Bruxism and hypertonicity of the masticatory muscles

Botulinum toxin type A preparations are better known in our country as Botox and are firmly associated with getting rid of early wrinkles. But there are a number of inaccuracies here. Firstly, Botox is not a group of drugs or an active substance, but a trade name for a very specific drug, which, nevertheless, has become a household name, that is, it is used to refer to all similar drugs in general. And secondly, the range of tasks for such tools is much wider!

What are the advantages of botulinum therapy with Botulax in the treatment of bruxism?

Myorelaxation Complete relaxation of tight masticatory muscles and elimination of painful spasm.
Long-lasting effect After one procedure, the relaxing effect lasts for several months.
Quick relief from pain The drug begins to act immediately and gently relieves stress and discomfort.
Point effect The medicine is administered to strictly defined points and does not affect the functioning of other facial structures.
Getting rid of a bad habit You will quietly get out of the habit of clenching your jaw and aggravating the consequences of bruxism.
Maximum safety The drug does not cause addiction and is completely eliminated from the body.

There is a solution for each case!

1 procedure

1 Botulax procedure Gentle and safe effect For mild cases of hypertonicity of the masticatory muscles RUB 15,000. 15,000 rub.
3 procedures

A course of 3 Botulax procedures Gentle and safe effects For moderate and severe stages of hypertonicity RUB 35,000. 35,000 rub.

Botulinum therapy can help if you have a habit of clenching your jaw tightly and grinding your teeth, you suffer from increased abrasion of enamel and destruction of crowns.

Symptoms of hypertonicity of the masticatory muscles and bruxism

the chewing surfaces of the teeth become worn and flat (the cutting edges disappear),
tooth enamel chips, wedge-shaped defects appear, fillings fly out, teeth quickly decay, become loose, gums hurt,
you experience discomfort when opening your mouth, while eating or yawning - there are clicks, crunching sounds,
you or your loved ones notice that you are grinding your teeth - the characteristic grinding appears mainly at night (the so-called “night bruxism”), when it is difficult for a person to control himself during sleep,
cramps the jaw - you cannot fully open or close your mouth, the jaw seems to be blocked,
it is difficult for you to keep your mouth open for a long time, overexertion and pain appear during bruxism,
when talking or chewing, you feel that your facial muscles are “clogged”, tired,
when you are angry, tense or just working in concentration - your mouth is tightly closed, your lips are pursed, your teeth are closed, you are literally clenching your jaw,
there are problems with your bite – your teeth don’t fit together correctly, your jaws are misaligned relative to each other, causing you to bite your cheeks or tongue,
after concentrated work or under stress, you often have a pressing sensation in your temples, pain and dizziness,
you notice ringing and noise in your ears,
Over time, the lower half of your face has become visually square, heavy,
there are problems with posture - you are slouched, your lower back hurts, your neck is stiff, one shoulder is higher than the other.

If you find one or more signs in yourself, then this is a reason to consult a specialist for medical help. And the first step is a comprehensive diagnosis and search for the causes of hypertension.

We approach the treatment of bruxism comprehensively! We carry out in-depth diagnostics, find the exact cause of facial muscle spasm and eliminate it using advanced methods - safely and with high results.

Free consultation

Symptoms of TMJ problems

The disease manifests itself with the following symptoms:

Painful sensations occur on palpation.
When opening the mouth, the patient feels a sharp pain.
Due to pain, a person experiences difficulty eating and communicating.
Breathing through the mouth is difficult.
To the touch, the chewing muscles are compacted and slightly increased in volume.
Facial asymmetry with unilateral spasm.
Low-grade fever.
Headache.

The gnathologist
carries out differential diagnosis with a fracture or dislocation of the jaw, as well as with an infectious lesion.
There are three degrees of disease progression: mild (the patient is able to open his mouth four centimeters), moderate (the mouth opens two centimeters), severe (the patient cannot open his mouth more than one centimeter).

