part of TMJ problems is not FDA-approved, it is not eligible for insurance coverage.
Dr. Barry Eppley
Q: I was wondering if I could get a Botox procedure done in my masseter muscles to help with my teeth clenching. I have tried mouth guards and it doesn’t solve the problem because I’m also clenching my teeth a lot when I am awake. Please send me any information you can regarding this issue.
A: I have used Botox for masseter muscle injections for clenching and bruxism for the past five years. I have yet to see a patient who has not had some near immediate and significant improvement of their clenching afterwards. The duration of the pain relief will last as long as the Botox is effective, generally around four months or so. This makes perfect sense as the clenching is muscular in origin. While it can also involve the temporalis muscle, the large masseter muscles are certainly a major source of the clenching problem. While the simultaneous use of oral splints still has a role, particularly to prevent excessive tooth wear, the direct injection of a true ‘anti-spasm’ agent into the muscle is undoubtably more effective and immediate. (results within a week or less)
I have found that the starting dose of Botox is 25 units per side. Both sides are only done if the patient feels that the pain is on both sides. Many patients will have only a one-sided or unilateral source of masseter pain and clenching. The injections are placed in the lower half of the masseter. If a line is drawn from the earlobe to the corner of the mouth, the injections are placed in the part of the masseter muscle that lies below that imaginary line. This is a simple office procedure that is both quick and fairly painless. Compared to cosmetic Botox injections in the forehead, masseter muscle injections are surprisingly more comfortable.
Dr. Barry Eppley