Bruxism – an aesthetic issue or a dental problem?

AUTHOR:

Dr Magdalena Trzcińska-Kubik, PhD

dentist, certified aesthetic medicine doctor, with completed specialization in maxillofacial surgery

It is estimated that up to 30% of patients present to clinics with symptoms of bruxism. Many individuals receive only symptomatic treatment for years and are often referred to specialists only when significant hypertrophy of the masseter muscles, chronic headaches, tooth hypersensitivity, or aesthetic disturbances of the lower face have already developed. Meanwhile, bruxism is not merely a dental dysfunction – it is a psychosomatic disorder that requires comprehensive, multidisciplinary diagnosis and treatment.

Bruxism, defined as an unconscious, habitual parafunctional activity involving excessive masticatory muscle activity, is a condition with a complex etiology: neurogenic, stress-related, biomechanical, and hormonal. Therefore, it is crucial to adopt a holistic view of the patient – effective therapy often requires close collaboration between a dentist, an aesthetic medicine physician, a dental physiotherapist, a psychologist, and a psychiatrist, as well as the inclusion of self-therapy and relaxation techniques. Only such a comprehensive approach offers a real chance for long-term improvement. Relying solely on symptomatic treatment, such as botulinum toxin, leads to deterioration of the stomatognathic system, muscular compensations, and progression of dysfunction.

Pathophysiology and the role of muscular disorders

From a pathophysiological perspective, bruxism is not confined solely to the masseter muscles. It represents a global tonic-postural disorder, involving the temporalis muscles, pterygoid muscles, cervical girdle muscles, and suboccipital muscle groups responsible for head stabilization. Persistent nocturnal episodes of muscle activity lead to chronic overload, ischemia, fibrosis, and biophysical disturbances within muscle fibers.

Particular importance should be given to the temporalis muscles, which – if therapy is improperly conducted (e.g., reduction of tension only in the masseters) – take on compensatory loads. This results in increased pain, exacerbation of temporomandibular joint (TMJ) dysfunction, and deterioration of masticatory mechanics. Including them in therapy is essential for effective and safe intervention.

Not only botulinum toxin

Due to the aesthetic aspect of bruxism (the so-called “square face”), treatment is not limited to dentists but also involves aesthetic medicine practitioners, with botulinum toxin being the most commonly used method. Although it is a well-known and effective tool used for many years, its role should be interpreted with caution. According to current knowledge, botulinum toxin should not be the first-line therapy. It provides rapid relief but does not address the underlying causes of muscle tension or support regeneration of overloaded structures.

It is more appropriate to consider botulinum toxin as a “last-resort treatment” – a stage preceded by comprehensive diagnostics and regenerative therapy. Overuse leads to muscle weakening, compensations in adjacent areas, impaired chewing function, and even worsening headaches when dosing or technique is inappropriate.

Regenerative therapies: platelet-rich fibrin, collagen therapy, and biostimulation

Regenerative therapies are playing an increasingly important role in the treatment of bruxism. Platelet-rich fibrin (I-PRF, A-PRF) and injectable collagen therapy open new possibilities – they act not symptomatically but causally, regenerating overloaded structures, reducing tension, and supporting the restoration of physiological muscle function.

Platelet-rich fibrin is highly effective in injections:

• within the masseter muscles,
• temporalis muscles,
• suboccipital muscles, shoulder girdle, and neck,
• as well as directly into the temporomandibular joint (TMJ) – where it exerts regenerative effects on the synovial membrane and cartilage structures.

An important complement to therapy is injectable collagen therapy, particularly based on tropocollagen enriched with bioflavonoids (hypericin, rutin, quercetin). These preparations allow subtle modulation of muscle tension, restore proper tone, improve elasticity, and reduce pain without the risk of excessive muscle weakening often associated with botulinum toxin.

In bruxism cases, administration of iPRF (as a standalone preparation or combined with tropocollagen) is performed in the masseter muscles, temporalis muscles, and other overloaded muscle groups. Reduction or even complete resolution of symptoms typically occurs within a few days, although some patients experience immediate pain relief after the procedure. The remaining preparation after centrifugation can also be used for aesthetic indications—such as revitalization of the periocular area and the skin of the face and neck.

Following such treatment, patients quickly experience muscle relaxation, and with regular therapy, a long-term effect is achieved—natural and free from the risk of compensatory mechanisms.

The first visit as the foundation of treatment

The therapeutic protocol should begin with a comprehensive assessment of the stomatognathic system and the entire cervical-shoulder complex. It is essential to recognize that bruxism is not a localized issue of the masseter muscles but a global disorder.

Therefore, the first injection session should include all overloaded muscle groups, not just the masseters. The temporalis muscles are particularly important – their omission leads to compensation, excessive overload, and often a dramatic increase in pain. This is a common cause of therapeutic failure in cases treated exclusively with botulinum toxin.

Depending on clinical evaluation, treatment may also include injections of fibrin, autologous exosomes (e.g., AutologIX), or autologous stem cells – techniques that enable tissue reconstruction in the most biological and safe manner.

A comprehensive therapeutic model

Bruxism treatment cannot rely solely on injections. Essential components include:

• a customized occlusal splint prescribed by a dentist,
• regular dental physiotherapy,
• elements of self-therapy and home exercises,
• relaxation techniques and stress management (psychologist/psychiatrist).

It is the combination of these elements that ensures an effect that not only alleviates symptoms but effectively halts the overload process.

Summary

Modern bruxism treatment requires an interdisciplinary approach. In an aesthetic medicine setting, regenerative therapies play a key role in supporting muscle and temporomandibular joint function. Botulinum toxin remains a valuable tool but should be used only after causal treatment options have been exhausted. A comprehensively managed therapy – combining diagnostics, regenerative injections, physiotherapy, and psychological support – offers patients the greatest chance for long-term improvement, restoration of balance, and preservation of natural muscle function.