Treating the effects of bruxism with botulinum toxin.
Although the pathogenesis of bruxism remains unclear, multiple factors, such as physical or psychological stress, malocclusion, sleep disorders, and medication side effects, can cause bruxism. Treatment can be difficult given psychogenic and neurogenic components, and bruxism can be resistant to medical and behavioral therapy. There are various treatment options for bruxism, including oral splints; medications, such as muscle relaxants; antidepressants; and botulinum toxin. Multiple studies have shown that botulinum toxin injections into the masseter and temporalis muscles result in relaxation of the muscles and improvement of bruxism and the pain associated with chronic clenching and grinding.
In a recent study by Al-Wayli, 50 subjects who reported nocturnal bruxism were randomized to receive botulinum toxin versus conventional treatment (pharmacotherapy or oral splints). After 3 weeks, 2 months, 6 months, and 1 year, patients who received botulinum toxin had significantly less pain after only one treatment than did the traditional treatment group. Similarly, in a study by Lee et al., subjects randomized to receive botulinum toxin versus a placebo saline injections showed not only decreased pain but also decreased bruxism seen with nocturnal electromyography.
In our clinic, botulinum toxin is a safe, effective treatment for patients who grind, clench, develop temporal-mandibular joint pain, or have masseter hypertrophy. Botulinum toxin when injected into the temporalis and masseter muscles also helps with tension headaches and migraines related to clenching of the jaw. Albeit effective, the dose of botulinum toxin used in the aforementioned studies ranged between 25 U and 40 U of botulinum toxin and were lower than what we have found to be effective. Our patients receive 50 U botulinum toxin in each masseter muscle (100 U total). In a small minority of our patients, the temporalis muscle also needed 15-20 U per side as well. Clinical improvement starts within 3-5 days, and patients can expect to have relaxation of the muscle and decreased pain for 6 months. Side effects include mild swelling and bruising. Rarely, if the injection is not performed properly, the risorius muscle may be paralyzed, leading to an asymmetric smile. In addition, if the botulinum toxin is underdosed, the pain may not completely subside and the patient may report some symptoms returning within a couple of weeks of the initial treatment. Most patients also report thinning of the face and jaw, which is a much anticipated and appreciated result. Masseter hypertrophy with and without bruxism is treated similarly with botulinum toxin to sculpt the lower face.
Bruxism is a growing problem leading to facial pain, headaches, migraines, and significant dental pathology. Traditional treatments have been ineffective at treating the pain and masseter hypertrophy associated with chronic grinding and clenching, Botulinum toxin is a safe, effective, treatment with little downtime or side effects for treating both the neurogenic and muscular components of bruxism.
BY LILY TALAKOUB, MD, AND NAISSAN WESLEY, M D
Dr. Talakoub and Dr. Wesley and are co-contributors to this column. Dr. Talakoub is in private practice in McLean, Va. Dr. Wesley practices dermatology in Beverly Hills, Calif. This month's column is by Dr. Talakoub. Write to them at dermnews@mdedge. com. They had no relevant disclosures.
Al-Wayli H.J Clin Exp Dent. 2017Jan I;9(l):e112-e117.
Asutay F et al. Pain Res Manag. 2017;2017:6264146. doi: 10.1155/2017/6264146.
Lee SJ et al. Am J Phys Med Rehabil. 2010 Jan;89(l):16-23.
Santamato A et al. J Chiropr Med. 2010 Sep;9(3): 132-7.
Shetty S et al. J Indian Prosthodont Soc. 2010 Sep;10(3):141-8.
Tan EK et al. J Am Dent Assoc. 2000 Feb;131(2):211-6.
Please Note: Illustration(s) are not available due to copyright restrictions.
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|Title Annotation:||Aesthetic Dermatology|
|Author:||Talakoub, Lily; Wesley, Naissan|
|Date:||Sep 1, 2018|
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