The main causes of bruxism in adults and jaw strain

psycho-emotional reasons: nervous overstrain, prolonged stress, difficult experiences of situations,
dental reasons: prolonged absence of teeth, malocclusion, diseases of the temporomandibular joint, complete or almost complete absence of teeth, inconvenient and poorly made crowns and dentures, fillings that are too high, injuries to the dental system,
disorders of the musculoskeletal system: injuries and curvature of the spine, poor posture, asymmetry in the work of the core muscles,
neurological causes: epilepsy, birth trauma, brain and central nervous system damage,
other reasons: taking certain medications, smoking, abuse of caffeine-containing drinks.

“We always take a comprehensive approach to solving problems of hypertonicity of facial muscles. First of all, we look for causes from the maxillofacial apparatus - we carry out a full diagnosis and examination, evaluate the functioning of the masticatory muscles, identify the patient’s characteristic habits and collect a medical history. If necessary, we refer the patient to specialized specialists - a neurologist, psychotherapist, etc. It is very important to cure hypertonicity - at least so that the patient in the future can safely begin high-quality dental restoration: implantation, prosthetics or treatment.”

Aida Vladimirovna Jutova, implant surgeon, periodontist, work experience of more than 10 years make an appointment

Causes of trismus

The problem of spasm of the lower jaw can be associated not only with damage to nerve endings and reflex contraction, but also with other factors:

infectious and inflammatory diseases of the oral cavity;
previous injuries;
unsuccessfully performed anesthesia of the teeth of the lower jaw;
arthrosis of the mandibular joints;
pathologies of ENT organs;
irritation, inflammation of the trigeminal nerve;
purulent processes, etc.

In addition, trismus can be a consequence of pseudobulbar palsy, meningitis, epilepsy, calcium deficiency, etc. Symptoms may first appear after injury, temperature changes, or sudden hypothermia. Sometimes the jaw cramps after opening the mouth wide, for example, after removing a wisdom tooth.

Botulinum therapy as one of the methods for treating hypertension and bruxism

Botulinum toxin type A, which is used in medicine and cosmetology, is able to relieve spasms and relax overstrained muscles, specifically reducing their activity or immobilizing them completely. But not forever, but only for a certain period of time - during this time the body adapts to new circumstances and stops overstraining a certain area. That is, the therapeutic effect for a diagnosis such as “bruxism” lasts for a long time, which is confirmed by numerous reviews from patients.

How it works?

Botulinum toxin type A is a neurotoxin produced by the bacteria Clostridium botulinum. It blocks nerve impulses from the central nervous system to muscle fibers. That is, in fact, the drug paralyzes a certain muscle without transmitting motor commands from the brain to it.

In medicine and cosmetology, it is used in ultra-small and highly purified forms - that is, it is not poisonous or toxic to the body!

The drug is injected into clearly defined points in order to affect only a specific muscle and not affect the work of others. The dosages are harmless, and the blocking is reversible. Over time, the drug is completely eliminated from the body - usually this takes from 5 to 7 months. Gradually, neuromuscular conduction in the area is restored, and mobility returns to the muscle - but since it has “rested,” the spasmodic fibers are smoothed out, and the body adapts and normalizes the load.

Botulinum toxin only relieves hypertonicity and allows the muscle to relax. This is the basis of its well-known cosmetic effect - smoothing out wrinkles by blocking the work of facial muscles. That is, it is wrong to think that you can “pump yourself up” with botulinum toxin preparations - they do not in any way increase the volume of soft tissues.

To relieve excess tension in the masticatory muscles, we use the drug Botulax for intramuscular injection with 99% active substance content, thereby increasing the speed of onset and duration of the therapeutic effect. And thanks to the high degree of purification of the drug, the risk of adverse reactions is minimized. The dosage and course are selected by the doctor strictly individually!

The main reasons why the oval of the face “floats”

Age-related changes

Skin aging is the most common cause of changes in facial contours. Most often this is expressed after 35 years. The production of collagen and elastin, which are responsible for the firmness and elasticity of the skin, begins to decrease.

Weight fluctuations

If extra pounds appear, the skin, accordingly, stretches. In case of sudden weight loss, it begins to sag because it does not have time to adapt to the new volumes.

