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 have had a problem since I was in 10 years old. I have visited many doctors but none have had a proper remedy. Ever since I have started feeling it, I am been taking medicines. And right now I am frustrated with taking medicines. The problem is that my face clamps down suddenly on my right upper and lower jaw while I am talking, eating, brushing or even when I am not doing anything. I have visited many neurologists and finally visited orthopedic surgeons but nothing works. I was just going through some internet sites and visited yours and would be very kind if you could help me out. Thank you.
A: While I don’t have the insights that would be provided by an actual examination or knowing what treatments you have had, your description sounds like a condition known as hemifacial spasm. This is caused by involuntary contractions of the muscles of mastication, the temporalis and masseter muscles. Since you have visited neurologists I will assume that causes of intracranial pathology (brain tumors, vascular lesions) has been excluded. I would recommend a series of Botox injections into those muscles which exhibit spasm. Botox is very effective for masseteric spasm in the treatment of bruxism and myofascial pain disorders.
Dr. Barry Eppley
Q: I had jaw angle reduction surgery three months ago and I am unhappy with it. I wanted to make the thickness of my jaw angles more narrow and thought that Botox injections to the muscle would work. Instead the doctor told me that I needed bone removed instead. During surgery, the doctor cut off my entire jaw angle and I just don’t understand why? It’s make my face look too short now and I am less attractive than before. I am very sad about having this surgery.
I am only 32 years old and don’t want to live the rest of my life looking like this. I have attached some pictures and x-rays (before and after surgery) for your review.
A: I have reviewed your case and the x-rays. What you had was a classic jaw angle reduction surgery. This is well shown on the x-rays and in your before and after photographs. Overall, I think the surgery was done adequately. One of the jaw angles has been cut off more than the other, accounting for the asymmetry in how the jaw angles look now.
For those seeking to get a narrower and less square face, this can be a good operation. One of the negative aspects to the procedure is that it makes the jaw angles blunted in addition to making it more narrow. In fact, it makes the jaw angles more narrow by virture of changing a square corner into a rounded one. That may not always be a good aesthetic trade-off. (and is what bothers you now)
In the desire to make a square face more narrow in a female, you have to distinguish between keeping the jaw angle square but making the bigonial width more narrow…or narrowing the width of the jaw angles but keeping the squareness to it. That is a very important distinction to make because achieving those looks requires two completely different approaches. The former needs to be done with Botox injections or doing a sagittal bone reduction in a flaring jaw angle (if present). The latter is done by the classic jaw angle reduction osteotomy. They both will make the lower face more narrow but the shape of the jaw angle will look different. Jaw angle reduction surgery makes the face look shorter in the back, muscle reduction or sagittal bone reduction does not create that effect.
The question now is. where do you go from here? Do you want some of the squareness to the angle back? If you do, then one may consider a thin jaw angle implant. (3 -4 mms) This will get the definition of the jaw angle and not add much width to it.
Dr. Barry Eppley