The Truth About Botox for TMJ Disorders, According to an Orofacial Pain Specialist
Botox quickly gained a stellar reputation for its ability to fight fine lines and wrinkles. Now, the neuromodulator is applauded for its ability to: help realign lazy eyes (when injected into a key eye muscle); give the appearance of a more elongated face (when injected into the chin); mitigate hyperhidrosis (aka excessive underarm sweat); alleviate migraines; and even take the edge off an overactive bladder. What’s more, if you suffer from dysfunction of the temporomandibular joint (TMJ), a group of facial bone disorders that can cause severe pain, tenderness, and a decreased range of motion in the jaw, Botox can help with that, too.
What is TMJ?
Before revealing the correlation between Botox and TMJ, it helps to know what TMJ is from an all-encompassing viewpoint. Short for temporomandibular joint, TMJ is a disorder that resides in the actual jaw joint. This is important to note since TMJ is often confused with TMD (temporomandibular joint disorder) which is actually the category assigned to a handful of disorders that can affect the jaw joint. In layman’s terms, TMJ refers to the joint itself, whereas TMD refers to the disorders that can wreak havoc on the joint.
“TMD/TMJ problems are orthopedic problems involving muscles, joints, ligaments, and tendons,” says orofacial pain specialist Donald R. Tanenbaum, DDS, MPH. “Common problems are joint sprains, tendon strains, and muscle problems including soreness, spasm, inflammation, and tension.” The cause of these symptoms is simple: overuse.
“Behaviors and habits like nail and cuticle biting, and tooth contact or clenching, overwork the jaw muscles, potentially leading to muscle injury and symptoms of pain, limited jaw motion, the inability to bring the teeth together normally and/or lockjaw,” says Dr. Tanenbaum. “In addition, tooth grinding and clenching during the sleeping hours can also overwork and fatigue the jaw muscles leading to morning headaches, jaw muscle soreness, aching teeth, and limited jaw motion.
Does Botox actually help with TMJ disorders?
Think about how Botox works: It’s designed to inhibit muscle contraction. As such, injecting Botox into the masseter (the muscle that’s largely responsible for jaw movement) can, in effect, alleviate the overstimulation of certain daily habits that can lead to TMJ issues. But don’t worry! Getting Botox won’t make it impossible to open your mouth or impair your speech.
“Botox does not stop muscle contraction but reduces the intensity of the contraction,” says Dr. Tanenbaum. “Since it works by reducing the ability of a muscle to contract and tighten as vigorously as normal, it can help muscles that have been overworked begin to relax and recover their health.”
All this to say: Yes, Botox for TMJ really does work. “Botox injections can help reduce the common TMJ symptoms of pain, soreness, tightness, tension, and fatigue,” says Dr. Tanenbaum. (But remember: This is still a relatively new practice. Most Botox for TMJ studies insist that more research is needed to definitively prove the benefits of treatment.)
One thing to note: Botox isn’t the answer for every TMJ/TMD issue. According to Dr. Tanenbaum, it’s not regularly used to treat clicking and locking jaw issues.
Botox for TMJ Logistics
Although the masseter is the largest muscle in the jaw, Dr. Tanenbaum says that, for the most effective treatment, Botox needs to be injected into the temporalis to address TMJ.
“[The masseter and temporalis] bring the teeth together from an open mouth position,” he explains. “These are called the jaw elevators. At times, the jaw opening muscles, called the lateral pterygoids, also need to be injected. [But] for the most part, the temporalis and masseter are the focus of the Botox injections.”
Given the size of the jaw muscles, more units of Botox are needed to adequately soothe clenching. “Typically, 25 to 30 units of Botox are needed in the right and left masseter muscles, and 20 units in the temporalis muscle,” Dr. Tanenbaum says. After getting injected, he says that most patients feel relief within five days, however, the most noticeable benefits pop up around the two-to-three-week mark, with full benefits lasting up to eight weeks. So, just like facial Botox, it’s important to know that the results won’t last forever.
Side Effects of Botox for TMJ
When Botox is injected into the forehead, there’s the minimal concern of paralyzed expression or a drooping eyelid. While rare, it is possible. Similarly, Botox for TMJ has potential side effects, but they’re uncommon. “Side effects only occur if the Botox is not injected in the right locations, leading to drooping of the lip,” Dr. Tanenbaum says. “Otherwise, patients can chew, swallow, and speak without concern.”
The Downside of Botox for TMJ
When considering Botox for TMJ, Kate Zoumboukos, DMD of SW Austin Dental, calls out the cost of Botox. Although the neuromodulator is thought to have a solid risk-to-benefit ratio (and the Journal of Oral Maxillofacial Surgery agrees), the high cost of treatment can take it off the table for many people.
Cost aside, Dr. Tanenbaum says that, as effective as Botox for TMJ can be, he doesn’t suggest it as a standalone therapy. “It should be complemented by education, strategies to change daytime jaw overuse behaviors, jaw stretching exercises, breathing exercises to keep the jaw and neck muscles loose, oral appliance for the sleep hours to diminish the impact of bruxism, and management of life stressors,” he shares. “These treatments are often helpful on their own or make the Botox treatments more beneficial.”
Before modern medical advances, TMJ used to be alleviated without the use of neuromodulators. Even though it’s possible, Dr. Tanenbaum says that Botox is now a valuable treatment that has helped countless patients.
“It has been a great asset to use in patients who could not tolerate a bite appliance while sleeping, or [who] got worse when using them,” says Dr. Tanenbaum. “It has also helped patients that commonly braced their jaw muscles during the day, or lived with their teeth together, change these behaviors, resulting in comfortable jaw muscles and less facial/temporal headaches that would come on during the day.”
Still, Dr. Tanenbaum says that Botox shouldn’t be looked at as a solution for eternity. Instead, Botox for TMJ should be used to initially relax the jaw in a manner that helps the patient comfortably work on reducing jaw-tightening behaviors. After all, you don’t want to overuse Botox for TMJ. “Ongoing injections over a number of years can weaken the jaw muscles excessively and cause facial slimming that may not be desired by the patient,” says Dr. Tanenbaum. “On the flip side, some patients only come to see me to reduce their square facial profile by slimming down the masseters.”
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