Botox Injections to Treat TMJ: Safe? Effective?

“I’ve had jaw pain and TMJ for about four years now. I have the special bite guard. I’m a college student, and the frequent traveling makes it hard to keep track of the bite guard. I heard that getting Botox injected at the temporomandibular joint helps reduce the jaw pain from my TMJ. What do you think about using botox for TMJ? Do you advise the use of botox for TMJ?”

Botox should be used to treat TMJ only in the most extreme cases, since there can be serious side effects and because it doesn’t treat the root cause of the jaw pain.

Think of using botox for TMJ like using Advil for a headache — you can keep popping pills, but if you never figure out the root cause of your headache, you’ll be managing symptoms instead of getting healthy.

Here’s what I recommend:

1. See if you can resolve the jaw pain another way. Botox, like surgery, should be used only as a last resort after you have tried everything else. In most cases, TMJ can be resolved with jaw relaxation techniques, eating soft foods, or talking less. Botox for TMJ should be a last resort after trying all the other less drastic treatments. Click here to read my guide on the various TMJ/TMD treatment methods.

2. Find the root cause. TMJ often has a root cause, like stress, teeth grinding, and even sleep apnea. It takes work to figure out the root cause, since TMJ is a complex and multifactorial condition, but it’s worth it — otherwise, you’re stuck having to treat your symptoms with band-aid solutions, and never getting your jaw healthy again. Seek out a TMJ specialist who can help you identify what exactly the root cause is. Most dentists and plastic surgeons are not as knowledgeable as the specialists. Many times you will find these specialists near hospitals or dental schools, under the umbrella of Head and Neck Pain centers.

The Pros and Cons of Botox for TMJ

Pros

• Botox for TMJ provides immediate relief. Botox is a brand new treatment that is not well documented for its use in TMJ therapy. However, it can provide immediate relief.
• Botox for TMJ can restore normal facial expressions. Its appeal, though, goes beyond pain relief, as it often restores the normal facial expressions of the patient. Years and years of overusing the masseter muscles over develops the masseter (main chewing muscle), leading to a square face.

Cons

• Botox is a toxin. When you treat TMJ with Botox, you are dulling the function of the nerve that generates the pain with a toxin. The dosages used for botox for TMJ are higher than when using botox for wrinkles, and there are serious side effects of too much Botox.
• Botox for TMJ is not a permanent fix. Botox wears off over time and is merely a band-aid that does not address the root of the problem. It may make you think that since there is no pain that you can go back to chewing gum. The pain tells you not to.
• Botox is easy to overuse. Botox changes the appearance of the face, making it more oval and with more defined cheekbones from a weaker masseter. It also reduces wrinkles. Since these kinds of changes to physical appearance can be addictive and because too much Botox for TMJ can have serious side effects, I think it’s something to be aware of if you do choose Botox to treat your jaw pain.

When to Use Botox for TMJ

• As a last resort. Botox should be used for TMJ only if all other treatment options have been exhausted.
• To reset a learned response. In some cases, TMJ is caused by a learned behavioral response, meaning, at one point, you picked up the habit of clenching your jaw subconsciously. Botox for TMJ is thought to be able to erase this memory by “resetting” the muscle. In this sense, it’s a cure, but I have not seen Botox for TMJ used effectively in this manner.

What is TMJ/TMD?

Temperomandibular Joint Disorder (TMJ), now referred to as TMD, is not pleasant, and difficult to deal with. The jaw pain is nearly constant, and interferes with everyday activity like eating, talking, smiling, and even sex.

Sufferers of TMJ usually have a history of some form of trauma to the jaw joint, like a fall, an auto accident or aggressive orthodontics or oral surgery.

The joint is very complex, perhaps the most complex joint in the body. The joint was crucial in our evolution as it allows us to do movements other than just vertical chewing.

With the complexity, however, come problems. The joint essentially can “dislocate” and move up and down a ramp at the base of the skull. Try jutting your chin out away from your head (protrusion). Even though there are just two joints at each side of our heads, we can wiggle our jaw back and forth.

But as with every joint, there is a pad or disc that separates and cushions the two articulating bones. Just imagine how this little disc has to move around to keep up with the movements of the jaw (all you big talkers and gum chewers, take note).

Ligaments and muscles keep this all under control and choreographed if all is well and balanced. TMJ is a very complicated subject in dentistry and is not as well understood as we’d like to admit. And to complicate matter, many different camps exist when it comes to cause and cure.

Hope that helps! The take home message: Botox for TMJ is a viable option, but it’s an option that should be a last resort only after you’ve tried to find the root cause of your TMJ and have spent time treating it with all the other less drastic treatment options.

Dr. Mark Burhenne DDS

Learn More: The Complete Guide to Temporomandibular Joint Disorder (TMD, TMJ)