Easing a jaw that clenches through the night

He came in about the shape of his lower face and mentioned, almost in passing, that he woke most mornings with a sore jaw and had already cracked a molar. His dentist had made him a night guard, which he wore.

Both masseters were substantially hypertrophied. We treated each side with a neuromodulator at a moderate dose rather than a heavy one, and warned him that tough food would feel like harder work for a few weeks while the muscle adapted. He was reviewed at four weeks.

The photograph is at twelve weeks, taken at the appointment where he had his second dose. The lower face is a few millimetres narrower on each side — a real change, and a small one. What he actually valued was the morning headaches stopping, which no photograph shows.

Individual results vary. A jaw this heavy is not typical, and a smaller muscle will show a smaller change; the clenching relief is often the better reason to treat.