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Bruxism and TMJ Botox is an Effective New Treatment

Alexander Rivkin

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Bruxism is a disorder of unconscious jaw clenching and teeth grinding that causes pain in the temporo-mandibular joint, a sensation of soreness and tension in the jaw as well as headaches, neck pain and even migraines. Over the years, continuous grinding wears down the teeth and can even cause cracking and severe tooth damage. Bruxism to some degree, especially at night, is very common. As long as there are no symptoms of pain or dental damage, it does not necessarily require treatment.

Bruxism can be exacerbated by a variety of factors. Malocclusion (poor fitting together of the teeth), stress, anxiety, certain medications such as SSRI antidepressants and certain diseases such as Huntigton's and Parkinson's can all worsen bruxism. Use of drugs like methamphetamine and cocaine, as well as overuse of caffeine and alchohol will frequently cause people to brux.

Treatment of bruxism has been plagued with difficulty. Dental devices have been successful in protecting teeth from damage at night, but have not been effective at stopping the pain and soreness that accompanies severe bruxism. Of course, the clenching and headaches do not subside with dental devices. Biofeedback, relaxation exercises and meditation have been variably effective in controlling stress with some people, but most do not find the relief that they are looking for in behavioral modification techniques like these.

Botulinum toxin (Botox) has recently been seen to be very successful in treating the grinding and clenching of bruxism. Botox is an injectable medication that weakens muscles and is used commonly in cosmetic procedures to relax the muscles of the face and decrease the appearance of wrinkles. Botox was not originally developed for cosmetic use, however. It was, and continues to be, used to treat diseases of muscle spasticity such as blepharospasm (eyelid spasm), strabismus (crossed eyes) and torticollis (wry neck). Bruxism can also be regarded as a disorder of repetitive, unconscious contraction of the masseter muscle (the large muscle that moves the jaw). Botox works very well to weaken the muscle enough to stop the grinding and clenching, but not so much as to interfere with chewing or facial expressions. The strength of Botox is that the medication goes into the muscle, weakens it and does not get absorbed into the body. Side effects and allergies are unheard of. Despite the occasional brouhaha in the media, Botox has been shown to be one of the safest medications ever seen. Over the last 20 years and 20 million treatments, there has never been a serious complication directly attributed to the drug. This is a safety record that puts aspirin to shame.

The procedure involves about five or six simple, relatively painless injections into the masseter muscle. It takes a few minutes per side and the patient starts feeling the effects the next day. Occasionally, some bruising can occur, but this is quite rare. The symptoms that are relieved by this procedure include:

Grinding and clenching
Morning jaw soreness
TMJ pain
Muscle tension throughout the day
Migraines triggered by clenching
Neck pain and stiffness triggered by clenching

The optimal dose of Botox has to be worked out for each person - some people have stronger muscles that need more Botox. This is done over a few touch up visits with the physician injector. This treatment is expensive, but sometimes Botox treatment of bruxism can be billed to medical insurance (plans vary - its good to call your plan beforehand to find out what is covered and what documentation is necessary). The effects last for 3 months or so. The muscles do atrophy, however, so after a few rounds of treatment it is usually possible to either decrease the dose or increase the interval between treatments.

Alexander Rivkin M. D. is a Yale trained facial cosmetic surgeon and UCLA faculty member who has focused his practice exclusively on providing his patients with the latest in non-invasive, non-ablative cosmetic treatments. Dr. Rivkin is an international authority on non surgical cosmetic treatments. He divides his time between patient care, clinical research, educating other physicians, media appearances, and lecturing at scientific conferences throughout the world. Dr. Rivkin has made his name in developing non-surgical alternatives to commonly performed cosmetic procedures. He has been featured on the shows like the TODAY show, the Tyra Banks Show and EXTRA as well as in numerous national publications for the innovative procedures he has invented. He was the first physician in the country to offer the Non-Surgical Nose Job, his signature method for non-invasive correction of cosmetic nasal irregularities.


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