By Katie Barrer, RDH
Sleep bruxism can be brutal—for patients and for restorative work. Years of clenching and grinding can lead to jaw pain, broken fillings, crown failures, and a constant cycle of repairs.
Botox for teeth grinding is an effective option for patients who have not found relief with traditional treatments, offering a way to relax jaw muscles and reduce the impact of bruxism.
One of the most useful applications of Botox in dentistry is its ability to reduce the intensity of sleep bruxism, especially when injected into the masseter muscles. For many patients, this can mean less pain, fewer fractures, and better quality of life.
At the same time, we now know that sleep bruxism and obstructive sleep apnea (OSA) are often linked. That means dental teams need a thoughtful, airway-aware protocol before reaching for the syringe.
This article explores how Botox can help with bruxism, why OSA screening is non-negotiable, and how hygienists and dentists can use this modality safely and responsibly.
Note: This article is for dental professionals and is not a substitute for medical advice. Always follow your state’s scope-of-practice laws and collaborate with the patient’s physician or sleep specialist when OSA is suspected.
Bruxism, commonly referred to as teeth grinding or jaw clenching, is a widespread condition that affects millions of individuals across the globe. Characterized by the involuntary grinding or clenching of the teeth—often during sleep—bruxism can lead to a range of painful and damaging symptoms. Patients may experience persistent jaw pain, frequent headaches, and significant dental damage, including worn tooth enamel, chipped teeth, and even fractured restorations. The root causes of bruxism are multifactorial, with stress, anxiety, and sleep disorders frequently playing a role in its development. Left untreated, bruxism can compromise both oral health and overall quality of life. Fortunately, a variety of treatment options are available, from traditional approaches like mouth guards to innovative therapies such as Botox injections, which can help patients find relief from the pain and dental consequences of chronic clenching and grinding.
Botox injections have emerged as a highly effective treatment for bruxism, particularly for patients who struggle with jaw pain and persistent muscle tension. Botox, or botulinum toxin, is a neurotoxin that works by temporarily blocking the nerve signals responsible for muscle contraction. When precisely injected into the masseter muscles, Botox helps relax these overactive muscles, reducing the intensity of clenching and grinding. This targeted approach not only alleviates jaw pain but also helps protect teeth from further damage and can improve sleep quality by minimizing nocturnal muscle activity. The procedure itself is minimally invasive, typically performed in a dental office, and most patients begin to notice relief within two weeks. While Botox is generally well-tolerated, potential side effects can include mild bruising at the injection site or temporary changes in chewing strength. For many patients, however, the benefits—such as pain reduction and improved comfort—far outweigh these minor risks, making Botox a valuable addition to the bruxism treatment toolkit.
Botox (botulinum toxin type A) works by temporarily weakening overactive muscles. When precisely injected into the masseter (and sometimes temporalis) muscles, which are key jaw muscles involved in chewing and bruxism, and with the temporalis muscle playing a significant role in jaw movement and bruxism, it can:
Several randomized controlled trials and systematic reviews have found that BTX-A injections into the masseters can reduce bruxism-related pain and biting force, suggesting a role as a therapeutic option when conventional approaches (e.g., splints, behavioral modification) are not enough. PubMed+2ScienceDirect+2
Clinically, many patients report:
Botox injections into the jaw muscles, including the masseter and temporalis muscle, can help reduce grinding teeth and tooth grinding, leading to pain relief and improved jaw function.
When placed thoughtfully within a comprehensive treatment plan, Botox can be a powerful adjunct for bruxism management—not a standalone cure. Botox is also being explored as a treatment for temporomandibular disorders due to its effects on muscle hyperactivity.
Here’s where it gets more complex.
Research over the last decade has shown a frequent association between sleep bruxism and obstructive sleep apnea, though the exact causal relationship is still being worked out. OUP Academic+2BioMed Central+2
Some studies suggest that in certain patients, bruxism episodes may occur around respiratory events and might even play a role in helping reopen the airway by bringing the mandible forward. SpringerLink+1
What this means clinically:
As Dr. Allan Stein, a dentist focusing on sleep-disordered breathing, emphasizes: if a patient is bruxing as a response to poor oxygenation, Botox can help the symptom but does nothing to resolve the underlying airway issue. The takeaway: we must rule out or address OSA—not just silence the bruxism.
The good news: dental teams are perfectly positioned to screen for possible OSA and collaborate with medical providers.
Here are simple, chair-friendly tools and cues you can integrate:
The Epworth Sleepiness Scale is a brief, validated questionnaire that asks patients how likely they are to doze off in everyday situations. Higher scores indicate increased daytime sleepiness and a greater risk of sleep disorders, including OSA. Chest Journal+1
Your daily bread and butter:
While wear alone doesn’t diagnose OSA, significant, unexplained incisal wear combined with other risk factors (snoring, daytime sleepiness, weight, neck circumference) should raise your suspicion for sleep-disordered breathing.
The Mallampati score is a simple way to assess airway visibility by looking at how much of the soft palate, uvula, and oropharynx is visible when the patient opens wide and protrudes their tongue.
Higher Mallampati classes (III–IV) are associated with increased risk of OSA, and multiple studies have shown it can function as an independent predictor of OSA in sleep clinic populations. OUP Academic+2Sleep Foundation+2
Adding Mallampati scoring to your exam helps:
Train your team to ask about:
All of this builds the case for whether a medical referral or sleep study is appropriate before—or alongside—Botox for bruxism.
