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Bruxism and the Role of Botox in its Treatment

Bruxism may not kill, but it may cause significant pain and distress lasting for years. Moreover, the problem, commonly known as “teeth grinding,” is not rare. Even worse, science is still unclear about what causes the problem, meaning no treatment works for all. However, there are multiple treatments for the condition. This article will show where Botox treatment fits into Bruxism management and how it compares to other treatments.

young woman experiencing bruxism pain

Bruxism is not just about grinding teeth, which is definitely its prime problem, but it may also cause significant jaw pain. It can also cause face, neck, and shoulder pains. In addition, people living with the condition are more likely to experience headaches, disturbed sleep, earache, mood disorders, and more.

Studies show that bruxism may occur in almost one-third of adults, though the severity of the conditions may differ significantly with each individual. One of the reasons why the condition is so challenging to treat is due to a lack of understanding of what causes the condition. Nevertheless, nowadays, most researchers think that the condition occurs due to some changes in the brain and autonomic nervous system [1].

What is bruxism?

It is a condition when a person keeps on grinding or clenching their teeth. It is about repetitive and involuntary masticatory muscle activity. This means that muscles used to chew food keep contracting involuntarily and repetitively, causing much distress, pain, harm to teeth, changes in the lower jaw and more. Though its definitions may differ, teeth grinding and clenching are the condition’s most common symptoms [2].

At present, bruxism is divided into two types:

· Sleep bruxism (SB) – occurs during sleep.

· Awake bruxism (AB) – occurs when awake.

These two types are quite different, as sleep bruxism is considered a sleep or movement disorder, and awake is just a movement disorder. Awake bruxism is generally made worse by emotional stress, but the same is not always true for sleep bruxism. Both kinds of bruxism may occur in otherwise healthy adults.

Is bruxism a disorder?

That may sound a bit strange of a question. Nonetheless, some researchers think that it is not just a disorder but also a risk factor. Bruxism must be managed, as it increases the risk of a mechanical injury to one’s teeth, hypersensitive teeth, dental implant failure(s), stiffness in the jaw, jaw pain, changes in the jaw, pain around the ears, headaches, sleep disturbances and mental distress [2].

So, as one can see that bruxism is not just about teeth grinding - it is much more than that. It also means that the treatment approach to the condition will involve overcoming some of the issues caused by bruxism.

The treatment approach to bruxism

In this article, we are primarily interested in using Botox to manage bruxism. However, before understanding the role of Botox in managing the condition, it is vital to look at a broader picture and it is essential to understand various treatment approaches to the condition. Only then can we understand how Botox treatment fits into managing bruxism.

Before we look at the treatment of bruxism, one needs to understand that there is currently no ideal treatment for the condition. Most treatments try to prevent teeth grinding and clenching. Since, at present, there is insufficient understanding of what causes the disease, there are unfortunately no treatments or medications currently available to overcome the condition’s root cause.

#Treatment modality

Table of common modalities for treating bruxism

As one can see there are many treatment approaches to manage the condition. However, there is no single treatment that would work in all the cases. Moreover, various treatments have different modes of action, which means that most of those diagnosed with bruxism would end up receiving multiple treatments.

middle-aged women doing facial exercises for bruxism

With the availability of so many treatment options, there is one significant issue in that it is often not obvious what treatment(s) you should consider, let alone how they compare. Here we look at one of the lesser-known treatment, that is Botox therapy. This therapy is among the effective treatments for the condition, but it also has drawbacks as it does not address the root cause.

Role of Botox in bruxism treatment

Botox is a botulinum toxin injection, a kind of neurotoxin derived from the bacteria Clostridium botulinum. It applies to nerve conduction by temporarily blocking acetylcholine production. When taken orally, it causes severe food poisoning. Fortunately, when used by trained specialists and injected locally, it is quite safe. Its local injections do not cause any pain except mild discomfort. One of the good things is that its impact on nerve activity is only temporarily. Since Botox blocks acetylcholine production, consequently, it acts on motor nerves and does not interfere with the working of sensory nerves [2].

Most people are aware of it being used in cosmetic procedures. Injecting it in low dosages causes muscles to relax due to nerve blockade, which results in a reduction of wrinkles. However, it can be used to block just any motor nerve, that is, for blocking any nerves that cause contraction of muscles and movement.

Botulin toxin A (Botox) for bruxism

Botulin toxin A (Botox) injection in the masseter and temporal muscles, both of which are involved in teeth grinding, provides much relief because it causes relaxation of these muscles. Hence the repetitive motion of grinding and clenching teeth is overcome temporarily, which also provides much-needed pain relief. In addition, Botox can help reduce the frequency of bruxism episodes.

