What are the next steps if botox is ineffective for bruxism?

Doctor's Answers (1)

Dr Jaclyn Toh

"Dentist with an interest in comprehensive dentistry."

Botox is not intended as a primary treatment for bruxism.

The root cause of bruxism (teeth clenching or grinding that occurs in the absence of food) has yet to be fully explained. Some possible causes that have been suggested include:

  • Sleep apnoea
  • Stress
  • An unexplained neurological program deep in the brain that has yet to be discovered
Botox acts by paralysing the elevator jaw muscles (usually the temporalis and masseter muscles), reducing the ability of the muscle to flex. Unless you receive high enough doses of Botox to paralyse your muscles completely, which would also prevent you from chewing, the bruxing will continue.
At present, there is no known cure for bruxism that works equally well for all patients.

Managing bruxism

The primary goal of managing bruxism is to prevent irreversible damage to the teeth and other dental work (fillings, crowns, bridges, implants, veneers etc) in the mouth. When you are asleep, the protective mechanisms that regulate muscle forces are switched off. This means that patients who brux can easily exceed their typical daytime muscular forces during sleep. 
The most reliable way to protect the teeth is with a custom-made night guard that is worn to sleep.
Some night guard designs can reduce the activity of the strong elevator muscles and reduce the intensity of bruxism. Night guards will improve the efficacy of Botox since it reduces muscle activity. This means that you may need lower doses of Botox or less frequent Botox.
You should be screened for sleep apnoea because some night guard designs may worsen this, while some night guards can be used to treat mild sleep apnoea.