For many patients, Botox can significantly reduce the intensity of clenching and grinding by calming the overactive masseter muscles. A good candidate for Botox treatment typically experiences persistent jaw pain, jaw soreness, headaches, or dental damage from unconscious grinding, especially when these symptoms occur during sleeping or as part of nighttime bruxism or nocturnal bruxism. This often results in:
Botox is often considered when other treatments, such as mouth guards, muscle relaxation exercises, or behavioral therapy to reduce stress, have not provided sufficient relief. Other symptoms of bruxism that may improve with Botox include migraines and jaw soreness. Other patients may experience different side effects or responses to treatment, highlighting the importance of individualized care. The impact of bruxism on the jaws and the importance of jaw muscle relaxation are key considerations in treatment planning. Botox injections are carefully calibrated to avoid affecting facial expressions, preserving essential facial functions. Unconscious grinding is a common feature of bruxism, often occurring during sleep.
Because Botox is a noninvasive, fast, and low-risk treatment, more dental offices are offering it as part of a comprehensive solution for bruxism—especially when symptoms have not improved with night guards or behavioral therapies.
Effectiveness is commonly measured using VAS score and subjective evaluation, such as patient questionnaires. Some clinical trials have compared Botox to a placebo group or divided participants into two groups to assess outcomes. However, further studies are needed to confirm long-term safety, efficacy, and to standardize protocols for botulinum toxin use in dentistry.
However, appropriate training and screening protocols are essential. This is where the American Academy of Facial Esthetics (AAFE) plays a critical role.
While Botox injections offer a promising solution for many patients with bruxism, they are not the only option available. Traditional treatments such as mouth guards and occlusal splints remain the first line of defense for protecting teeth from the effects of grinding and clenching. These devices act as a physical barrier, reducing dental wear and helping to alleviate symptoms. Additionally, stress reduction techniques—such as cognitive behavioral therapy, relaxation exercises, and improved sleep hygiene—can address underlying triggers of bruxism. In some cases, combining these approaches with Botox injections can provide more comprehensive relief, especially for patients with severe or persistent symptoms. Each treatment has its own benefits and limitations, so a personalized approach that considers the patient’s unique needs and preferences is essential for effective bruxism management.
The standard treatment protocol for Botox injections in bruxism involves carefully administering the neurotoxin into the masseter muscles, which are primarily responsible for jaw clenching and teeth grinding. The number of injections and the dosage of Botox are tailored to each patient, based on the severity of their symptoms and the size of the muscles involved. The procedure is typically quick and well-tolerated, with most patients experiencing minimal discomfort. After treatment, patients are advised to attend regular follow-up appointments to monitor their progress, assess pain reduction, and determine if additional injections are needed. Side effects are generally mild and may include temporary soreness or minor bruising at the injection site. Ongoing evaluation is important to ensure that the treatment remains effective and to make any necessary adjustments, helping patients achieve lasting relief from the painful symptoms of bruxism.
Even though Botox can dramatically reduce bruxism symptoms, underlying airway issues must be considered. Some patients grind because their airway is compromised during sleep, and their body is attempting to stabilize it.
Dentists and hygienists are uniquely positioned to identify these patterns because they see the oral consequences firsthand.
The combination of:
creates a safer, more effective treatment path. AAFE’s training programs emphasize this full-picture approach—so clinicians don’t treat symptoms in isolation, but integrate esthetics and function.
Although many healthcare providers can treat bruxism, dentists are often the first clinicians to recognize its tell-tale signs:
Because dentists see these indicators every day, they are uniquely positioned to incorporate Botox injections as a therapeutic tool, alongside splint therapy, occlusal adjustments, and referrals when necessary.
AAFE’s curriculum is tailored specifically for dentists and dental teams, teaching them:
For dentists already diagnosing bruxism routinely, adding Botox is a natural extension of their existing clinical expertise.
AAFE is the leading provider of facial esthetics education for dental professionals because its programs go far beyond teaching injection points—they teach:
For bruxism specifically, AAFE training equips clinicians to:
This allows dentists to expand their skill set, improve patient comfort, and create new revenue streams—all while elevating the standard of care.
Because regulations vary by state, the authority to perform Botox injections depends on specific scope-of-practice laws. In many states, dentists are among the primary professionals permitted to administer neurotoxin injections.
Dentists who receive appropriate training—especially through organizations like AAFE—are well-positioned to lead the charge in providing comprehensive care for bruxism and jaw-related pain.
Other providers may administer Botox depending on state laws, including physicians and nurses, but dentists hold a uniquely relevant perspective because they manage the functional and anatomical consequences of bruxism daily.
Botox administered by a trained dental professional offers patients:
When delivered as part of a thoughtful, team-based approach supported by AAFE education, it becomes a powerful, patient-centered therapy that enhances outcomes and builds trust.
Katie Barrer, RDH, is a certified esthetic injector. She elevates her traditional hygiene skills by integrating Botox and dermal filler into her practice, viewing them as essential components to enhance patients’ self-assurance and improve their overall dental health and function. She is a faculty member of the American Academy of Facial Esthetics and looks forward to contributing to the evolution of dental hygiene by educating other hygienists and health-care professionals. The number of dental professionals offering botox treatments has increased significantly, and practicing within the legal scope is essential. Follow her on instagram @theRDHinjector or email katieb.rdh@gmail.com.