What does science say about Botox’s role in managing bruxism?

Though there are many bruxism treatments, many of them do not work or reduce bruxism episodes. Just take the example of occlusal splints. They do not reduce the severity of the condition. Instead, they primarily help protect teeth from further damage.

Unlike other treatments, Botox acts quickly, almost immediately after the injection providing prolonged relief for several weeks to months, which in effect reduces the cycle or number of episodes of bruxism and significantly reduces its severity.

Another good thing about Botox is that it works for all people. Since it blocks nerves in anyone who is given this treatment, its benefits, results and predictability are quite similar in patients experiencing different symptoms. Unfortunately, the long-term results of the therapy may differ among individuals.

Botox is a well-tested treatment method. Moreover, there is significant evidence supporting its effectiveness and safety, both in the short and long run. Researchers have been studying the role of Botox in managing bruxism ever since its introduction a little more than 30 years ago.

One of the studies done in 2012, a systemic review that explored the data from a variety of studies performed between 1990 to 2011, concluded that there is sound evidence that Botox reduces bruxism events, providing much pain relief [3].

what does science say about Botox and bruxism injection as a trend over time

And even more robust evidence supporting Botox’s role comes from a recent systemic review published in 2019. It is the most extensive study to date where researchers reviewed 68 studies, excluding all that were not performed by modern methods, carried out in animals, essentially case reports, or those that did not compare Botox with a placebo, while ultimately focusing on four studies in their final analysis. [4].

Their comprehensive study analysis concluded that Botox significantly helped reduce jaw pain in those with bruxism. It also resulted in a significant reduction in bruxism episodes compared to placebo. Thus, it concluded that there is sound evidence that Botox is one of the safe and effective ways to manage bruxism.

Botox application in masseter muscle of young adult woman

Multiple clinical studies confirm Botox’s effectiveness in both the short and long term

One of the most thorough and higher-quality studies by Lee and colleagues tested botulinum toxin (Botox) in 12 adults afflicted with bruxism. Before the study, they registered the severity of sleep bruxism. Then, they divided all participants into two groups, with six patients receiving Botox at 4, 8, and 12 weeks, while the other half received saline injections. The researchers found a much better effect with Botox, resulting in reduced muscle activity than the placebo group [5].

It is pretty easy to recognize that Botox provides quick relief; however, these studies also show that it can provide lasting relief. Because Botox causes reversible changes in nerve conduction, its benefits might be less pronounced over time.

Guarda-Nardini and colleagues decided to carry out a comparative study with a long-term follow-up of six months. They included 20 participants, of which half were males and the other half females. This is also important to keep in mind that pain perception differs between the genders. They paid particular attention to myofascial pain along with bruxism episodes. The study found that Botox provided much more pronounced relief compared to saline in both genders. They also found that over time, the effect of Botox diminished a bit, and at six months, benefits were not as pronounced in some patients [6].

Al-Wayli and colleagues tested the efficacy of Botox for relieving nocturnal bruxism (SB) by carrying out a study on 50 individuals living with sleep bruxism. Unlike the prior studies discussed, they divided patients into two groups, one receiving Botox and the other receiving a conventional treatment such as biofeedback. The study had a short-term and long-term follow-up period of six months and one year. They concluded that Botox was more effective than other conventional treatments for managing the condition. They further mentioned that Botox appears to help due to its impact on local muscle activity rather than on the brain or central nervous system [7].

In another study, Zhang and colleagues measured the impact of Botox therapy on occlusion force, or biting or grinding force of teeth. They conducted the study on thirty patients, divided into three groups: Botox, Placebo, and control. They found that though benefits were seen in all three groups, they were more pronounced in the Botox group. This shows both the importance of local Botox injections and psychological interventions in managing the condition [8].

Latest studies further confirm these benefits of Botox for bruxism

Researchers are still testing Botox in various clinical conditions and in different population groups. What is good is that Botox shows promising results in all studies. There is little doubt that it works, though some patients may experience lesser benefits than others.

Thus, there has been a couple of studies in 2020 on sleep bruxism, myofascial pain, and more. One of the studies included 30 patients, and it reported benefits using both subjective and objective methods. The study found that Botox helped reduce electromyography (EMG) bursts and hence teeth grinding severity in those afflicted by bruxism [9]. And, another study of 44 patients found that it resulted in an improvement in patients’ ability to open their mouths [10].

