Here’s a story about a young woman named Sarah who came into my office a couple of weeks ago with her mother. Sarah is a 17-year old, college-bound, high achiever who was convinced that the shape of her face had undergone a dramatic change during the past few years. She was particularly concerned about her jawline. She felt that her jaw muscles looked bigger and more pronounced than before.
When I work with a new patient the first thing we do is sit down, relax, and have a conversation. I usually learn more during this conversation than I do from the physical examination. During my conversation with Sarah I asked her a lot of questions about her life and carefully listened to her answers. It didn’t take long for me to begin to see where her problems started. The physical examination reinforced my hypothesis.
In order to understand what happened to Sarah’s face we must take a look at the master muscles; they are the muscles that control the movement of the jaw. Masseters are like all other skeletal muscles in your body in that they will maintain a baseline shape and size when used normally. And, like all other skeletal muscles in your body, they will change in size and shape when over-used. It’s the same as when you workout your biceps in order to change the size and shape of your arms.
Each time you close your jaw or even swallow, you are using your masseters. Normal chewing and swallowing will not cause them to change in shape or size. What makes masseter muscles change, is when they are contracted over and above what is considered normal, over a long period of time. Since the masseters define the shape of your jaw, over-use behavior can actually change the shape of your face.
By chewing gum, biting your nails, biting your cuticles, chewing on pens, or even holding your glasses between your teeth, you are using your masseter muscles way beyond what they were designed for. Some people hold and clench their upper and lower teeth together during the day without realizing it and over a period of time this causes their masseter muscles to bulk-up.
Also of concern is sleep bruxism. Hundreds of thousands of people grind or clench their teeth while they’re sleeping. This excessive teeth grinding, jaw movement side to side-to-side, and/or clenching in a static, braced position plays a huge factor in the enlargement of the masseters and consequently, the shape of the jaw. So, the answer is:
Can bruxism change the shape of your face? Yes…
To reduce the impact of bruxism on the masseter muscles, I normally provide my patients with a custom-fitted oral appliance (also referred to as a night guard). The oral appliance is a very effective tool in reducing the impact of grinding and clenching. But an oral appliance will not stop over-use behavior.
Although Sarah wasn’t complaining about pain, soreness and stiffness are also common effects of bruxism. Imagine how sore your hand would be if ityou kept it in a fist for most of the day and night. Jaw over-use is just like making a fist in your face, and it can create excruciating pain for many people.
Let’s go back to Sarah. Through our conversation I was able to identify the main reasons that her jawline had changed so dramatically. It turns out that she is a long-time gum chewer, a nail biter, and a nighttime clencher. Sarah has literally been working-out her masseter muscles every day and night for years.
An oral appliance strategy as been put into place that will reduce the impact of Sarah’s sleep bruxism. Next, The next step is for her to change her daytime over-use behaviors. Today, Sarah is wearing the oral appliance at night and working hard to correct her daytime over-use behaviors.
An additional approach that could work for Sarah is Botox. Botox is a popular cosmetic therapy that has the potential to diminish the forces of nighttime bruxism. It works by diminishing the capacity of the masseters to contract, with the result often being a reduction in the bulk of the over-used muscles.
Today, Sarah is wearing the oral appliance at night and working hard to correct her daytime over-use behaviors. But before I will go forward with Botox for Sarah, she must convince me that she understands that if she does not correct the daytime over-use behaviors, Botox is not an option.
Here’s The Takeaway: If you have noticed changes in the shape of your face or your jawline, it’s probably not your imagination. Find a dentist that has special training in bruxism as soon as possible.
I invite you to follow me on Facebook, Twitter or LinkedIn to keep up with all the new research and case studies in this field (and with Sarah’s progress).