What is the Normal Dose of Botox for Bruxism?

I just got 20 units in each masseter and 10 units in each temporallis muscle. My first dose was 2.5 months ago, which was only 10 units in each masseter, and it did not improve my symptoms. I am just nervous of this does maybe being too much and then having some negative side effects like, jaw hanging open, can't chew, trouble swallowing, etc. In your experience, has this dose ever caused this?

Doctor Answers 4

Botox masseter dosing

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Thank you for your question. Botox in the masseter region usually takes longer than in the standard areas to take effect. I tend to use anywhere from 15 units (conservative treatment) to 50 units (for someone with really strong masseters) on each side to get the desired result. It may start within the first week but I tell my patients to wait three weeks before doing a more thorough evaluation. The treatment typically lasts longer than the forehead/crows feet/frown regions. It is also a gradual onset of the return of masseter function. I have tried the masseter injections myself and space the treatments around 4 months apart, but use smaller doses to maintain the effect. I normally know the effects are wearing down when I start to clench my teeth more heavily at night when asleep. Once you stop using Botox, the masseter muscles will return to their original baseline when the effects of Botox wears off completely.

Botox and grinding

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Different doctors use different doses of botulinum toxin for teeth grinding or bruxism. It is better to increase the dose gradually and that is what your doctor is doing. Some patients may need more than you. Fortunately the side effects you mention are unusual at normal doses.

The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs


Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox For Bruxism

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The typical dose is 20-30 units per side. It sounds like your doc is proceeding in the right way by starting with the smaller dose and then increasing it depending on the effect, until you get to the dose that works best for you. The side effects you mention are possible if given too much, but given the approach of your injector, the likelihood of this happening is very, very, very low. Hang in there and don't worry- you'll likely start to notice a difference soon.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 28 reviews

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Botox dosage recommended for bruxism

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No need to worry.  The typical dosage for bruxism is 20 to 40 units into each masseter.  The dosage is dependent on the size of the muscle and how strong it is.  Once you have the correct dosage for you, the result can last for many months.  Patients love it.

Martie Gidon, MD, FRCPC
Toronto Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.