Medically reviewed by Brittany Ferri, PhD
This article provides a comprehensive overview of Botox injections for bruxism, including how it works, its effectiveness, potential downsides, and cost.
What is Botox and how does it work for bruxism?
Botulinum toxin (commonly known as “Botox”) is a toxin derived from the bacteria Clostridium botulinum.
It weakens muscle activity by inhibiting the release of acetylcholine (ACH), a neurotransmitter responsible for activating muscle contractions and glandular secretions. Botox is most commonly injected into specific areas to reduce wrinkles, neckbands, and other cosmetic issues. It has also been used to help with tremors, migraines, and teeth grinding/jaw clenching (bruxism) by reducing over-activity of the muscles responsible for these conditions.
Does Botox help jaw clenching (bruxism)?
Bruxism is characterized by the clenching or grinding of teeth due to contraction of the masseter, temporalis, and other jaw closing muscles. This can result in severe tooth wear, jaw pain, headaches, and other issues.
It has been hypothesized that paralyzing these jaw closing muscles with Botox injections may disrupt the feedback loop from the trigeminal motor nucleus and inhibit the central bruxism generator. However, a randomized control trial comparing Botox to placebo shows that Botox does not stop the grinding or clenching activity itself; instead, it reduces the strength of contractions in the muscles.
Although it does not stop the activity, Botox has been shown in multiple clinical studies to improve both objective outcomes, such as range of jaw movements, as well as subjective outcomes, such as pain at rest, pain while chewing, and other pain symptoms. Therefore, it is a promising option that can alleviate bruxism symptoms especially in cases where conventional treatments have failed.
What are the downsides of using Botox for bruxism?
Fortunately, serious side effects from Botox treatments are rare. The injected muscles may be sore or bruised for a few days afterward. In a systematic review of 10 clinical studies involving 237 participants, only 5 experienced short-term adverse effects, including a change in smile for 2 participants and chewing difficulties for 3 participants.
Botox treatment can be expensive if it’s not covered by your insurance. The total cost depends on the severity of your condition, your location, and the amount of Botox used. For 60 units of Botox, the cost can range from $450 to $600, but it could also cost anywhere from $500 to $1,500 depending on the number of units required. Keep in mind that repeated injections are often necessary to maintain the effects, so the cost of Botox can add up quickly.
Is Botox injections for bruxism covered by insurance?
The coverage for Botox treatment for bruxism varies based on your insurance company and policy. Some insurance plans cover it if it is deemed medically necessary, although you might need pre-certification. Therefore, before receiving treatment, it is important to have your provider check with your insurance provider to determine if it is covered under your plan. If not, the cost of the treatment will need to be paid out of pocket.
How long does Botox for bruxism last?
The effects of Botox injections wear off over time and need to be repeated, on average, every 3-6 months. One study shows that participants began to feel the effects around 2 weeks after the injection and lost them at 3-6 months. However, there have also been studies reporting effects lasting up to 1 year. This may be due to individual differences or different protocols (e.g. site of injections, amount of Botox used, etc.). More studies are needed to confirm this.
How many units of Botox injections do I need for bruxism?
Currently, there are no established protocols for using Botox to treat bruxism. Different studies that have been published have used varying quantities and locations for the injections. For instance, one study suggested using a maximum of 100 units of Botox per dental session, while another recommended using 14 units for each masseter and 20 units for stronger muscles, based on the patient’s response to the treatment. However, there is a lack of research to compare the effectiveness and safety of different amounts, injection locations, and Botox brands to determine the best protocol.
While Botox injections have shown promise as an alternative for managing pain symptoms due to bruxism, especially in cases when conservative methods have failed, its high cost, need for repeated injections, and lack of standardized protocol may limit its widespread use.
References:
Sendra, L. A., Montez, C., Vianna, K. C., & Barboza, E. P. (2021). Clinical outcomes of botulinum toxin type A injections in the management of primary bruxism in adults: A systematic review. The Journal of Prosthetic Dentistry, 126(1), 33-40.
Al-Wayli H. Treatment of chronic pain associated with nocturnal bruxism with botulinum toxin. A prospective and randomized clinical study. J Clin Exp Dent. 2017;9(1):e112-e117.
