Adulthood, to me, isn’t defined by securing that prestigious dream job, getting married, or having children—no, I believe you truly become an adult when all your conversations begin with “I slept horribly last night.” Using that benchmark, I’ve been an adult since I was at least 27 years old, and over the past five years, I’ve tried a lot of tricks in pursuit of quality sleep.
These solutions are often just that—tricks, which might give you a few nights of relief (if you’re lucky). My short-lived quick fixes have included melatonin-spiked gummy vitamins; CBD, in all its iteration, blackout curtains; multiple weighted blankets; and endlessly looping tracks of whalesong. But as a seasoned beauty editor, I was stunned when two quick injections of Botox turned out to be my savior, giving me two months of blissful beauty sleep.
For the uninitiated, Botox and neurotoxins like it don’t solely smooth wrinkles, though it’s this property that motivated me to get injected in the first place. The treatment works by blocking nerve signals to the injected area, temporarily preventing muscle contractions. When I got injected in my forehead, Botox inhibited my ability to raise my eyebrows, thus preventing the skin in that area from folding and wrinkling. That’s not what improved my sleep (just my selfies!)—it was getting treated with Botox in my jaw muscles that helped combat a root cause of my poor slumber: bruxism.
What is bruxism?
Bruxism is the formal term for teeth grinding and clenching (“bruxing”). Some people do it during the day, some do it at night, and of course, plenty of people do both. It’s particularly common among children, and while many of them grow out of it, it’s believed that 10% of American adults have bruxism. However, that number is an estimate, as not everyone knows they’re suffering from it, especially sleep bruxers. (I’ve always clenched during the day, but only realized I was also doing it at night when I started using invisible aligners.) And it’s sleep bruxism that can cause serious issues.
“I would argue bruxism is a sleep disorder, since it’s a behavior that is not normal during sleep,” explains Michael Breus, Ph.D., a Los Angeles–based clinical psychologist also known as The Sleep Doctor. “The jaw clenching and movement will force the brain to stay in a lighter stage of sleep … thus people will often report being sleep-deprived.”
If left untreated, bruxism can lead to temporomandibular joint syndrome (TMJ) and continued tooth damage—Breus notes that dental stress fractures are quite common—but the sleep deprivation it causes can lead to even more health concerns. According to the division of sleep medicine at Harvard Medical School, studies show a correlation between poor sleep and a risk for chronic diseases, including diabetes and heart disease, and mood disorders like depression and anxiety.
And here’s the catch-22: poor sleep can lead to depression and anxiety, yet Breus points out that these mood disorders and stress can also cause bruxism (though it can also be a side effect of some medications or a symptom of sleep apnea). “I would argue bruxism is an extension of anxiety,” he says. Even more frustratingly, teeth grinding is worsened by sleep deprivation.
When I asked if it were possible to train oneself out of this problematic teeth clenching, he pointed out that less stress would result in less bruxism—so chill out, basically. Easier said than done, especially after the year we just lived through. And while I work hard at being less reactive to stress while I’m awake, all bets are off once my subconscious takes over, after dark. The most common treatment for bruxism is a bespoke mouthguard to wear overnight, but another popular treatment—Botox injections—directly addresses the muscles responsible for the grinding.
How do Botox and other neurotoxins treat bruxism?
Here’s an exercise: bite down firmly, then place your fingertips along your jawline. As you get to know the area, clench your teeth and release. You may feel a pair of muscles bulging and relaxing about an inch up from the “corner” of your jawbone, approximately an inch toward your nose from your earlobe. These are your masseters, the muscles responsible for mandibular tension and the area injected when treating bruxism.
“Any and all bruxism can be treated with neurotoxins,” explains Dr. Ava Shamban, a board-certified dermatologist based in Beverly Hills, California. “Once the muscles are blocked, grinding, clenching, and pressure will resolve, to an extent.” If you’re suffering from pain and soreness in your teeth from your bruxism, you’ll experience relief as your neurotoxin kicks in.
But isn’t masseter Botox an aesthetic procedure, not a therapeutic treatment?
Actually, getting neurotoxin treatment in this area packs a fabulous one-two, therapeutic-cosmetic punch. It just goes by another name in the aesthetics world: masseter reduction. “Ongoing grinding and contractions build muscle, often giving a larger, more square jawline,” Dr. Shamban explains. “Debulking the area [with neurotoxins] gives way to a more oval shape.” However, if someone thins out these muscles but also has some skin laxity and a naturally weaker jawline, it could lead to facial sagging. This cosmetic aspect is why not everyone is an ideal patient for masseter reduction; a trained provider will be able to determine if you’re a good candidate.
The risk of lower-face laxity is just one of the many reasons it’s worth seeing a board-certified doctor for treatment. After all, if you’re pursuing masseter reduction for a slimmer-looking jawline, you don’t want to risk potential jowls. Plus these muscles play an essential role in your everyday life. “When injecting neuromodulators that affect movement, animation, speaking, and eating, it is important to be injected by an expert so any untoward results can be avoided,” says Dr. Yoon-Soo Cindy Bae, a board-certified dermatologist in New York City. Dr. Shamban agrees, adding, “There is the product [neurotoxin] and then there is artistry, which can be 60–70% of the outcome. Choose well.”
Are there other risks associated with masseter Botox?
There’s always the possibility of risk when you sign up for an injectable treatment, and there are currently no neurotoxin brands that have received FDA approval for masseter treatment. For that reason, some providers opt not to inject certain areas. Dr. Dennis Gross, a New York City board-certified dermatologist, doesn’t treat masseters at all. “It is a blind shot,” he warns. “There is no way to actually see the muscle, and there is no way to tell how deep the needle should go.” If the needle goes too deep into the muscle, it can push the muscle outward, into a bulge—typically the size of a walnut and up to the size of a golf ball—that can’t be corrected and will go away only once the neurotoxin wears off.
Additionally, Dr. Bae shares, there are animal studies that demonstrate bone loss when treating masseters with neurotoxins, particularly when used in higher doses. “The muscle activity is needed for bone remodeling,” she explains. Over time, mature bone tissue naturally is reabsorbed by the body, making way for new bone tissue. It is possible that long-term neurotoxin treatments in the masseters could result in weakened bone density in the jaw, but further studies are needed.
That said, it’s not necessarily unsafe to get masseter injections or Botox for teeth grinding—it’s just understudied. The treatment is also extremely popular: Dr. Bae and Dr. Shamban cite it as a common request in their respective practices, with both men and women booking the appointments. “Some [want it] for pain, some for protecting their teeth, and some for the aesthetic appearance that has been altered by bruxism—and some for the trifecta, naturally,” says Dr. Shamban, adding that “the risks associated with any neuromodulators, injected properly, are relatively low overall. This area is no exception.”
