botulinum toxin injections for bruxism

BRUXISM AND BOTOX

bruxism

Bruxism is a phenomenon of repetitive involuntary contractions of masticatory muscles without food goal. It can be treated by injecting botulinum toxin. These contractions may cause different movements of the jaws relative to each other such that:
– tightness
– squeaks
– tonic movements
– advanced movements / Reversing the lower jaw

These movements are diurnal and / or nocturnal and of varying intensity. Bruxism is present in 20% of adults with a female predominance. No obvious cause could not be found. However bruxism has been associated with several factors: restlessness, anxious personality, smoking, and coffee and alcohol.

dental consequences

The stresses exerted on the teeth by bruxism lead to several types of dental injuries:

dental abrasions

llustration 1: Dental abrasion with greater height loss of the upper dental arch

Les abrasions (illustration 1), Which are predominant in case of gnashing. This is the wear of the enamel of the occlusal surface of the teeth. The teeth become worn and decrease in height.

 

 

 

Illustration 2: Abfractions hémiarcade the upper right (sector 1)

The abfractions (illustration 2) are they, more frequent in patients with a static bruxism: clenching teeth without grinding. They correspond to a loss of tooth substance at the tooth neck. The pathophysiology of abfractions reported a demineralization of vestibular dentin related to micro fractures consecutive compressive stress on the teeth.

 

 

Any enamel lesion showing dentin exposes the same dentine caries risk (dentin is softer and weaker than enamel to bacterial attack leading to tooth decay). In addition to dental lesions, mechanical stress of bruxism lead to prosthetic destruction: loss amalgam, loosening of prosthetic crown ...

Sometimes you evoke bruxism patients regularly with problems molars and to a lesser extent the premolar problems (loss of fillings, unsealing crown…).

otherwise, stresses on the dental arches can create pain mimicking dental organ damage by search without success caries and other infectious attacks.

muscle consequences

Bruxism is the result of the contraction of different muscles. The most used are: the masseter muscles, temporal and medial pterygoid. To a lesser extent the lateral pterygoid also solicited.
The muscles become sore and tense. Patients have sometimes confused with temporal muscle pain temporal headaches. Pain and masseter stiff feel are also regularly found in bruxism patients.

muscle masseter et muscle temporal

Muscle masseter et muscle temporal

These symptoms disrupt the normal functions of chewing and speech. Because of these intense stress, muscle hypertrophy giving a result of square jaw can be unsightly.

joint consequences

The temporomandibular joint (TMJ) united the mandible to the skull. It ensures the movement of the lower jaw relative to the upper jaw.

articulation temporo-man-dibulaire, locating and cutting

Articulation temporo-man-dibulaire, locating and cutting

The consequences of bruxism are multiple on ATM, they are especially harmful to the patient's daily life that it is one of the most used joint in the human body.

Premature organic achievement of ATM started mostly by rupture of the posterior brake. This leads to a forward movement of the articular disc, it is then left in position pathological causing cracking at the joint possibly associated with a restriction of the mouth opening.

Then the disc fragments and may be expelled in front of the joint by contacting the cartilage surface of the mandibular condyle and the glenoid temporal. The articular cartilage surface is very thin they come to wear which leads to osteoarthritis of the TMJ.

Pain or dysfunction of this joint necessarily have a functional impact:
– limitation of mouth opening,
– difficulties and pain when chewing hard food,
– speech disorder during severe attacks.

Bruxism may be perfectly unconscious and only its consequences can be symptomatic.

Diagnostic du bruxism

The current diagnosis of bruxism is usually based on indirect elements namely highlighting the consequences of bruxism. Ringer donc de bundles of arguments here associés vont driving to the suspicion of bruxisme et en aucun cas une preuve directe affirmer inflation and the explorer bruxisme Wahrheit qualitative and quantitative. These arguments are: muscle and joint pain with functional disorders, dental injuries abrasions, abfractions, dental prosthetic elements regularly damaged or loosening of prosthetic crowns.

Treatment and management of bruxism

Ideal for treating a disease is to remove the cause. Having said that due to the very psychological and chronic nature of the case it is very difficult to remove the causative psychological factor of bruxism.

However, it is possible in some cases significantly reduce the stress factor in some patients by offering sports type methods, meditation relaxation therapy. This may in some significantly reduce pain due to bruxism.

Physical therapy can reduce muscle and joint pain. Rehabilitation helps recondition the patient not bruxer day. That said it does not reduce sleep bruxism.

drug treatments are largely symptomatic. They are effective against pain in the early stages of muscle and joint damage. However they do not reduce muscle contractions, it is painkillers, anti-inflammatory and muscle relaxants.

Botulinum toxin

The most effective treatment for bruxism is based on the partial paralysis of the masticatory muscles with botulinum toxin. This toxin is injected percutaneously at the masticatory muscles.

In most cases the injected muscles are: the temporal and masseter. These injections depending on the dose used to significantly reduce the strength of these muscles. This does not remove the muscle contractions but significantly decreases the intensity which reduces the effects of bruxism. The injection is performed as an outpatient. When injected, the toxin will spread into the muscle and its effect will be felt within 2 at 15 persist for days on average 4 at 8 month.

This treatment has no marketing authorization (Regulatory Affairs) in France for this indication but many national and international scientific publications confirm its effectiveness. The treatment has an average efficiency 4 at 6 months since the action of botulinum toxin is completely reversible after this period. The injections can be repeated if symptoms reappear embarrassingly. Most of the time patients require 2 sessions of injections per year and as they feel the need.

A post-injection monitoring consultation is essential, it ensures good treatment efficacy and good evolution suites.

The risks

Any medical procedure, very well led, harbors a risk of complications. Do not hesitate to contact the surgical team that took care of you, or clinical emergencies or contact 15 in case of serious emergency.

– In the suites injections can be difficult to chew hard food. This is not serious and completely reversible in some months. This proves that Botox works. On the other hand it may be that the dose injected is insufficient and therefore only partially relieves the troublesome symptoms. It will be necessary to raise it at the next session of injections.

– As the jaw muscles contract less in response to botulinum toxin, their volume may decrease. This may alter the facial refining it at the angles of the jaw and decreasing the volume of the temples muscles.

– Because the toxin is administered by intramuscular injection dissemination can extend to other muscles than those targeted. Thus the toxin may act on other muscles of the face and especially those of the smile. Fortunately this effect is rare and transient and regress completely within months.

– As with every drug there is an allergy risk. This can sometimes require monitoring after injections.

– It should not be practiced rap distances immediately injection under 3 months subject to risk a vaccine effect leading to the production by the patient of antibodies against the botulinum toxin rendering it ineffective for the following injections.

– Botulinum toxin is injected within muscles. As these are richly vascularized it is possible that a hematoma develops there. This normally very rare complication is more common in patients with disorders of blood clotting. Most of the time these hematomas resolve spontaneously without sequelae.

In total, should not overstate the risks, but just be aware that a medical procedure, even seemingly simple, still a small share of hazards.