Bruxism is defined as Excessive grinding of the teeth or clenching of the jaw.
This condition can affect adults and children, and can occur during day or night.
Symptoms
Treatment
By injecting small doses of botulinum toxin directly into the masseter muscle (the large muscle that moves the jaw), the muscle is weakened enough to stop involuntary grinding of the teeth and clenching of the jaw. This significantly relaxes the muscle and reduces the wear and tear on the teeth due to grinding.
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Relief from Teeth Grinding: Effectively reduces excessive grinding of teeth, particularly during sleep.
Jaw Tension Reduction: Helps relax the masseter muscle, alleviating jaw clenching and associated discomfort.
Tooth Protection: Minimizes wear and tear on teeth, preventing damage such as flattening, fracturing, or chipping.
Enamel Preservation: Helps maintain tooth enamel by reducing grinding, potentially preventing exposure of deeper tooth layers.
Pain Relief: May decrease tooth pain and sensitivity associated with bruxism.
urrent evidence suggests that onabotulinumtoxinA (Botox) injections can reduce pain and improve function in some patients with temporomandibular joint (TMJ) disorders, particularly those with myofascial or muscular TMD, but the overall quality of evidence is low to moderate, and results are mixed.
Several recent systematic reviews and meta-analyses have evaluated the efficacy of botulinum toxin for TMJ disorders:
– A 2024 meta-analysis of 15 RCTs (n=504) found that botulinum toxin type A significantly reduced pain intensity in muscular TMD at 1 and 6 months compared to placebo, with higher doses (60–100 U bilaterally) providing greater pain reduction. No significant increase in adverse events was observed, suggesting a favorable safety profile. [1]
– Another 2024 meta-analysis (14 RCTs, n=395) concluded that botulinum toxin was not significantly better than placebo for pain reduction, maximum mouth opening, or other functional outcomes at 1, 3, or 6 months, and did not increase adverse events. [2]
– A 2020 systematic review found botulinum toxin slightly more effective than placebo for pain reduction at 1 month, but not at 3 or 6 months, and highlighted low-quality evidence and heterogeneity among studies.
– Recent RCTs and controlled trials show that botulinum toxin can improve pain, muscle tenderness, and mandibular range of motion in persistent myofascial pain TMD, with effects lasting up to 6 months.
– A 2025 prospective randomized study found botulinum toxin more effective than low-level laser or ultrasound for pain and joint sounds at 15 days and 3 months, but not for improving mouth opening.
Limitations:
– Most studies focus on muscular/myofascial TMD, not intra-articular (joint) pathology.
– Evidence quality is limited by small sample sizes, heterogeneity in diagnostic criteria, dosing, and outcome measures.
– Long-term safety data are limited, though short-term adverse effects are generally mild.
Summary:
Botox injections may benefit select patients with refractory myofascial or muscular TMD, especially for pain reduction, but should be considered only after failure of conservative therapies.
