Why did Kela stop reimbursing Botox treatment for bruxism?

17.3.2026 Written by Dr. Mimosa Uoti

Good to know about Botox treatment for bruxism

• Kela stopped reimbursing botulinum toxin treatment for bruxism in March 2025

• The treatment is not first-line, but it may help some patients

• Studies have shown reductions in pain and muscle tension

• Treatment is always assessed individually during a doctor’s consultation

  
  

Botox treatment for bruxism is no longer reimbursed by Kela, but that does not mean the treatment has disappeared. In this article, we explain why the reimbursement was removed, what the research shows, and who may still benefit from the treatment.

Dr. Mimosa Uoti presenting a botulinum toxin preparation.

Kela decided to remove reimbursement for botulinum toxin treatment for bruxism. This sparked considerable discussion among both patients and healthcare professionals. Until then, reimbursement had been available for the botulinum toxin preparation when prescribed by a dentist or a physician.

After the change, the medication is fully paid by the patient, although the consultation visit may still be partially reimbursed by Kela. As a result, botulinum toxin is no longer considered a reimbursable medicine for the treatment of bruxism under the national health insurance system. It is important to note, however, that botulinum toxin is still widely used in medicine, and in certain indications, such as chronic migraine, reimbursement remains possible.

Following this change, many patients have questioned whether botulinum treatment still has a role in the management of bruxism and what that role is today. In this article, I review the different treatment options for bruxism and the current research on the effectiveness of botulinum toxin treatment.

Why was Kela reimbursement removed and what does it mean for patients

The decision by Kela is primarily based on treatment guidelines, most importantly the Current Care Guideline for temporomandibular disorders (TMD). This guideline does not recommend botulinum toxin as an established treatment for pain and dysfunction of the masticatory system. The reason is limited and inconsistent research evidence, and the treatment has not been shown to be clearly superior to other conservative therapies.

However, the guideline does not prohibit botulinum toxin treatment, nor has it been proven ineffective. Kela reimbursement requires that a treatment is either part of an established guideline or otherwise strongly evidence-based. For this reason, reimbursement for botulinum toxin in the treatment of bruxism was removed.

The Current Care Guideline outlines first-line treatments for bruxism and other TMD-related conditions. These include patient education and self-care guidance, jaw movement exercises, physiotherapy, occlusal splints, and, when necessary, pain medication. The aim of these treatments is to reduce pain and mechanical load on the masticatory system and to restore normal function. The guideline also notes that the prognosis of TMD is generally good, and most patients improve with these conservative treatments.

If symptoms persist, second-line options may include more targeted physiotherapy such as manual therapy of the jaw muscles, cognitive behavioral therapy, acupuncture, and in some cases even surgical interventions. Botulinum toxin is mentioned in the guideline mainly as a treatment studied in research settings, not as a recommended standard therapy. Therefore, no formal level of evidence is assigned to it in the guideline.

What research and clinical experience say about botulinum toxin in bruxism

In a systematic review titled Botulinum toxin in the treatment of bruxism (PubMed PMID 38151884), 12 randomized controlled trials were analyzed. The studies evaluated the effects of botulinum toxin type A on bruxism, focusing on outcomes such as masticatory muscle activity measured by EMG (RMMA), muscle pain, and sleep quality.

The main finding was a clear reduction in muscle activity in approximately half of the patients, meaning that nocturnal muscle activation decreased in some individuals. Several studies also reported a significant reduction in muscle pain, typically measured using the VAS scale. In another systematic review, pain decreased on average from 7.1 to 0.2 over one year of follow-up. This is the most consistent finding in the literature: botulinum toxin appears to have the strongest effect on pain and muscle tension.

The issue is not so much a lack of effectiveness, but rather the limited and inconsistent nature of the available evidence.

Some studies have also reported a reduction in bruxism episodes and bite force, but these findings are not consistent. One individual study (doi: 10.17219/dmp/186553) found an improvement in sleep quality after treatment. However, this is based on a single study and therefore requires further research.

A key limitation in studies on botulinum toxin for bruxism is not only their small number, but also small sample sizes and highly variable study designs. More long-term studies and standardized treatment protocols are needed.

Although botulinum toxin is not included in current Current Care Guidelines for the treatment of bruxism, the evidence is not clearly negative, quite the opposite. A recent systematic review of randomized controlled trials shows that the treatment may reduce both masticatory muscle pain and muscle activity in some patients. The issue is not so much a lack of effectiveness, but rather the limited and inconsistent nature of the available evidence. Despite this, in clinical practice I repeatedly see patients who gain significant relief from botulinum treatment in situations where conventional therapies are not sufficient. The current situation is therefore somewhat contradictory: a treatment with promising evidence and clear clinical benefit for some patients still remains outside formal recommendations and reimbursement.

The removal of Kela reimbursement does not mean that botulinum treatment for bruxism has disappeared, but it has affected accessibility and cost. This makes individual assessment essential. For some patients, conservative treatments are sufficient, but for others, botulinum treatment may still play a significant role in symptom management. In my clinical work, I often see benefit particularly in patients with clear masticatory muscle hypertrophy, insufficient response to occlusal splints, significant pain or headaches related to bruxism, or muscle tension that interferes with daily life or sleep. In such cases, the treatment can serve as a complementary option alongside other therapies, not as a replacement. Suitability for treatment is always assessed individually during a doctor’s consultation.

Do you want to know if Botox treatment for bruxism is right for you?

Book a free consultation where your situation is assessed and we determine whether botulinum toxin treatment could be a beneficial part of your bruxism care.

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