Aesthetic medicine
Botulinum toxin: the dental indications, and expression lines
Botulinum toxin — colloquially known as “Botox”, the trade name of one preparation — is most widely associated with expression lines. In a dental clinic, two other uses are more interesting: excessive activity of the chewing muscle in bruxism, and a smile that exposes a wide band of gum.
Two dental indications that are rarely discussed
In bruxism — clenching and grinding — the masseter works at an intensity it was not designed for. The result can be worn teeth, fractured restorations, tension and pain around the temple and jaw joint, waking with a tired jaw, and over time a visibly enlarged muscle (masseter hypertrophy) that widens the lower third of the face.
In a so-called gummy smile, the muscles lifting the upper lip work more strongly than usual and expose a wide band of gum. This is an anatomical characteristic, not a disease. If it does not bother you, it does not need treating.
What botulinum toxin actually does
Botulinum toxin is a medicine that temporarily reduces the strength of muscle contraction at the site of injection. The effect develops over several days, reaches its full expression around the second week, and then slowly fades until muscle function returns completely.
In bruxism the aim is not to immobilise the muscle but to reduce the force of night-time clenching. This is a symptomatic measure. It does not treat the cause and does not remove the need for a splint, for occlusal assessment, or for addressing factors such as stress and disturbed sleep.
The aesthetic uses
In the upper face, botulinum toxin is used for dynamic lines — those that appear on movement: horizontal forehead lines, the vertical lines between the brows and the lines at the outer corner of the eye. On deep static folds visible at rest, the effect is limited, and no one should promise you otherwise.
Where the masseter is hypertrophic, reducing muscle bulk over time also softens the jawline contour. Some patients seek this deliberately, but it requires repeat treatment and is not permanent facial reshaping.
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What the evidence supports
The use of botulinum toxin for expression lines has been studied in a substantial body of clinical research and is established practice. For bruxism, the literature consistently shows reduced muscle force and reduced subjective complaints, but study methodology varies considerably, and the long-term effects of repeated treatment on muscle mass and underlying bone remain under investigation.
You will not find a success percentage on this page. Such numbers imply a predictability that aesthetic procedures do not have and hide the differences between patients. At consultation you will get an honest qualitative assessment of your own case.
Stages of treatment
How the procedure runs
Fifteen to thirty minutes in the clinic, with a review two weeks later.
Consultation and assessment
We assess muscle activity, symmetry, your medical history and medication. In bruxism we also examine the teeth, existing restorations and patterns of wear.
Informed consent
You receive written information about the product, the expected effect, its duration, possible adverse effects and the cost. Consent is signed before we proceed.
Injection
Marking of the injection points and administration with a fine needle. Usually 10–20 minutes. You will feel brief stings and a sensation of pressure.
The first days
Avoid rubbing the area, lying face down and intense exercise for the first hours. The effect appears gradually rather than immediately.
Review at day 14
We assess the result and adjust if needed. From there we plan whether and when to repeat.
Who this is for
Who this suits
- Diagnosed bruxism with tension and fatigue in the chewing muscles
- A pronounced gummy smile that bothers you
- Dynamic expression lines that appear on movement
- Realistic expectations and acceptance that treatment must be repeated
Good to know
- Pregnancy and breastfeeding
- Neuromuscular conditions such as myasthenia gravis and certain other neurological disorders
- Infection or inflammation at the injection site
- Expecting the procedure to cure the underlying cause of bruxism
Good to know
Risks and limitations
Bruising, swelling and tenderness at the injection points are possible, as is headache in the first days. These reactions are usually mild and transient.
More specific risks are asymmetry, temporary weakness of a neighbouring muscle group and, when the upper face is treated, drooping of the eyelid or brow. These are temporary and resolve as the effect of the product wears off, but that can take weeks. When the masseter is treated, a temporary sense of reduced chewing strength on hard foods can occur.
The effect is temporary for every indication. If you stop, muscle activity returns and so do the symptoms. In bruxism, botulinum toxin is part of a plan rather than a standalone answer — a splint remains the main protection for teeth and restorations.
The procedure is not performed in pregnancy or breastfeeding and requires discussion in advance with certain neurological conditions and certain medications.
Alternatives
Alternatives we will discuss
An occlusal splint
In bruxism this remains the primary means of protecting teeth and restorations. Cheaper, no injections, and no need to repeat every few months.
Addressing the cause
Stress, sleep apnoea, certain medications and occlusal problems all contribute to bruxism. Assessing them is part of the plan, and sometimes means referral to another specialist.
Surgical or orthodontic options for a gummy smile
For some anatomical causes, orthodontics or corrective surgery is more appropriate, with a result that does not need repeating.
Doing nothing
If expression lines or gum display do not affect your daily life, that is an entirely reasonable choice.
Meet the dentist
Dr Nevena Karadjova
Dentist · Specialist in Oral Surgery
All implantology and All-on-X surgery of the clinic: implants, bone grafting and sinus lift, oral surgery, aesthetic medicine.
- DMD, Medical University of Varna
- Specialty in Oral Surgery, MU-Varna, 2019
- Assistant, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, MU-Varna, 2016–2019
- Resident, Maxillofacial Surgery Clinic, UMHAT “Sv. Marina”, Varna, until 2017
- 2,000+ implants placed personally
Frequently asked questions
Questions about botulinum toxin
The aim is to reduce excessive activity, not to remove expression. Dose is chosen according to muscle strength and the result you want. If you prefer a subtle effect, say so at consultation — it is easier to add a little at the review than to reduce what has already been given.
The clinical literature consistently shows reduced muscle force and fewer subjective complaints, although study methodology varies. It is a symptomatic measure that reduces clenching force without removing the cause. A splint remains the main protection for your teeth and restorations.
The effect is temporary for every indication and fades gradually until muscle function returns fully. Duration depends on the area, the dose, muscle activity and individual metabolism. At consultation you will be given a range appropriate to your case rather than a universal figure.
We discuss it only where there is a direct indication, for example bruxism that threatens new restorations. It is never offered automatically as an add-on to a treatment plan. If you came about a tooth, the conversation stays about the tooth unless you raise it.
It is a smile that exposes a wider band of gum, most often because the upper lip lifts more strongly or because of anatomical proportions. It is not a disease. It is treated only if it bothers you, and for some causes an orthodontic or surgical solution is more appropriate.
All aesthetic medicine in this clinic is performed by Dr Nevena Karadjova, a specialist in Oral Surgery and formerly assistant in the Department of Oral and Maxillofacial Surgery at MU-Varna. Knowing facial anatomy matters a great deal in injectable procedures.
We do not publish a price, because the cost depends on the area and the amount of product required. You receive a written price after consultation, before agreeing to anything. That price includes the review at day fourteen and any adjustment made then. No further charges are added afterwards.
Related treatments
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A consultation covering muscle activity, the alternatives worth considering and a written price before any procedure is carried out.
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