Botox is the most recognized name in a drug class called neurotoxins. It was first approved in 2002 as a cosmetic treatment to reduce facial wrinkles and frown lines. Soon after, it was discovered that Botox can be useful in treating a wider variety of muscle problems such as migraine headaches, cervical dystonia, excessive sweating, bladder overactivity, vocal cord paralysis, and the symptoms of TMJ, to name a few.
Today, Botox and other neurotoxins are widely promoted as treatments to manage the symptoms of temporomandibular problems (TMJ). If you are considering Botox for TMJ, it’s important to understand what it is and how it works.
How Does Botox For TMJ Work?
Reduces Muscle Contraction
The most common words used to describe Botox’s impact on muscles are weaken, relax, inactivate, and partially incapacitate. In essence, Botox reduces the ability of specific muscles to contract to their full extent. Therefore, it can be an effective way to treat muscle stiffness, spasm, and overactivity.
Patients can experience pain relief after Botox injections because the drug leads to a reduction in lactic acid and other pain-producing substances found in over-contracted muscles. Botox also appears to reduce the release of pain-producing chemicals associated with peripheral nerve endings. This is why Botox, as a result of ongoing research, is being utilized as an option to treat neuropathic or neuropathy pain.
Blocks Electrical Signals
Botox works by blocking electrical signals from nerves to muscles. Although the brain may be telling muscles to contract with normal force, the muscles do not completely receive that message as long as the Botox is active. After an injection, Botox typically does not start working for three to five days and usually remains active for approximately three to five months.*
*This can vary from person to person.
Stays Where It’s Put
Botox, when injected by a trained clinician, stays where it is put. It does not roam throughout the body or spread to adjacent muscles, assuming the proper volume and techniques are used. While swelling and bruising can result, it’s often dependent on the clinician’s technique and the depth of the injections.
Considering Botox For TMJ Problems? –
5 Things You Need To Know
The majority of patients who ask for Botox are suffering from chronic jaw muscle pain, tightness, and soreness due to persistent muscle tension. This muscle tension is often due to bruxism, which is the grinding or clenching of the teeth, at night, during the day, or both. Other overuse behaviors, including excessive gum chewing, cheek and tongue biting, ice chewing, jaw muscle bracing, and nail and cuticle biting, can also cause jaw muscle pain during the day.
To treat TMJ symptoms, Botox is typically injected into the masseter and temporalis muscles, which are responsible for closing the jaw from an open position. Sometimes, Botox is also injected in the lateral pterygoid muscles, the ones responsible for mouth opening and side-to-side jaw motion.
1. Botox Should Not Be A Stand-Alone Therapy For TMJ
Botox can be beneficial when first-line therapies have already been pursued with limited or no benefit. First-line therapies for TMJ include education, habit modification, exercises, oral and topical medications, dietary caution, physical therapy, and oral appliances.
Botox alone will not commonly help inflammatory pain in the TM joints or predictably reduce the clicking and locking of the TM joints associated with loose ligaments and changes in the shock-absorbing disc’s position.
Botox is often used to help break a cycle of pain, reduce suffering, and buy time for the patient, but only when other therapies have been ineffective. Patient participation to reduce the risk factors that cause the jaw muscles to contract must continue in order to maximize the benefit of the Botox and reduce the need for ongoing injections.
2. Botox For TMJ Requires A Series Of Injections
Because Botox is most commonly used for patients who have suffered for a long time due to both known and unknown factors, one injection series typically will not, on its own, solve the problem. Symptoms that have been reduced and or eliminated after the first injection session can, and often, return at variable degrees of intensity requiring subsequent injections. This occurs most commonly when the risk factors leading to muscle pain have not been controlled or eliminated.
An experienced, trained clinician can determine the proper dosage, location, and frequency of Botox injections.
3. Prior to Botox Injections, TMJ X-Rays Are Recommended
Several ongoing studies have been designed to determine if Botox because it reduces muscle pull, could compromise the bone density of the TM joints. At the moment, results have been inconclusive. However, because of these concerns, there should be a baseline x-ray of the TM joints and follow up x-rays if Botox injections are ongoing.
4. Botox Can Slim The Jawline
Another way Botox is being used is to slim bulky overbuilt jaw muscles, which are sometimes the results of overuse, such as clenching and grinding during the day or night, gum-chewing, etc.).
Over time, Botox changes the jaw muscles’ composition, increasing the volume of collagen and fat, and shrinking the size of muscle fibers. A series of injections in the masseter muscles can slim a facial profile without compromising jaw function or eating ability.
However, when the temporalis muscles are also injected due to cosmetic concern of bulkiness and/or headache pain, care must be taken to avoid a hollow, caved-in appearance over time. This is another reason to choose an experienced, trained clinician.
(Some patients who do not have TMJ problems also request Botox injections as a way to slim their jaw profile.)
5. Botox Is Not For Kids
Botox’s use in children and young teenagers should be avoided. As the bone mass of the TMJs has not fully matured at these young ages, reducing muscle pull around the TM joints as a result of Botox injections is contraindicated.
Botox For TMJ Is Here To Stay
In summary, Botox is not a cure, but an extremely valuable tool in unwinding years of jaw muscle pain for patients who continue to suffer. Botox is one of many tools orofacial pain specialists like me use to help our patients who suffer from TMJ problems.
Botox for teeth grinding is in the news! Check out my interview on ABC’s Good Morning America for their segment on this innovative strategy. Click the image below to view the short clip:
If you’re considering Botox for TMJ, your health care provider’s knowledge, experience, and level of training go a long way toward a successful outcome.