Teeth Grinding/Jaw Pain

Sometimes, large masseters are caused by Bruxism, which is the involuntary or habitual grinding of the teeth, typically during the night. This will cause the masseters to enlarge and if left untreated can cause TMJ dysfunction and orofacial pain. Bruxism is often associated with stress.

History-taking is very important in the treatment of the masseter muscles. The following should be explored:

• Is the patient suitable medically for treatment?

• Is there a genetic component?

• Has the patient had treatment before? Were they satisfied with the results?

• Did the effect of the treatment last well?

• Has the patient ever had any complications with this treatment before?

• What is bothering the patient (i.e appearance of a wide face, headaches related to jaw clenching, TMJ dysfunction or orofacial pain.)

• Does the patient have Bruxism (teeth grinding)?

• Is there additional involvement of the temporalis muscle?

• What is the age of the patient?

Dr Gemma will examine the face, jaw and neck. In particular, she will look at many features, such as:

• Position of the masseters, size of the masseters and shape of the jawline

• Any asymmetry

• Elasticity of the skin

• Feel the size and shape of the masseters and temporalis muscles by getting the patient to chew/clench while touching the masseter and temple area

Dr Gemma will assess the face and neck and decide on the best dose for treatment. If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested.

If the patient is older in age, or has less elastic skin, then a treatment plan involving multiple treatments of smaller doses may be required.

If a patient has a history of complications with treatment, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen.

It is important to remember that follow up appointments are very important in determining if dose adjustment is required, and it is common to need a few treatments to determine the correct dosing for that patient.

There is very little pain with masseter treatment. Some people complain of a sharp sting that resolves very quickly. The feeling is the same as treatment in other parts of the face.

• Dr Gemma will take a history and perform an examination

• The area for treatment will be marked

• The face will be cleaned with alcohol swabs

• Dr Gemma will treat both sides

• Pressure with gauze may be applied if there is any bleeding

• The procedure itself takes less than 10 minutes

In general, treatment of the masseters is low risk. Most people could have treatment during their lunch break and return back to work without their coworkers noticing. Some of the risks include:

• Headache

• Bleeding, bruising, or mild swelling

• Infection (uncommon)

• Allergic reaction (uncommon)

• Uneven masseter slimming: one side can be better treated than the other, usually because the patients muscles are asymmetrical to start with. Some patients they have a stronger masseter on one side compared to the other (often the side that is favoured for chewing). This may need to be corrected at the follow up apppointment.

• Muscle droop: There is a low risk of injecting into a nearby muscle, causing drooping of that muscle. This could result in asymmetry of the smile or loss of extreme smiling.

• Jawline sagging: If too high of a dose is chosen in older patients, and the skin isn’t as able to retract as quickly, sagging along the jawline (increase appearance of jowls) can occur. To avoid this, multiple smaller treatments are recommended to achieve the result more slowly.

• Pregnant/breastfeeding or those trying to conceive

• Myasthenia gravis or Eaton Lambert Syndrome

• Allergies to ingridents in the product used

There will be no effect immediately after treatment. The effect of the injections will start to occur in 2-7 days. Pain relief may start to be noticed from 1-2 weeks post treatment. A review is usually booked at the 2-4 week mark. If at that time, further treatment is necessary, it can be performed.

We need to wait until the treatment has reached its peak effect to determine the effect on jaw clenching/pain/headaches.

Results will always be best with masseters after multiple treatments, as this allows the masseter muscle to atrophy (shrink).

These issues are not uncommon. At your 8 week review appointment, further treatment may be administered if further improvement is wanted by the patient. This will incur the same price per unit fee. Dr Gemma will first have to assess if further improvement is possible.

The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement, and the strength of the masseters.

Typically:

• At 8 weeks, there is a maximal effect

• At 16 weeks, 80% of movement should be back

• Most people have re-treatment around the 5-6 month mark

Second treatment should be at the 2-4 week mark if the patient requires more product. Second treatment should be at 3-4 months if the patient is happy with the result. Ongoing treatments are usually 6 monthly from there.

With regular treatment of masseters over time (~2 years), many patients find that they do not need their treatments as regularly and do not require as high doses (usually requiring treatment every 5-6 months)

Pricing for jaw pain/teeth clenching will be determined and discussed during your appointment. With larger doses the cost increases. If smaller amounts are required then the price will be lower. Maintenance after 2 years of regular injecting may result in lower dosing being required and therefore lower costing.

• Do not apply makeup for at least 4 hours

• No massaging or applying pressure to the area for minimum 4 hours (ideally 24 hours)

• No heavy exercise for 24 hours

• No drinking alcohol for 24 hours

• No lying down for 4 hours

• Avoid acid containing products on the face/neck for 24 hours

• No swimming in pools or the ocean for 24 hours