Several new applications of botulinum toxin for therapeutic purposes have recently been proven effective. While some are still considered off-label, new market authorizations are growing, with the recent example of France just approving Botox® for new therapeutic purposes.
Image: Sleepmedres.org. n.d. [online] Available at: <https://www.sleepmedres.org/m/makeCookie.php?url=/m/journal/view.php?number=116>
One of the common conditions which toxin can help treat is bruxism. Tan et al, (2000) first postulated that toxin was safe and effective in the treatment of severe bruxism through the reduction of muscular activity. In recent years, this notion gained much significance; multiple studies have been conducted to test and understand the efficacy of toxin on bruxism.
What is Bruxism?
Bruxism is a condition of repetitive activity of the masticatory muscles causing a patient to grind or clench their teeth. Bruxism manifests itself into two categories: awake bruxism and nocturnal bruxism where the patient clenches their teeth in their sleep. Bruxism can often be severe, leading to jaw disorders, migraines or damaged teeth, and abnormalities of the orofacial structure.
Treatments for Bruxism
Treatments for bruxism include addressing the perceived underlying causes such as stress and anxiety. This is done through practising relaxation techniques and improving sleep. Furthermore, it is recommended that patients avoid smoking and drinking, and eating hard foods or chewing gum in the case of tooth or jaw pain. Various clinical drugs have been investigated in their efficacy in alleviating bruxism symptoms, but have been shown to not be entirely effective. In fact, the recommended modalities of treatment have not been proven to be entirely effective as they do not solve the problem, instead aiding in the management of symptoms.
Toxin for Bruxism
The positive impact of toxin on bruxism occurs when toxin acts on the neuromuscular junction. This reduces the contraction of the muscle, lowering biting pressure up to 20%-30%. Furthermore, a reduction of up to 30% of the masseter muscle can be expected. To address bruxism, the injection should occur around 1.5 cm from the lower border of the mandible. Injecting into facial nerves should be avoided. Literature provides evidence that 20-30 units injected on each side are efficient. Each mandible should be injected three to five times with 5 to 10 BU (Botox dosage) per injection. Nonetheless, a standardized dosage does not yet exist.
A 2019 peer review of 68 studies found that toxin injections successfully reduce the frequency of episodes and decrease the maximum occlusal force generated, thus decreasing original symptoms. The authors further claim that toxin is a safe and effective treatment for patients with bruxism, especially in patients with severe bruxism. However, the therapeutic effect on the masseter muscle comes into effect only about three weeks after treatment.
Aside from treating bruxism, injecting toxin in the masseter muscles has the alternative effect of slimming and contouring the lower face. The toxin inhibits the clenching of the jaw, thus, transforming a square jaw into a more oval, feminine shape.
Juvapen Expert for Bruxism
It is especially important that the practitioner masters the injection technique when treating bruxism as the wrong depth or location might result in an injection into the facial nerves potentially leading to chewing and talking disorders. With Juvapen Expert administering the exact dosage, the practitioner can focus its attention solely on technique to ensure a concise treatment.
Juvapen Expert, video credit: Dr Munir Somji, UK
Mayo Clinic. 2022. Bruxism (teeth grinding) – Symptoms and causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/bruxism/symptoms-causes/syc-20356095#:~:text=Bruxism%20(BRUK%2Dsiz%2Dum,a%20sleep%2Drelated%20movement%20disorder.> [Accessed 12 July 2022].
Kwon, K., Shin, K., Yeon, S. and Kwon, D., 2019. Application of botulinum toxin in maxillofacial field: part I. Bruxism and square jaw. Maxillofacial Plastic and Reconstructive Surgery, 41(1).
Fernandez-Nunez, T., Amghar-Maach, S. and Gay-Escoda, C., 2019. Efficacy of botulinum toxin in the treatment of bruxism: Systematic review. Medicina Oral Patología Oral y Cirugia Bucal, 24(4), pp.416-424.
Asutay, F., Atalay, Y., Asutay, H. and Acar, A., 2017. The Evaluation of the Clinical Effects of Botulinum Toxin on Nocturnal Bruxism. Pain Research and Management, 2017, pp.1-5.
nhs.uk. n.d. Teeth grinding (bruxism). [online] Available at: <https://www.nhs.uk/conditions/teeth-grinding/> [Accessed 12 July 2022].
Kwon, K., Shin, K., Yeon, S. and Kwon, D., 2019. Application of botulinum toxin in maxillofacial field: part I. Bruxism and square jaw. Maxillofacial Plastic and Reconstructive Surgery, 41(1).
Dalmedo, V., 2017. Management of masseter hypertrophy and bruxism with Botulinum Toxin A. [online] The PMFA Journal. Available at: <https://www.thepmfajournal.com/features/features/post/management-of-masseter-hypertrophy-and-bruxism-with-botulinum-toxin-a> [Accessed 13 July 2022].
TAN, E. and JANKOVIC, J., 2000. TREATING SEVERE BRUXISM WITH BOTULINUM TOXIN. The Journal of the American Dental Association, 131(2), pp.211-216.