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What is Bruxism?

Bruxism is a condition in which you grind and/or clench your teeth. This can be a result of stress, concentration, exercise or habitual. If you have bruxism, you may unconsciously clench your teeth when you’re awake or clench and grind during sleep. This is considered a parafunctional habit and can have a detrimental effect on your teeth.
Bruxism can negatively impact the health of your teeth and jaw and is often related to Temporomandibular joint disorder (known as TMJD or TMD).

What is TMJD?

Temporomandibular joint dysfunction (TMD, TMJD) is an umbrella term covering pain and dysfunction of the muscles of mastication (the muscles that move the jaw) and the temporomandibular joints (the joints which connect the mandible to the skull).
, Bruxism

What are the signs and symptoms of Bruxism/TMJD?

The signs and symptoms of bruxism/temporomandibular joint disorders can be as varied as the causes, but you may experience one or more of the following symptoms:

teeth can look shorter (speed up the ageing process) or worn down
teeth or fillings can break or fall out (including fillings that are on the side of your teeth near the gumline)
a change in your bite and how your teeth meet
clicking, popping or grating sounds when you move your jaw
difficulty opening and closing your mouth or a ‘locking’ jaw
pain or discomfort in your jaw muscles, especially when you eat or yawn
pain in front of your ears, which may spread to your face, head, neck or upper back
migraines or headaches
pressure behind your eyes or inside your ears
aesthetically your face may appear square or you may have a thick jawline (masculine appearance)

What treatments are available for Bruxism/TMJD?

Lifestyle changes
Mouthguards/Occlusal splints
Medication such as Botox
Joint surgery

, BruxismResting the Jaw involves:
– Avoiding chewing gum or eating hard food (e.g. crusty bread, tough meat or raw vegetables)
– Avoiding episodes of wide mouth opening (e.g. yawning, singing, shouting, or prolonged dental appointments)
– Avoid clenching or grinding the teeth during the day by keeping the teeth a few millimetres apart at rest
– Avoid habits such as biting your nails, lips or cheeks, finger sucking or pencil chewing
– Avoid activities where there is awkward jaw posturing for a while (e.g. scuba diving, snorkelling, playing a musical instrument or contact sports)
– When opening the jaw, try to move it in a simple up-and-down direction without pushing the lower jaw forwards
– Be aware that the discomfort is made worse by stress. Try to relax more and sleep comfortably to ensure a restful night’s sleep.

Why I have been advised treatment with Botulinum Toxin and/or Mouthguards?

To prevent further grinding, clenching, and wearing out of your teeth which can lead to sensitivity and further dental work such as cracked and broken teeth/fillings
To help reduce the size of enlarged and overworked Masseter/Temporalis muscles (hypertrophy)
To help increase mouth opening for eating and cleaning back teeth
To help reduce jaw pain, neck pain, shoulder pain
To help reduce migraines and headaches

What else will it achieve?

If you do not like the shape of your face because it is square or you have a thick jaw line (masculine) and wish to have a more feminine appearance.

How can this be managed and what is the cost?

Complimentary Bruxism Consultation to discuss the different options and suitability.
Treatment appointment to include occlusal splints/mouthguard therapy or Botox therapy or a combination of both (usually the best outcome).
Occlusal assessment and Occlusal splints/mouthguards- £220-320
Botox therapy- £400-500
Complimentary Review Appointment

How can this be managed and what is the cost?

Complimentary Bruxism Consultation to discuss the different options and suitability.
Treatment appointment to include occlusal splints/mouthguard therapy or Botox therapy or a combination of both (usually the best outcome).
Occlusal assessment and Occlusal splints/mouthguards- £220-320
Botox therapy- £400-500
Complimentary Review Appointment

What is Botulinum Toxin Type A?

Botulinum toxin Type A (Botox®) contains a specifically prepared naturally occurring purified protein that originates from bacteria. It has been used in clinical practice for more than 10 years.