The above studies also focused on sleep quality and sounds made during sleep by those living with bruxism. These studies found that Botox treatment resulted in another significant benefit, reduced noises made during sleep and enhanced sleep quality.

The latest studies continue to add to ever-increasing evidence supporting using Botox for managing bruxism. Moreover, all studies confirm its benefits, and none of them reported any severe side effects. Moreover, when it comes to safety, it is worth knowing that healthcare workers have more than three decades of experience using Botox.

Botox injection hypodermic needle and botulinum toxin A medicine bottles

Botox has many other benefits apart from reducing pain or bruxism episodes

The primary aim of bruxism treatment is to prevent teeth grinding, clenching and a variety of other symptoms experienced both during the day and at night. Since a Botox treatment can last weeks, it is equally suitable for sleep and awake bruxism.

Botox’s benefits are more than just reducing bruxism events. It can significantly reduce myofascial pain. Not only that, it can enhance sleep quality and, thus, the quality of life. Further, it is worth keeping in mind that Botox would also help prevent other bruxism complications, especially those related to dental health.

Further, studies are yet to explore some other benefits such as helping improve mood, reduce mental distress, and helping prevent mood disorders in those living with the condition. In addition, treating nocturnal bruxism (SB) may also help prevent sleep interruption and enhance sleep quality overall, which may have multiple health benefits in the long run.

How does it compare to other treatments?

As mentioned earlier in the article, there are many treatment approaches for the condition. Quite often, doctors will use a few treatment methods together. Nevertheless, studies clearly show that Botox is one of the better ways to treat the condition.

In order to understand the role of Botox in bruxism, it is vital to understand how it compares to other treatment options. Although, regretfully, there are few studies comparing various interventions or treatments head-to-head. Nevertheless, there is sufficient data to make some comparisons.

Thus, for example, occlusal splints are frequently used to manage bruxism symptoms. These are often custom-made as well as over-the-counter (OTC) dental appliances to prevent harm caused to teeth due to grinding and clenching. These appliances, medically known as occlusal stabilization splints and commonly referred to as nightguards or mouthguards, also reduce jaw pain. There have been some comparisons between Botox and intraoral splints, and studies show that Botox is as effective, if not more [3].

young person inserting intraoral dental occlusal stabilization splint (Impression or boil and bite)

Though occlusal splints are also quite safe, they can be uncomfortable to use. For example, one needs to wear an occlusion splint every night while sleeping, which is pretty awkward. Moreover, occlusal splints are usually not worn during the day as they can affect daily activities like speech and eating. However, a few Botox sessions can achieve the same effect without causing much discomfort making Botox preferably for some cases.

When comparing occlusal splints and Botox, it is vital to understand that occlusal splints are more readily available. One can even buy ready-to-use occlusal splints without a doctor’s prescription. They almost have no contraindications. Consequently, they are also more readily accessible and affordable. They have the benefit of lower cost, especially in the long run. Finally, it is also essential to keep in mind that Botox’s effect diminishes with time requiring new injection treatments. However, occlusion splints offer a reasonable cost-benefit consideration over a long period as well giving occlusal splints a specific role in managing bruxism.

Another study shows that Botox is especially better for those living with nocturnal bruxism (SB)-associated chronic pain making the treatment good for both short-term and long-term pain relief [7].

Likewise, studies show that psychological interventions also play a vital role in the long run. For example, though Botox is good for symptomatic relief, its effect erodes over time. On the contrary, psychological interventions like learning relaxation techniques might be slow to work, but in the long run, they might also provide much relief [8].

Botox is good for bruxism, but it has its downsides too

Despite the robust evidence from so many clinical studies, it is worth noting that most studies had a small sample size or a small number of participants. Generally, the findings of smaller studies are less predictable for a larger population. This does not mean that the studies are not as valuable as other studies – it just means there is a need for more extensive clinical studies with many more participants.

Similarly, one must note that Botox affects local muscles only, that is, masseter muscles. It does not have any other effect. Thus, what it is doing is reducing the force of teeth grinding or even preventing it altogether. Though its impact erodes over time, but it does result in some long-term benefits. Also, it is worth noting that it does not influence the central nervous system directly, though it may have some indirect side effects.

Further, all these studies have one significant limitation: they all used Botox alone. However, in practice, doctors are not likely to use any single treatment. Instead, they are likely to combine multiple treatments like physical therapy (aka physiotherapy), drug therapy, psychological therapy, and more. Thus, while the aforementioned studies show satisfactory benefits, using Botox along with other treatments and interventions will generally result in even greater results.

