In a competitive society, now furthermore stressed by a global epidemic, patients feel the tension. Some patients might react with grinding their teeth. Severe grinding might lead to extensive damage to teeth as well as facial pain. The origin for grinding lays in an hyperreactive masseter muscle.

The most effective treatment for hyperreactive muscles – is botulinum toxin – the great muscle modulator. So far, the evidence for the treatment of grinding with botulinum toxin is limited to small studies and a couple of systematic reviews summing up these studies. However, the evidence looks encouraging.

With Caucasians, in my experience, 50 units of abobotulinumtoxinA or 25 units of onabotulinumtoxinA per masseter will be sufficient. The masseter muscle can be easily identified when the patient clenches the teeth. In skinny patients, it may show as a bulge; in not-so-skinny patient, it can be easily felt by touch. The key tip here, of course, is that injections should be done in a relaxed muscle.

I usually distribute the toxin in three triangular injection point, with the base points above the jawline – using my standard 33 Gauge needle. Please note that the relief of the symptoms does not occur immediately but needs a couple of weeks. The treatment needs to be repeated when the grinding starts again. In the first years, approximately two to three injections per year are sufficient. Most patients already express an alleviation as they experience less tension, and some of them even do not need to wear occlusal splints any more.

As grinding is not a symptom frequently shared with a treating dermatologist, aesthetic physician or plastic surgeon, it might be often overlooked. So, we should include a question on grinding when we do see our aesthetic or dermatology patients specifically in those with an already visual hypertrophic masseter. Trust me, patients will be extremely grateful.