My Approach to Bruxism Treatment Using Botox

Treating Bruxism at Skin Science Clinic

What I find particularly interesting is how varied clinicians’ approaches are to treating bruxism—especially in relation to diagnosis, dosage, injection technique, and follow-up care. Through years of hands-on experience, I’ve developed a treatment strategy that delivers safe, consistent, and long-lasting results.

Understanding Bruxism: What Causes Teeth Grinding?

Bruxism often stems from a combination of psychological and physical factors, such as stress, sleep disturbances, dental misalignment, and lifestyle habits. It commonly presents as:

• Involuntary jaw clenching (especially at night)
• Worn or flattened teeth
• Tension, headaches and neck pain
• Enlargement of the masseter muscles (hypertrophy)
• Facial asymmetry or a widened jawline

For those unfamiliar with the anatomy or causes of bruxism, please see our educational video below, which offers a helpful overview.

Step 1: Accurate Diagnosis Before Treatment

Before administering any Botox treatment for bruxism, it’s essential to confirm the diagnosis. This involves:

• A full medical and dental history
• Enquiry into stress, anxiety, and sleep patterns
• Assessment of jaw function and muscle tenderness
• Palpation of the masseter muscle to detect hypertrophy
• Ensuring the patient has been evaluated by a dentist—especially if they have tried mouthguards or bite splints

This comprehensive assessment ensures we are treating the true underlying cause, rather than masking unrelated symptoms.

Step 2: Choosing the Right Botox for Bruxism

I have worked with various brands of botulinum toxin, but my experience has led me to prefer Allergan’s Botox due to its superior:

• Potency
• Longevity
• Predictability of results

When treating functional conditions like bruxism, choosing a reliable formulation is crucial for sustained symptom relief and patient satisfaction.

Step 3: Optimised Botox Dosing Strategy

Typical guidelines suggest injecting 25–30 units of

per side into the masseter muscle. However, in my experience, this is often insufficient for patients with moderate to severe bruxism.

At Skin Science Clinic, my protocol involves:

• Initial injection of 40–44 units per masseter
• Follow-up at 4 weeks with a top-up of 16 units per side (if needed)
• Total dose: ~60 units per masseter muscle

This two-stage dosing strategy significantly improves outcomes without increasing side effects. Importantly, we do not charge extra for the additional dose—our focus is on clinical efficacy rather than cost-cutting.

Step 4: Injection Technique to Avoid Masseter Bulging

Unlike the conventional 3-point injection method, I use five injection points per masseter. This enables:

• Even distribution across the muscle
• Better depth control
• Prevention of asymmetrical results or masseter bulging

I also vary the injection depth to target different muscle layers and avoid under-treatment in bulkier areas of the muscle.

Step 5: Comfort and Safety During the Procedure

To ensure patient comfort and maximise precision:

• I use a 32G needle for accurate, low-discomfort injection
• A strong topical anaesthetic (more effective than standard EMLA) is applied for 5 minutes beforehand
• I mark anatomical landmarks and safe zones with a white pencil prior to treatment—this helps avoid rare complications such as risorius muscle involvement

While I am highly experienced in this procedure, maintaining meticulous technique ensures consistently excellent results.

Step 6: One-Month Clinical Review and Aftercare

Many clinics omit a follow-up appointment, but I believe it is essential:

• At 4 weeks, I re-assess the masseter muscle by palpation
• If any asymmetry, bulging, or persistent contraction is detected, I perform a targeted top-up injection
• Patients are also educated on bruxism triggers, including stress, caffeine, alcohol, and poor sleep hygiene

Where appropriate, I liaise with the patient’s dentist or GP to coordinate holistic care, such as custom bite guards or stress management.

Conclusion: A Comprehensive and Patient-Centred Approach

Botox is a powerful, non-invasive solution for patients suffering from bruxism. My approach—developed over years of treating functional and aesthetic facial concerns—relies on accurate diagnosis, optimal dosing, and ongoing review.

This ensures patients receive the longest-lasting, safest, and most effective outcome possible. If you are suffering from teeth grinding, jaw tension, or related symptoms, we would be delighted