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: I want to investigate the use of botox to help with my jaw clenching and teeth grinding. I currently wear an appliance to help protect my teeth, but still clench and have jaw pain.
A: Clenching and the sequelae from it, pain and excessive tooth wear, is the result of overactive masseter muscles. (and sometimes the temporalis muscle as well) No one knows why this muscle hyperactivity occurs although it is blamed on personality types and stress. The exact reason why, however, is unknown. The traditional treatment of clenching uses non-muscular therapies such as dental appliances and anti-inflammatory or anti-spasm drugs. The purpose of a dental appliance (i.e., splint or mouthguard) is primarily to protect the teeth from excessive wear. It does an excellent job of that and there is no better substitute. The other objective of some dental appliances is to break the cycle of muscle spasm through jaw opening (increasing the interdental space and stretching the muscle out) and changing how one’s teeth interdigitate. (bite or occlusion) Their effectiveness in this regard is quite variable. Great claims are made by some as to how beneficial they are. But, in the end, they will work well for some and not for others.
Botox takes a different strategy to the muscle problem in clenching. By directly injecting the muscle into the most spastic and painful areas, these zones of paralysis or muscle weakening that Botox causes can very effectively reduce the muscle spasm and pain. For some patients, it can be a near miracle. For others the relief is still significant. I have yet to see any clenching patient who does not get noticeable relief. Sometimes additional or supplemental injections are needed to get the right dose of Botox after the initial treatment. The relief will last as long as the Botox works, for 3 to 4 months.
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