Do you wake up with a stiff jaw or a headache? On this page you can calmly read what bruxism is, how it develops and what options are available.
The complaint
De klacht
Bruxism is the unconscious clenching or grinding of the teeth, often at night during sleep, but sometimes also during the day with tension or concentration. Many people only notice it through the consequences: a painful or tired jaw on waking, headaches around the temples, sensitive teeth or a partner who hears the grinding. The chewing muscles, especially the masseter on the side of the jaw, are heavily loaded. If you recognise this, it makes sense to have the cause and the consequences calmly examined.
Mogelijke aanpak
When the chewing muscle is persistently overloaded, a targeted treatment with botulinum toxin can be considered. A small amount is then injected into the masseter muscle, which can reduce the force with which you clench and grind and give the muscle more rest. The effect is temporary and lasts on average about 3 to 6 months, after which the treatment can be repeated. Whether this is suitable for you depends on the cause and is assessed during a consultation.
Botulinum toxin addresses muscle force, not the underlying cause such as stress or a sleep disorder. That is why I always look at bruxism more broadly and refer back to the dentist or GP where needed.
Teeth grinding usually happens unconsciously, especially the nighttime form. The symptoms you feel during the day are often the first sign. Think of a tired or stiff jaw when you wake up, a dull headache around the temples, ear pain without an ear infection, sensitive or worn teeth, and sometimes a clicking or painful jaw joint. A partner who hears the grinding at night is also a common sign.
There are two forms. Sleep bruxism happens during sleep and is hard to notice yourself. Daytime bruxism is more often linked to tension, stress, or intense concentration, where you clench your jaws without realizing it. Both forms can occur together.
Bruxism rarely has a single cause. It is usually a combination of factors. Stress and tension play a role for many people, as do sleep quality and sometimes an underlying sleep disorder. The position of the teeth and bite, certain medications, caffeine, alcohol, and smoking can also contribute. Because the cause differs from person to person, a proper assessment is more important than immediately reaching for a treatment.
Occasional clenching does not need to be treated right away. An assessment is useful when the symptoms persist or keep coming back, when you regularly wake up with jaw pain or headaches, when your dentist notices wear on your teeth, or when the jaw joint becomes painful or starts clicking. In those cases, it is good to look together at what is going on and which approach suits you.
There is no single solution that works for everyone. Often the least invasive options are tried first, and from there you look further.
These options are often combined. A bite splint protects the teeth, while treatment of the chewing muscle can reduce the force itself.
Botulinum toxin is a substance that temporarily slows the signal transmission from the nerve to the muscle. For bruxism, a small amount is injected into the masseter, the large chewing muscle on the side of the jaw. The muscle then contracts less forcefully, so you usually grind and clench less hard at night and the jaw gets more rest. The underlying tendency to grind does not disappear, but the load on the teeth, jaw, and muscles can decrease.
The effect comes on gradually, usually within a few weeks, and lasts on average about 3 to 6 months. After that, muscle strength returns and the treatment can be repeated. The treatment itself is short and usually no anesthesia is needed.
Treatment of the chewing muscle can be useful for persistent, bothersome grinding or clenching linked to an overloaded masseter, especially when a bite splint and attention to underlying factors do not provide enough relief.
Botulinum toxin is not the right choice when the symptoms mainly come from an untreated sleep disorder, from a dental or joint problem that needs to be addressed first, or when occasional clenching does not yet cause real complaints. The treatment is also not used during pregnancy or breastfeeding, with certain muscle and nerve disorders, or with a known allergy to the substance. During a consultation, it is checked whether there are reasons to avoid it.
Everything starts with a conversation. You are asked about your symptoms, your sleep, possible stress factors, and what your dentist may have already found. The chewing muscles are assessed and it is looked at which approach suits you. Sometimes that means first a bite splint or a referral, and not immediately an injection.
If it is decided together to treat the chewing muscle, this is done with a few small injections into the masseter. The treatment is short and you can usually resume your daily activities afterwards. After a few weeks, the effect is evaluated and it is looked at whether and when a repeat makes sense. What a treatment costs is discussed during the consultation.
As with any medical treatment, there are possible side effects. Around the injection site, temporary mild tenderness, redness, or a bruise can occur. Because chewing force decreases, chewing hard foods may feel a bit more tiring in the first weeks. Rare and usually temporary are an asymmetrical feeling when biting or a change in facial contour. These effects are discussed beforehand so you know what to expect.
Treatment with botulinum toxin is one of the options, not a mandatory step. A bite splint or mouthguard through the dentist remains an important foundation, especially to protect the teeth. When stress or sleep play a role, addressing those factors can reduce symptoms. For dental or joint problems, an assessment by the dentist or GP is the right first step. Which combination makes sense for you depends on your situation and is discussed during a consultation.
Dr. De Smedt explains
The masseter is one of the strongest chewing muscles and, with bruxism, works in overdrive for long periods at night, often without you noticing. By giving the muscle some targeted rest, the force with which you grind and clench can decrease, and the load on your teeth and jaw joint goes down. Important to know: this reduces the force, not the cause. That is why I always look at the whole picture first, and work together with your dentist or GP where needed.
Dr. Thierry De Smedtaesthetic doctor, Ghent
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