Botulinum toxin is used to treat patients with certain neuromuscular conditions. In the 1950s, scientists discovered that botulinum toxin can reduce muscle spasms that cause chronic muscle cramping, pain, and wrinkling of skin.  The solution prevents some of the muscle fibers from contracting. One of the most researched medicines in the world, BOTOX® treatment is approved for medical uses across the world. BOTOX is one of three brands of botulinum toxin.  The other two are Dysport and Xeomin.  Dentists have started offering botulinum therapy for patients who clench their jaws so much that even the use of a protective mouth guard does not prevent them from breaking teeth and causing headaches and migraines.  Some dentists also offer the treatment for wrinkles.

 BOTOX® is the first medicine to be studied and then approved by the FDA specifically for the prevention of headaches in adults with Chronic Migraine who have 15 or more days each month with headache lasting 4 or more hours each day in people 18 years or older.

At Cook Family Dentistry, we recommend a removable oral appliance (“night guard”)  as the first line treatment approach for patients who exhibit signs and symptoms of chronic clenching and grinding.  Although it is commonly referred to as a “night guard,” patients benefit from wearing the appliance any time that they clench and grind. Many patients report clenching and grinding at work or while driving and notice a correlation between clenching/grinding and stressful times.  If the patient wears the guard but continues to experience fractured teeth, fillings, and crowns, headaches, or migraines we discuss botulinum therapy.

In addition to tooth problems, some patients report problems with their jaw joint (the Temporomandibular Joint, or TMJ) such as pain, limited opening, and lock jaw. For these patients, we first recommend gentle, conservative home remedies such as soft foods, warm compresses, stretching exercises anti-inflammatories (ibuprofen).  If home remedies fail to give relief, we often recommend a night guard and may refer them to an Oral Medicine specialist.

We have administered bilateral injections of the botulinum toxin neuromodulator Xeomin.  Xeomin is a brand name that is administered in the same dose as the Botox brand with the same efficacy and duration.  Xeomin has been studied and used extensively and has been proven to be exceedingly effective and safe.  For patients who clench their teeth, the benefits of Xeomin include reduction of:

  • tooth fracture
  • tooth loss
  • toothache
  • jaw ache
  • muscle soreness

  • headaches

  • migraines

Injection of Xeomin for clenching involves easy, gentle injections into the masseter muscles and in some cases, additional injection into the temporalis muscles.  Masseter injections are administered from the outer surface of the face near the lower border of the jaw bone.  Temporalis injections are administered into the bulk of the muscle above the temple area around the hairline.   Although neuromodulators for esthetic (upper face) areas often take days to take effect, my patients who have received the injections for clenching report relief within 24 hours, and sometimes immediately.  The effect typically lasts 4 months.  My patients have reported lasting effects of from 2 to 4 months.  Every patient in my office who has received botulinum therapy has raved about the relief that they finally achieved from chronic pain.

The National Institutes of Health recognizes this safe and effective treatment.  See  and  for more information.

The following is a link to two studies demonstrating the safe and effective use of neuromodulators for clenching.

The Mayo clinic statement on the use of neuromodulators to reduce muscle overactivity:

In addition, see this link from Pub Med, titled Interventional neurology: botulinum toxin as a potent symptomatic treatment in neurology.

To reduce the chronic, severe clenching forces that have caused you tooth pain, tooth fracture, filling and crown fracture, tooth loss, and headaches, I recommend masseter injections of Xeomin neuromodulator every four months.  It is hoped that in reducing muscle activity, the muscle will retrain itself, through atrophy and decrease the need for treatment over time.  This is not guaranteed, but has been reported.

I hope this information has made your life a little better.


Dr. Amy Cook


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