It is injected into a specific muscle and temporarily blocks the release of acetylcholine. This causes a temporary cessation of nerve signals reaching the muscle which prevents the muscle from contracting. The muscle is then relaxed, which reduces the forces of clenching, but still allows normal functioning for chewing and speaking.

Botulinum toxin is approved in the UK for the treatment of several medical conditions including migraine, muscle spasm and hyperhidrosis (excessive sweating).

What are the recommendations prior to injection?

Tell your clinician if you are suffering from any illness and inform them if you are taking any medication. These may affect treatment with Botulinum toxin.
To avoid bruising, do not take aspirin or anti- inflammatories prior to treatment.
Tell your clinician if you are pregnant or breastfeeding your baby because this treatment is not advisable during this period.
Tell your clinician if you have had any problems in the past with previous injections of Botulinum toxin or with injections in general.
Tell your clinician if you have any inflammation in the muscles or skin where your doctor plans to inject.
Tell your clinician if you have had any problems swallowing.
Tell your clinician if you have had any surgery that may affect the area to be injected or if you have any pending operations.

How is the treatment given?

Botulinum toxin comes in the form of a powder and is mixed with saline to form the solution which is then injected into the muscle.

Dr Nisha Patel/Suzanne Hogan will ask you to clench a few times in order to understand your facial muscles, she will then disinfect your skin and mark the injection sites before injecting the treatment at several points.

What happens after treatment?

To limit complications, it is recommended;

Not to rub or massage the treated areas for 24 hours after treatment.
To cleanse the areas gently, without rubbing it that evening
To avoid bending down and not to do any tiring physical exercise (gym, exercise class) or take a sauna the same day
The results of treatment are seen within a week of injection, and maximum effect may be seen 5-6 weeks after injection. Treatment has been shown to be affective up to 4-6 months after injection. At least 3 months must pass between treatments.

Is this a safe procedure?

As with any medicine, the injection of Botox® may cause side effects for some patients. Do not worry when you read this list of side effects, you may not have any.

Side effects usually occur within the first few days of injection and are temporary.

The most common side effects are headaches, skin redness, local muscle weakness and facial pain.

Other side effects may be associated with the injection (bruising, redness, pain, burning, stinging, and swelling).

Botox injection to the masseter muscle is very safe. Once the treatment has kicked in, there may be tiredness from heavy chewing of hard foods (such as steak). This starts after 1 week and can last a couple of months.

The strength of the bite goes down in 30% of people after a week. This recovers after 3 weeks as other muscles become stronger.

There can be some sagging of the skin if the muscle shrinks faster than the skin. Very rarely a sunken appearance develops on the cheeks. This is because the upper fibres of the muscle shrink down. Also rarely, Botox may spread to nearby muscles causing as an uneven or lopsided smile. Sometimes its not possible to smile as hard as before. This is temporary and wears off.

Sometimes a part of the muscle that has not taken the medication may become too active, and cause a bulge. This is usually when the top (superficial) part of the muscle does not take the medication. This can be treated with a further dose of Botox injection at 6 weeks and is included in the original price.

In a study of over 2000 treatments, the rate of side effects were as follows:
-  Reduced bite strength for a temporary period – 30%
- Bruising at the injection site – 2.5%
- Headache – 0.6%
- Bulging of part of the muscle that needed more treatment – 0.5%
- Sunken cheeks – 0.4%
- Sagging – 0.2%
- Reduced smile height – 0.15%

Adverse reactions possibly related to the spread of toxin distant from the site of administration have been reported very rarely with Botulinum toxin (e.g. muscle weakness, difficulty swallowing or pneumonia due to unwanted food or liquid in the airways).

Tell your clinician immediately if any of the following signs or symptoms appears:

Difficulty swallowing
Difficult breathing
Difficult speaking
Muscle weakness
Allergic reaction (swelling of face and airways)

Book your Complimentary Bruxism Consultation today with Dr Nisha Patel and Suzanne Hogan

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Brunswick Square Dental Practice is on the south side of beautiful Brunswick Place, facing west, which is at the top (north end) of Brunswick Square, just off the corner of Western Road, and a short walk through the Square from the seafront.

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