Bruxism is called the contraction of the lower jaw that leads to clenching, grinding of teeth on a permanent basis and without being aware of it. Bruxism can occur at night during sleep, so sounds may be perceived during sleep by the patient's partner. The patient may wake up in the morning with a feeling of tightness or even pain in the corner of the lower jaw (in the chewing muscles). It can also happen during the day (more common in women) and the patient may permanently feel a tension in the lower jaw. However, in both cases, at the latest with a visit to the dentist, who will detect damage or even cracks in the teeth, the diagnosis will be made. These patients show an "angulation" in the lower jaw, which makes their face look more severe.
Bruxism can affect up to 20% of adults (mainly women) and the percentage is even higher in children.
Causes of bruxism are daily stress or generalized anxiety, prolonged physical fatigue, sleep disorders (such as apnea and snoring), smoking, alcohol consumption, use of SSRIs (i.e. a specific class of antidepressants), excessive caffeine consumption and drug use (mainly cocaine).
The mechanism by which bruxism occurs is not fully understood. In recent years, neurology has been interested in this symptom, because many neurological diseases coexist with bruxism (such as migraine). Motor neurons in the brain stem, the cerebellum (a central structure responsible for balance!) but also motor and sensory areas of the cerebral cortex seem to participate in the matrix of bruxism. Therefore, damage to these areas or their overstimulation may cause bruxism. In migraine, a neurological disease in which we have this "sensitivity" in almost the entire brain, it is not uncommon for bruxism to coexist.
Thus, it came to our attention that many migraine patients, if asked, report the symptoms of bruxism many times without themselves having associated them with migraine. This relationship becomes even clearer with the finding that both bruxism and chronic migraine respond very well to the injection of Allantic toxin type A (the well-known Botox). To be more clear: in adult patients with chronic migraine who we administer Botox to various parts of the head (in the forehead, temples, base of the skull and neck according to an international protocol) if we make only two additional injections (one on the right and one on the left in the masseter muscle) in the lower jaw - in those who report bruxism - the results are better for both migraine and bruxism. Several times, patients report greater improvement in the symptoms of bruxism in relation to the pain of migraine.
Botox is injected into the masseter muscles above the angle of the lower jaw on the right and left (see figure). Because the masseter muscle is a large and deep muscle, the injection is completely painless. Whether in patients who have migraines or in patients who do not have migraines (where the injection is only made into the masseters), Botox, in our opinion, is the only solution to bruxism. Any medication or the special “bites” that are administered are not effective and are often not tolerated by patients. On the other hand, botulinum toxin type A is a completely safe solution, acts locally and can be repeated every 3 – 4 months.
