5 days post-op, is it abnormal to switch to "front teeth clenching" after Botox injections in masseter?

Question

It has been 5 days since my first botox treatment for TMJ/Masseter hypertrophy (20 units each side). After the first day I felt immediate reduction in clenching my molars, however as the days progressed to today, I've noticed I am clenching with my front teeth now (moving mandible a little forward and pressing bottom teeth to back of front teeth). Is this compensation going to minimize treatment effects of the botox I received and should I go back for more? if so, how much more?

Alexander Rivkin, MD · Answer

Hi and thanks for your question. Yes, sometimes areas surrounding the Botox treatment will engage to compensate for the reduction of movement. This is a temporary condition and will gradually improve. To speed up improvement, you may need some more Botox in the massters. How much will depend on how strong the massters feel at 2 weeks after your first injection. This is the time when Botox is most active.
Keep in mind, it will take a series of treatments to break the habit of teeth grinding. Most people will start seeing a change after the first session and after the second one it will be really significant. After a few sessions there is a good chance that you can stop and not need further injection. Most people have enlarged masseters because they have a habit of clenching and grinding their teeth from stress. 3 or 4 Botox sessions spaced about 3 months apart can break that habit. The bonus is that any headaches, neck pain or jaw pain you experience from grinding or clenching will also disappear. Hope that helps.

Jason Emer, MD · Answer

Yes, sometimes surrounding areas will engage to make up for the lack of movement (in this case reduction in clenching) in the treated area. Botox results resolve in 3-4 months. Best, Dr. Emer

Prashant Murugkar, MD · Answer

hi, sorry to hear of your problem, I personally think that this might just be a transient adaptation to the injection, 20 units on each side is the average dose and you will find that over the next few weeks it will settle down, you should keep your next appointment with your doctor to allow him/her to evaluate your results. hope this helps, do keep me posted of your progress, warm regards Dr Prashant Murugkar

Leonard Grossman, MD · Answer

There are two groups of muscles that affect chewing. One is the masseter and the second is the temporalis muscle. When the masseter muscle is being injected with Botox your clenching should become considerably weaker. What you're seeing is more of a conscious effort to use your front teeth as it is not the masseter muscle that is controlling the front teeth. Good luck from New York City

5 days post-op, is it abnormal to switch to "front teeth clenching" after Botox injections in masseter?

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