Edema

The main causes of edema can be a sedentary lifestyle, poor diet, and bad habits such as alcohol and smoking. All this retains fluid in the body and swelling develops. Since water metabolism is disrupted, the contours of the face become rounded, and the skin becomes looser.

Improper skin care

If your skin is not cleansed and moisturized enough, it will begin to show signs of aging very early. Moreover, it is important to remember that the choice of skincare products should be based on a specific skin type. This will help achieve maximum effect from cosmetics and prevent your skin from aging early.

Incorrect posture

Constant slouching can lead to more than just spinal curvature. This also leads to the fact that the oval of the face becomes more drooping, the cheeks begin to sag, and the corners of the lips begin to droop down.

Exposure to direct sunlight

Ultraviolet radiation has a very adverse effect on the skin. Due to prolonged exposure to the sun, the skin ceases to produce enough collagen and this leads to rapid aging.

Indications and contraindications for botulinum therapy of masticatory muscles

Indications

pain in the temporomandibular joint area,
limited mouth opening,
clicking, crunching, discomfort when moving the lower jaw,
pathological abrasion of enamel,
overstrain of the masticatory muscles, their soreness and heaviness,
preparation for implantation, classical prosthetics (especially veneers), orthodontic treatment.

Contraindications

pustular skin lesions, ulcers, acute infection in the area of the masticatory muscles,
viral and infectious diseases in the acute stage,
neuromuscular diseases (myasthenia gravis),
constant use of certain medications and antibiotics,
pregnancy and lactation period,
bleeding disorders,
diabetes,
allergic reactions to the components of the drug,
oncology and severe mental disorders.

Prevention of hypertonicity of the TMJ muscles

Preventive measures against hypertonicity of the lower jaw muscles will help prevent the disease with an integrated approach. It is much easier to follow the general recommendations of doctors than to face a painful spasm of the TMJ. Prevention includes the following activities:

Preventive visits to the doctor every six months.
Careful systematic oral hygiene.
Treatment of caries at its first symptoms.
Orthodontic treatment for malocclusion pathologies.
Disinfection of food products.
Antitetanus therapy for animal bites.
A set of necessary vaccinations.
Do not open your mouth wide (jaw dislocations often occur when trying to bite off a large fruit).
Do not overuse solid foods and do not chew nuts with your teeth.
Avoid stressful situations, react less to stress.

Main stages of treatment

Step 1. Preparation for the procedure

A doctor, for example, an implant surgeon or an orthopedist, may refer you to the botulinum therapy procedure for comprehensive preparation before installing implants or dentures. But you can also contact your dentist yourself with complaints about the symptoms of dental bruxism. On the recommendation of a doctor, after consultation and diagnosis, you can begin the injection course.

No complicated preparation is required. 2-3 days before the procedure, it is advisable to eliminate alcohol and reduce the consumption of tea, coffee and energy drinks, as well as stop taking blood thinning medications and antibiotics.

Experienced doctors who follow safety precautions! Our specialists have undergone appropriate training, are certified and accurately calculate the dosage of the drug. We carry out treatment carefully, safely and with results!

Step 2. Administration of the drug

The procedure itself takes on average 20 minutes. The doctor conducts a follow-up examination and marks points for drug administration.

The doctor takes the ampoule out of the refrigerator and opens the disposable syringe with the medicine in front of you - this way you will make sure that the storage conditions and sterility of the drug are observed. How many units of Botox are needed for bruxism? The specialist will calculate the dose individually, based on the severity of the symptoms, and divide it into 3-4 parts - that is, you will be given several small injections in different areas of the muscle. For injections, disposable sterile syringes with thin needles are used, so the procedure is almost painless. But for greater comfort, the injection site can be numbed.

Step 3. Rehabilitation period

The drug begins to act immediately, but gains maximum strength gradually - over about 10-14 days, during which the spasmodic area completely relaxes. At this time, it is undesirable to overheat and overcool the problem area: that is, you will have to limit physical activity, trips to the bathhouse and sauna, as well as to the pool.

It is also important in the first days to touch your face as little as possible and not to steam or massage the injection sites.

The effect of the drug lasts up to 7 months, but may weaken faster depending on individual characteristics. Your doctor will tell you at your follow-up appointment whether you need a repeat course.

