A dermatologist can administer masseter injections, as can oral surgeons and plastic surgeons, but be aware that these injections are off-label, so they require precision and extensive experience to avoid issues with chewing or smiling. These injections are also rarely covered by insurance unless your policy covers Botox as a medical necessity. In that case, getting coverage still usually requires documentation of chronic pain, failed other treatments, and possibly a formal TMD diagnosis. Check your individual plan to see if they specifically offer benefits for TMD and what is required to receive those benefits.
Corey L. Hartman, a board-certified dermatologist and founder of Skin Wellness Dermatology in Birmingham, Alabama, says many of his clients are pleased with these injections not only because they help with the clenching, but they also reshape the face by contouring the jawline. That said, it’s important to keep in mind that overdoing it with these injections can cause issues down the road.
“I like to be very conservative with the treatment because when you are affecting these muscles and stopping them from being quite so active, there’s a risk for long-term atrophy of the muscle over time,” says Hartman. “We’re talking about tiny doses, three times a year. When done appropriately, and under guidance, you really don’t have to worry about too much. But if you overdo it and use too much or do it too frequently, then you can — just like in any other part of the face — start to cause muscle atrophy.”
For these injections, similar to getting Botox in other areas of the face, it doesn’t take immediately, meaning you won’t notice immediate results. “When it comes to the masseter muscle, I usually tell those patients not to expect full improvement for maybe two or even three weeks,” says Alicia Zalka, a board-certified dermatologist in Danbury, Connecticut. “With that said, it generally lasts a little bit longer [than Botox in other areas]. Depending on their needs, I’ll ask patients to see me twice a year if they want to maintain it.”
Both Hartman and Zalka suggest starting slowly with injections by asking for fewer units than what may be typical, booking a follow-up to check in on the progress, and being sure to ask your dermatologist how often and how long they’ve been injecting.
Realign your bite with braces
If your bite is misaligned, this could require something like braces or Invisalign to help with crowding to fix the damage done to the bite. “When your teeth are not in their ideal position, either too crowded, or space, or just misalignment, your body subconsciously will look for that,” reiterates Huang. She notes that Invisalign helps evenly distribute the force of your jaw. “The mouth is built to be supported by all the teeth, not just the teeth that are touching,” Huang says.
Nothing working? Ask about dental reconstruction
In more serious cases, dental reconstruction may be needed. “Teeth have cusps,” says Veytsman.
“The purpose of cusps is to sort of serve as bumpers so that the teeth know where to stop when you’re chewing. When those are flat from grinding, that causes more grinding. [With full mouth reconstruction], we rebuild the anatomy of the teeth that have been lost to create a more stable position to the teeth.” Veytsman says she sometimes utilizes porcelain restorations on almost every tooth to open up the bite because people who clench and grind tend to lose volume in the teeth.
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