Teeth clenching, grinding and myofascial facial pain
Specialist assessment and treatment of bruxism and the muscle pain it causes in the jaw, face and temples.
The problem
Bruxism is clenching or grinding the teeth, usually during sleep and often without knowing it. Over time it overworks the muscles that close the jaw, and the result is a characteristic pattern: an aching jaw or temples on waking, tenderness in the cheek muscles, headaches, worn or cracked teeth, and sometimes earache or a feeling of the bite not meeting properly. Pain that comes from the muscles rather than the joint is called myofascial pain, and it is one of the commonest causes of facial pain that Chris sees.
Stress, poor sleep, some medicines and certain habits all make it worse. Many people have had their teeth, sinuses and ears checked and been told nothing is wrong, which is true but not helpful. The pain is real and it has a cause.
Assessment
Chris will take a careful history, examine the jaw muscles and joints, look at the pattern of wear on your teeth and check for other causes of facial pain that need to be excluded. Scans are not usually needed. The aim is a clear explanation of what is happening and why, which for many patients is a large part of the treatment.
Treatment
Treatment starts with the simplest measures. A properly made bite splint (night guard) worn during sleep protects the teeth and reduces muscle activity for most people. Chris will also go through jaw exercises, habit changes and help with sleep and stress where they are contributing, and may recommend a short course of medication to break a cycle of muscle spasm.
For patients whose pain persists despite these measures, Chris offers injections of botulinum toxin into the jaw‑closing muscles (the masseter and temporalis). This weakens the muscles enough to reduce clenching and pain without affecting normal chewing or speech, and the effect lasts three to four months. It is done in the outpatient clinic and takes a few minutes.
Do I definitely need treatment?
Not necessarily. Chris will first establish whether treatment is needed at all and whether there are reasonable alternatives to surgery. He may recommend leaving things alone when:
- the pain is mild and a properly made splint, exercises and changes to sleep and habits are enough
- a period of stress is the obvious trigger and the symptoms are already easing as it passes
- the pain is coming from somewhere else, such as the teeth, sinuses or a nerve, which needs different treatment
What does the next week look like?
A typical recovery. Yours will be discussed with you individually before you decide to go ahead.
- That evening
- After botulinum toxin injections, nothing beyond a few tiny marks. Normal evening.
- Day one
- Normal. Avoid rubbing the area.
- Days 2 to 3
- Normal. The muscles have not weakened yet.
- By one week
- The effect begins between one and two weeks. Chewing very tough food feels weaker; speech and smile are unaffected.
- Practicalities
- Driving
- Same day.
- Work
- Same day.
- Eating
- Normal. Steak and crusty bread take more effort for a few weeks.
Chris's view
"Once someone understands that their headaches, their tender jaw and their worn teeth are all one problem, they're halfway to fixing it. The splint does most of the rest. Botox is for the ones it doesn't reach."
Mr Christopher VinallWhen should I get advice?
Arrange an assessment if you wake with an aching jaw or temples, if your teeth are worn, chipped or sensitive without an obvious cause, if you have frequent tension‑type headaches, or if a splint from your dentist hasn't helped.