How long does it take to cure trismus?

Typically, full muscle recovery can take one to three weeks, depending on the cause of the trismus. More time will be needed for fractures of the jaw, which must heal properly and subsequently develop.

To prevent trismus of the masticatory muscle, you must:

do not cause diseases of teeth and gums;
get vaccinated against rabies and tetanus (rabies and, as a result, lockjaw can be fatal);
In case of blows or damage to the jaw, seek emergency help from dentistry;
avoid stressful situations, nervous tension;
when engaging in contact sports, wear special helmets and mouthguards for protection;
undergo regular preventive examinations with a trusted dentist. These are the doctors who work in the 32 Dent network of clinics, where you will be happy to see you at any time. Contact us!

Disadvantages of treating bruxism with Botulax

It is important to choose an experienced, certified doctor who has trained and has official approval for botulinum toxin injection therapy - this is a rather complex procedure with its own subtleties. If the rules of storage, selection of dosage and administration technique are not followed, complications may occur. And if hematomas, bruises or slight swelling basically go away on their own, then difficulties with swallowing and chewing should be eliminated together with a doctor.

Our doctors have been trained and certified - treating hypertonicity with botulinum therapy in our clinic is completely safe

Where is surgical treatment for paralysis of the facial muscles performed?

Specialists from the Department of Maxillofacial and Reconstructive Surgery of the Federal State Budgetary Institution NKCO FMBA of Russia, together with the Department of Ear Diseases, have developed and put into practice a unique method of surgical treatment of patients with paralysis of the facial muscles. The first operations on patients with this pathology in Russia were performed by specialists from the Federal State Budgetary Institution NCCO FMBA of Russia - otosurgeon, MD. Hassan Diab and maxillofacial surgeon Ekaterina Orlova.

A healthy person rarely thinks about how important facial expressions are and what role they play in our lives, especially a smile... Smile more often!

Why is botulinum therapy not enough to eliminate hypertension?

You need to understand that Botox treatment in dentistry, like orthopedic treatment of bruxism (that is, the manufacture of special protective mouth guards for teeth during bruxism), is only an additional, and not an independent method. Botulinum therapy protects against the consequences of muscle strain - that is, visible relief will actually occur after administration of the drug. The spasm will go away, the muscles will relax, you will stop involuntarily clenching your jaw and thereby injuring your teeth. But as soon as the effect of botulinum toxin wears off, the problem may return, albeit to a lesser extent.

Of course, if it was just a formed habit based on nervousness, and the causes of bruxism are psychosomatic or neurological, then during treatment you have a good chance to completely get rid of it. But if the source lies in other pathologies and disorders, then you also need to address them: take care of your posture, solve bite problems, restore damaged teeth, replace low-quality dentures, etc. And botulinum therapy will become an effective comprehensive measure.

Facial hyperkinesis

Facial hemispasm and paraspasm, blepharospasm are diseases associated with uncontrolled contraction of facial muscles. They are very similar to neuropathy, neuritis, and facial nerve paresis.

Facial muscle control is structured as follows:

Nerve cells of the cortex and subcortical nuclei of the brain send nerve impulses to the brain stem, to the control centers of the facial nerve;
These centers distribute impulses along the nerve fibers and send them along the nerve, like an electrical cable, directly to the facial muscles;
Each tiny nerve fiber causes its own microscopic section of muscle to contract.

Causes of facial hyperkinesis:

An error in the functioning of the subcortical nuclei of the brain, as a result of which excess uncontrolled nerve impulses are sent to the facial muscles, which lead to spasm;
Excessive stimulation of the facial nerve centers in the brain stem;
Irritation of the facial nerve itself after it leaves the brain.

In the first and second cases, this is the result of damage to the nucleus or center due to neuroinfection, multiple sclerosis, blood supply deficiency or tumor. In the third case, the disease occurs even with slight compression of the root of the facial nerve in the area of its exit to the base of the brain by an altered vessel (entanglement of the nerve by an artery), a tumor, or compression in the thickness of the parotid salivary gland in some of its diseases.

