Treatment for teeth grinding and clenching: night guard or Botox?

An international expert consensus describes bruxism as repetitive chewing muscle activity, characterised by clenching or grinding of the teeth and by bracing or thrusting of the jaw. When it happens during sleep it is called sleep bruxism, and when it happens while awake it is called awake bruxism. An important finding of the 2018 consensus report is this: in people who are otherwise healthy, bruxism should be seen not as a disease but as a behaviour that can be a risk factor for some clinical consequences (and in some cases a protective factor). So the aim is not to bring clenching down to zero but to prevent the damage it causes.

The NHS lists jaw pain, the jaw joint problems that can develop from it (temporomandibular disorder), worn teeth, headaches, earache and disturbed sleep as signs of clenching. Most people do not notice that they clench; tiredness in the jaw in the morning, pain in the temples, a grinding noise heard by a partner or wear seen by the dentist are the first clues. Tooth marks along the edge of the tongue and a white line inside the cheek level with the teeth can also suggest that the tissues are being pressed against the teeth during clenching.

On the side of causes, the NHS's order is clear: the most common cause is stress and anxiety. Sleep problems such as snoring and sleep apnoea, some medicines used for sleep, depression or anxiety, smoking, alcohol and caffeine are also among the triggers. This list explains why treatment does not end with a single device. A guard or Botox eases the consequences; the cause needs to be looked for elsewhere.

A night guard is the oldest and most common option. A hard plastic guard that sits over the teeth stops the upper and lower teeth rubbing against each other through the night. However, the evidence is not as strong as is often thought. A 2007 Cochrane review writes that there is not enough evidence to say that an occlusal splint treats sleep bruxism, that its use is debatable in terms of sleep outcomes, but that it may have a benefit in terms of tooth wear. That is why it is right to think of a guard not as a treatment that ends clenching but as a shield that protects the teeth and restorations.

Botox (botulinum toxin type A) is injected into a chewing muscle, mostly the masseter muscle at the angle of the jaw, and temporarily weakens the muscle. In a 2025 overview looking at fourteen systematic reviews together, 10 of the 14 reviews reported a reduction in pain with Botox, 7 in the frequency of bruxism episodes, and 5 in maximum bite force. The same overview stresses that the methodological confidence of all the reviews was low or critically low and that no firm conclusion can be drawn. In a 2026 meta-analysis comparing a guard with Botox, no significant difference was found between the two methods in reducing pain at medium-term follow-up in adults with sleep bruxism (the certainty of evidence for this result is moderate); Botox gave faster short-term relief in some studies, while the guard protected the tooth mechanically and preserved chewing function.

The effect of Botox is temporary. It does not change the muscle permanently, and as its effect wears off the injection needs to be repeated. That is also why the long-term effects of repeated injections matter. In a 2024 systematic review looking at the effect of Botox on the jawbone, a reduction of about 6 per cent in cortical bone thickness was seen in the jaw areas after injection in humans, with no marked change in bone volume or density; in animal studies, however, there was marked bone loss in the jaw joint area. The authors state that most studies did not address repeated injections and high doses, and that more rigorous studies are needed to understand the long-term effects on bone. The same review also notes that Botox is used off-label (outside its approved uses) for jaw joint problems.

For implants and dentures, clenching carries more weight. Between the root of a natural tooth and the bone there is connective tissue that senses and cushions pressure; with an implant, this tissue is not there. In a 2025 meta-analysis, the likelihood (odds ratio) of mechanical problems in implant-supported prostheses was found to be about 6 times higher in patients who clench and grind (a pooled analysis of 13 observational studies); the risk was higher in every subcategory, such as screw loosening, screw and abutment fracture, ceramic fracture and the prosthesis moving. These studies are observational, so it is not possible to attribute every increase to clenching alone; even so, the findings point the same way. The details are on our bruxism and implants page.

In the end, another systematic review published in 2025 writes that there is no single treatment that works on its own for every patient, and that a multi-pronged approach combining different methods may give better results. In practice, this means protecting the teeth with a guard, discussing muscle treatment if pain is marked, and dealing with stress, sleep and habits at the same time.

The first list gives situations where a night guard comes first; the second list gives situations where Botox or another route can be discussed, or where another problem needs to be investigated first. The decision is made with your dentist after an examination.

The order is first to understand whether there is clenching and the damage it causes, then to protect the teeth, and last of all, if needed, to move on to muscle treatment.

1. 1

   Talking through symptoms and triggers

   The dentist asks about tiredness in the jaw in the morning, headaches and pain in the temples, grinding noises, stress, sleep patterns, snoring, the medicines you take, alcohol, caffeine and smoking. What your partner or the person you sleep with has noticed is valuable.

2. 2

   Examination of the mouth

   Worn surfaces on the teeth, cracks, broken fillings, marks on the tongue and inside the cheeks, hands-on examination of the jaw muscles and the movement of the jaw joint are assessed. If there are implants or dentures, the screws and components are checked.

3. 3

   A sleep assessment if needed

   If there is snoring, pauses in breathing or daytime sleepiness, a referral is made to a GP (family doctor) or a sleep centre for sleep apnoea. In these tests, sleep bruxism can also be measured as muscle activity.

4. 4

   Making the night guard

   The dentist takes an impression or a scan and makes a hard guard that fits your teeth. The guard is worn at night and is checked and adjusted at intervals. Ready-made boil-and-bite guards may not fit the mouth properly.

5. 5

   Stress and habits

   The NHS writes that a GP (family doctor) can help with managing stress, stopping smoking and cutting down on alcohol. For daytime clenching, simple awareness habits that remind you that your teeth should not touch during the day are also used.

6. 6

   Botox if needed

   If muscle pain continues despite the guard and the other measures, Botox can be discussed. The injection is usually given into the jaw muscles, and its effect is temporary. It needs to be given by a doctor trained in this, and the dose, the interval between repeats and the possible side effects need to be discussed in advance.

7. 7

   Repairing damaged teeth

   Repairing worn or broken teeth is planned once clenching has been brought under control and the teeth have been protected. Otherwise, new restorations can also be damaged by the same force.

The options are not used instead of each other; most of the time they are used together.

The following are wrong decisions that are often made on this subject, and what they cost.

Clenching is a long-term behaviour; treatment is not a one-off but a process that is monitored. The sequence below describes the usual course.

1. The first weeks with the guard

   Getting used to sleeping with a guard can take a few nights. In the mornings there may be a slight feeling of difference in the teeth; if your bite feels different for a long time, the guard needs adjusting.

2. The first days and weeks after Botox

   The effect starts not straight away but within a few days. During this period a slight weakness in the muscles may be felt when chewing. If an unexpected side effect occurs, contact the doctor who gave the injection.

3. Over the months

   The effect of Botox wears off and whether a repeat is needed is assessed. The guard continues to be used, with regular check-ups.

4. In the long term

   Whether tooth wear has stopped, how sound the restorations are and the state of implant or denture components are followed at regular check-ups.

We do not give a figure here; the scope of treatment for clenching varies from person to person. The main factors that determine the scope:

The type of guard

A hard guard made from an impression is different from ready-made guards; how often the guard is replaced also affects the total.

The number of Botox repeats

Because the effect is temporary, the yearly total depends on how many times it is repeated.

Repairing tooth damage

Repairing worn or broken teeth involves separate treatments.

Accompanying problems

If there is sleep apnoea or a jaw joint problem, further assessment and treatment are needed.