Where does Botox fit into bruxism treatment?

Since there are so many treatment options for the condition, it is logical to ask where Botox treatment fits into bruxism treatment. Understanding that Botox treatment is quite an effective treatment option is vital. Moreover, it is quite a safe treatment that is good for most people. So, let’s look at some of the reasons to prefer Botox and understand its place in bruxism management.

Firstly, there are very few contraindications of Botox therapy, like severe myopathies, certain severe neurological conditions, pregnancy, and breastfeeding.

As far as pregnancy is concerned, it’s not that Botox has some harmful systemic effects, rather it is just better to avoid it, just like with certain medicines, alcohol consumption or drug use during pregnancy. After all, pregnancy is a short-term experience allowing resumption of or starting treatments afterward.

Secondly, Botox treatment is suitable for most people. It may be used as a first-line treatment for managing bruxism.

Thirdly, what is good about Botox is that it does not have any adverse interaction with other bruxism treatments. It means that one does not have to use it alone and may instead combine it with other treatments for additional benefits.

Botox primarily works locally, reducing hyperactivity and cyclic contraction of masticatory muscles. For example, Botox may work better when combined with psychotherapy or when combined with a medication. Psychotherapy and medical drugs mostly act on the brain reducing depression, stress, hyperactivity of the autonomic nervous system, and more. A well-thought out combination of treatments will likely lead to the best results.


Bruxism is quite common among children and adolescents and may affect one-third of people during their lifetime. For some individuals, it could be a cause of severe distress. Sleep bruxism is especially bad for health as it disrupts sleep and has many adverse impacts on health apart from its negative effect on dental health.

At present, researchers are unsure of what causes this involuntary excessive grinding of teeth. However, they think that it has much to do with certain changes in the brain caused by stress or other health issues. In this condition, masticatory muscle contracts uncontrollably, causing most issues. Thus, There are two treatment approaches to the conditions: lowering masticatory muscle activity and using methods that act on the brain to help calm down various brain centers. Both methods can also be combined.

Botox is a neurotoxin that causes reversible blockage of nerves innervating the masticatory muscle. This blockage of nerves helps provide almost instant relief in the condition. In addition, it prevents involuntary movements of masticatory muscles. It is equally good for reducing the severing of sleep and awake bruxism.

Studies suggest that Botox therapy is among the effective ways of preventing bruxism with proven efficacy. It provides significant benefits in the short and long term. Moreover, it is a perfectly safe therapy for most age groups. Not only that, Botox therapy is safe to combine with many other treatment modalities like psychological interventions and so on. Therefore, combining it with other treatments may help provide significant relief in many cases.


[1] Mesko ME, Hutton B, Skupien JA, et al. Therapies for bruxism: a systematic review and network meta-analysis (protocol). Systematic Reviews. 2017;6:4.

[2] Lal SJ, Weber DDS. Bruxism Management. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 May 2]. Available from:

[3] Long H, Liao Z, Wang Y, et al. Efficacy of botulinum toxins on bruxism: an evidence-based review. Int Dent J. 2020;62:1–5.

[4] Fernández-Núñez T, Amghar-Maach S, Gay-Escoda C. Efficacy of botulinum toxin in the treatment of bruxism: Systematic review. Med Oral Patol Oral Cir Bucal. 2019;24:e416–e424.

[5] Lee SJ, McCall WD, Kim YK, et al. Effect of botulinum toxin injection on nocturnal bruxism: a randomized controlled trial. Am J Phys Med Rehabil. 2010;89:16–23.

[6] Guarda-Nardini L, Manfredini D, Salamone M, et al. Efficacy of botulinum toxin in treating myofascial pain in bruxers: a controlled placebo pilot study. Cranio. 2008;26:126–135.

[7] 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:e112–e117.

[8] Zhang L-D, Liu Q, Zou D-R, et al. Occlusal force characteristics of masseteric muscles after intramuscular injection of botulinum toxin A(BTX - A)for treatment of temporomandibular disorder. Br J Oral Maxillofac Surg. 2016;54:736–740.

[9] Shim YJ, Lee HJ, Park KJ, et al. Botulinum Toxin Therapy for Managing Sleep Bruxism: A Randomized and Placebo—Controlled Trial. Toxins (Basel). 2020;12:168.

[10] Hosgor H, Altindis S. Efficacy of botulinum toxin in the management of temporomandibular myofascial pain and sleep bruxism. J Korean Assoc Oral Maxillofac Surg. 2020;46:335–340.


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