Even doctors often confuse facial hyperkinesis with neuropathy, neuritis of the facial nerve. We will definitely understand the causes of the disease and provide the necessary treatment.

Why are mouthguards needed for bruxism?

Another additional way to treat hypertonicity of the masticatory muscles in adults is to wear a special protective mouth guard (they are also called a “mouth guard” or “bruxism trainer”). These are plastic and dense overlays for teeth, which are worn mainly at night, and in case of severe symptoms, worn during the day. They are made from hypoallergenic materials in a dental laboratory individually for the patient or at the factory, if we are talking about mass production.

But this is also an auxiliary measure - a mouth guard helps muscles relax, protects against tooth wear and the consequences of bruxism, but does not remove the cause of hypertonicity.

protection of enamel from cracks, chips, increased abrasion due to involuntary clenching of teeth,
protection of artificial crowns, dentures (including those on implants) or brace systems from damage,
relieving tension and pain in masticatory muscles and joints,
protection against movement and displacement of teeth due to constant pressure on them,
gradual return of the jaws and joints to the correct position in the event of their displacement (of course, only individual mouthguards for bruxism made by a doctor work this way).

Choosing a sleep guard for bruxism: types and price

Firstly, there are universal and individual options: finished products are produced in factories using standard templates, and custom-made mouth guards are made exactly to your measurements.

Also, as we mentioned, mouthguards are not only night guards. The vast majority of patients suffer from teeth grinding during sleep, but a number of people cannot control jaw clenching during the day - for such cases, there are options for daytime overlays that are more invisible and do not affect pronunciation.

A mouthguard for teeth against bruxism, especially a night guard, can be bought at a pharmacy (either in Moscow or in any other city). It costs about two to three times less than a custom-made one. The quality depends on the manufacturer, and universal options have limitations in size and shape, so they simply may not fit the dentition. But the most important limitation, which patients often forget about, is that a ready-made onlay should be purchased on the recommendation of a dentist, and not self-medicated. Alas, without diagnosing and searching for the causes of spasm of the masticatory muscles, a ready-made mouth guard will do more harm than good.

Therefore, it is better if the mouth guard is made individually - based on a cast of your jaws. Individual mouthguards for bruxism, made for sleep, take into account anatomical features to the smallest detail and do not overload the teeth. And if you need to wear the veneer during the day, then it should match the shape of the teeth so that it is truly invisible when communicating. You can order such a mouthguard for bruxism in dentistry by contacting your doctor about this problem.

The doctor will also give recommendations on how long a day it is best to wear a mouth guard, how to care for it, and when the product should be replaced.

Results of surgical treatment of paralysis of facial muscles

The result of these operations (with the exception of static correction) does not appear immediately. As a rule, the result appears after 4-8 months - the first weak movements appear, which gradually intensify with mandatory adherence to the specialist’s recommendations. This is due to the fact that nerves re-grow, according to the literature - up to 1 mm per day. First, sensations appear in the form of “lumbago”, “running goosebumps”, etc. This indicates the growth of the nerve along the nerve fibers. The first movements are quite weak, since the muscles have been without load for a long time, so it takes time for their functional restoration, and it is necessary to constantly load them rationally. Thus, rehabilitation plays a very important key role in the final outcome. And the patient must be prepared for daily exercise and not immediate results.

What happens if hypertonicity of the masticatory muscles is not treated?

The masseter muscle, which moves the lower jaw, is the most powerful in the group of facial muscles. By contracting, it is capable of creating a force of up to 80-100 kg (compare - in order to chew food efficiently, we use barely 10% of this force).

Chronic spasm and overstrain of such strong masticatory muscles creates excess pressure on the teeth, periodontal tissues and temporomandibular joints. From here, many unpleasant consequences for the jaw system and health in general develop along the chain:

abrasion of enamel and reduction in tooth height,
chips and cracks, various enamel defects,
frequent caries,
overload of periodontal tissues and the development of gum diseases - in particular, dangerous periodontitis,
failure of fillings, crowns and dentures,
threat to implants, the possibility of their overload and loosening,
swelling and inflammation of the masticatory muscles,
dysfunction of the temporomandibular joint, pain and discomfort when chewing,
deterioration of blood circulation and tissue nutrition in the area of muscle spasm,
increased headaches, dizziness, noise and pain in the ears,
overstrain of the neck and back muscles, development of posture problems,
violation of facial aesthetics: angular jaw, deep wrinkles around the nose and lips, haggard face and reduction of the lower third.

