Treatment of Bruxism by Injection of Botulinum Toxin into Trigger Points: Practical Guide and a New Technical Procedure for an Effective Result

Objectives: Bruxism is a debilitating condition that causes pain and damage in the stomatognathic system. Although botulinum toxin is recognized as effective in treating bruxism, it is still reserved for severe cases. To date, injection methods and procedures are not standardized, unlike cosmetic uses, leading to divergent results. This report aims to exhibit a novel technical injection and procedures that allow effective and efficient treatment of bruxism while highlighting its analgesic and anti-inflammatory effects. Methods: Toxin injections were applied to masseter muscle in trigger points to 67 patients, enrolled between 2009 and 2015, suffering from awake and sleep bruxism. All patients regardless of the duration of bruxism, their injection depended on the number of trigger points, performed in the same way in each session until full recovery. Descriptive statistics were performed to analyze the data using SPSS software. Results: Two groups of patients were individualized, G1 (bruxism duration of more than one year with previous use of occlusal splint) and G2 (recent bruxism without prior therapy). Patients in group G1 required more injection sessions and higher doses of toxin than patients in group G2 (p<0.01). The number of trigger points was also greater in group G1. As injection sessions progressed, the recovery time lengthened over time. Conclusion: This study validates our injection method and procedures using botulinum applied into trigger points and demonstrates its effectiveness at an early stage of bruxism at first-line therapy. The persistence of trigger points worsens bruxism, and injections must therefore be performed in these areas.