What is bruxism?
Bruxism is the behavior of clenching or grinding teeth. It is divided into sleep bruxism (night) and awake bruxism (day). In sleep bruxism, the patient is usually unaware; diagnosis is made because the person next to them hears the sound or the dentist sees wear.
The causes are multifactorial: stress, anxiety, sleep apnea, malocclusion, certain medications (SSRI group), genetic predisposition. It cannot be reduced to a single cause. Therefore, treatment is also multi-layered: night guard, stress management, sleep hygiene, and masseter botox if necessary.
Relationship with TMJ (temporomandibular joint disorder)
The temporomandibular joint (TMJ) is the joint that connects the lower jaw to the skull. Excessive masseter activity creates excessive pressure in this joint and leads to the following symptoms: clicking/popping sound in jaw movement, pain when opening/closing, tenderness in the pre-auricular area, morning jaw stiffness, headache.
In TMJ problems, the order of treatment is important: first conservative (dental splint, soft food, warm application, stress management, physiotherapy), if no response, masseter botox, and if that is insufficient, correction of dental occlusion or, in rare cases, surgery. Botox is a very powerful tool at this stage but not the first step.
Treatment plan
Masseter botox is applied in the range of 20-40 units per side (similar to the aesthetic approach in Chapter 10, but the dose is adjusted according to the indication). The effect becomes noticeable in 4-6 weeks. Changes reported by the patient: resolution of morning jaw pain, reduction of TMJ clicking, improvement in sleep quality, decrease in headache frequency.
Treatment is repeated 2-3 times a year. A night guard is used concurrently because the guard mechanically protects the teeth; botox reduces muscle strength. These two approaches complement each other, they do not replace each other.
Recommendations with bruxism
- Limit alcohol and caffeine consumption before bed
- Use a night guard every night — you'll get used to it in a few days
- Conscious relaxation when starting to sleep (4-7-8 breathing technique)
- Notice and release jaw muscles during long hours in front of a screen
- Sleep, exercise, and therapy if needed for stress management
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