What types of anti-aging massage exist?

Sculptural

Sculptural massage deeply works the facial muscles, maintains their tone, which tightens the oval, eliminates the double chin, smoothes wrinkles in the forehead and eyes, evens out skin tone and removes puffiness. Recommended as prevention at the age of 25+ and ideal for 30+.

Buccal

During this type of massage, attention is paid to facial and chewing muscles, which improves blood microcirculation, strengthens facial muscles, restores facial skin, increases the elasticity and strength of muscle fibers.

Myofascial

One of the most powerful massage techniques. The effect is noticeable after the first massage - blood flow will increase, the movement of lymph will be activated, which removes toxins from the body, and muscle fibers will gain strength and elasticity.

Is it possible to undergo implantation for bruxism?

Only on condition that an integrated approach is applied to implantation and subsequent installation of the prosthesis. In order for your new teeth to serve you for a long time, we carefully plan the entire course of treatment from start to finish: we conduct in-depth diagnostics, identify related problems that may affect the result, take measures to eliminate them, and step by step work through the entire course of the operation and prosthetics.

For example, our patients often experience bruxism and problems with the temporomandibular joints due to the fact that the dental system has not been working properly for a very long time - the teeth were destroyed, the load was distributed unevenly. In itself, the return of all teeth through complex implantation is already a treatment for such conditions, since we think over dentures taking into account the correct functioning of muscles and joints, normal closure of the dentition, etc. But the body will need time to adjust to normal functioning. And that is why in cases of bruxism we are taking additional measures - increasing the number of implants installed for the entire jaw, making prostheses reinforced with a frame and made from more durable materials, and making protective soft mouth guards.

But if bruxism in adults cannot be cured only by dental methods, since the problem is not with the jaw system, but with the same psychosomatics, then we refer the patient for treatment to a specialized specialist - and return to dental restoration afterwards. We care about your health and do everything to ensure that the achieved treatment results last not just for a couple of years, but throughout your entire life.

Prevention of bruxism: how to help yourself

By prevention we mean measures that prevent dental hypertonicity and bruxism in adults, because without finding the cause and monitoring a specialist, treating them at home is an unsafe activity, as with any disease. So if you notice alarming symptoms, your first step is to get diagnosed and get a plan to comprehensively eliminate this problem.

You may need the help of several specialists (neurologist, dentist, gastroenterologist, ENT doctor, psychotherapist), because bruxism occurs in different people for very different reasons. You may be prescribed courses of physiotherapy, taking certain medications (for example, magnesium supplements), but all this, of course, is very individual.

Self-help measures are helpful if you discuss them with your doctor. For example, you can do a light relaxing massage against bruxism in the area of the chin and temples. There are also a number of exercises that can help relieve muscle spasms; it is useful to repeat them regularly before bed. Relieve general stress: sleep enough hours, walk more in the fresh air, reduce the amount of coffee and strong tea, take relaxing baths with herbs, avoid anxious situations.

All this will help consolidate the results of complex professional treatment and forget about unpleasant symptoms.

The main stages of trismus

third - a person can open his mouth 10 mm, the most difficult stage;
second - the patient can open his mouth 10-20 mm;
first - the patient opens his mouth 30-40 mm, respectively.

In all cases, a person should immediately consult a doctor. You may need treatment in a hospital setting. In the process of clenching the jaw, there is a high probability of damage to the gums and chipped teeth. If help is not provided in time, oxygen starvation may occur.

Dental diagnosis of trismus involves:

visual examination of the patient;
to unclench the jaw, the dentist injects a drug that relaxes the muscles;
To make the diagnosis more comfortable for the doctor and patient, an anesthetic drug is also administered;
In addition to the dentist, you may need to consult a neurologist, surgeon, or traumatologist.