Temporomandibular joint disorder (referred to as both TMJ or TMD) causes pain that can become chronic and debilitating. Everyday actions like speaking, chewing, and opening the mouth in any way becomes a challenge. Regardless of what it’s called, TMJ/TMD refers to a disorder of the jaw muscles or joint. According to The National Institute of Dental and Craniofacial Research, more than ten million people in the U.S. suffer from this disorder, reporting pain on one or both sides of their face. Botulinum for TMJ is an emerging treatment option for this disorder that can help you manage your pain while you treat its underlying causes.
What causes TMJ?
Your jaw connects to your skull with a ball and socket joint. Within this joint sits a small disc of cartilage that cushions the movement of the joint. It allows you talk freely, eat, and open your mouth.
Because you use this joint so often, it’s vulnerable to wear and tear over time. This stress can lead to damage, swelling, and other abnormalities at the joint juncture. This damage can cause TMJ symptoms, which include:
- Pain and soreness in the jaw, head, neck, shoulders, or ears
- Clicking, grinding, or popping sensations when you open and close your jaw
- Locked jaw
- Swelling in the jaw and face
- A suddenly uncomfortable bite that feels “misaligned”
- Tinnitus (ringing in the ears) or TMJ ear pain
In addition to simple wear and tear, TMJ pain has other causes, including:
- Trauma to the mouth or jaw
- Excessive teeth grinding, or bruxism
- Improper bite
- Excessive gum chewing
How does Botulinum for TMJ pain work?
Botulinum injections for TMJ uses botulin toxin type A injected into the joint or the affected muscles to essentially paralyze whichever areas are causing pain and damage. TMJ patients who clench and grind their teeth, for example, will no longer be able to clench or grind their teeth because the Botulinum injection causes partial paralysis.
Because the muscles that receive Botulinum injections are larger than the small muscles that are treated for wrinkles, patients receiving Botulinum injections for TMJ may not notice pain relief for two weeks or more.
While all TMJ sufferers may find some relief with this treatment, results are especially dramatic for patients whose TMJ is caused by bruxism or other stress disorders.
It is especially important to note that this treatment, although effective for pain, does not address the cause of your TMJ. For the best results with this type of treatment, it is important to get a proper diagnosis and work with your doctor to solve whatever causes your TMJ symptoms in the first place, such as physical therapy or behavior modification.
How does Botulinum help with TMJ headaches?
A common symptom for patients with TMJ is TMJ headaches. These are generally a result of stress, tension, and strain in the muscles of your face, neck, and temples.
The temporalis muscle originates at your temporal bone and circles under the cheekbone, attaching to the mandible. When strained by inflammation, this muscle can cause pain that is similar to a tension headache. Treatment for TMJ headaches can be challenging, with many common headache treatments being ineffective or short-lived. Botulinum for TMJ relaxes and releases this temporalis muscle, relieving the tension and strain, and, ultimately, relieving your TMJ headache pain.
Further, some patients find that Botulinum in the jaw allows them to relax and release tension in their shoulders. Many tension headaches originate in the muscles that drape along the top of the shoulders, connecting with muscles along the sides of the neck. This network of interwoven and connected muscles touch on the muscles in the jaw and along the sides and back of the head. Botulinum for TMJ headaches interrupts this chain of tension to relieve your pain.
How does Botulinum help TMJ jaw pain?
When Botulinum is injected in the masseter and temporalis muscles that control chewing, pain caused by the constant stress and strain on those muscles is eliminated. One study in 2016 saw not only a reduction in TMJ pain, but also a significant decrease in the use of analgesics as a result of this treatment.
You may even see these pain-relieving effects by the naked eye.
In patients with chronic and long-term TMJ caused by bruxism or tension and stress in the jaw, the masseter muscle is overdeveloped. This results in a square shape to the jaw. Many patients who receive Botulinum for TMJ pain in the jaw will notice a narrowing of their jaw as the masseter muscle relaxes and, eventually, begins to shrink.
Does Botulinum for TMJ work?
The idea of injecting a drug that causes partial paralysis into their face may be scary for many people, but for others, the pain-relieving benefits overcome their fears.
Although they are not approved for use by the U.S. Food and Drug Administration, Botulinum injections for TMJ have shown promise in some recent studies. In 2012, a study from France found that “Botulinum toxin A significantly decreases pain and improves movements of patients presenting with temporomandibular joint disorders.” These effects were observed for three months after the injection was received.
Earlier studies from 2003 and 2008 found similar results. Patients with TMJ, especially caused by overly enthusiastic chewing or jaw clenching, saw significant improvement in their symptoms. Over 90% of patients who did not respond to more conservative treatments for TMJ found significant and lasting relief with Botulinum injections for TMJ.
While researchers advise further study with larger sample sizes for more conclusive evidence of Botulinum’s safety and effectiveness, there are ongoing and statistically significant indicators that Botulinum injections for TMJ work. Another study from 2014 looked at one clinic’s administration of this treatment over five years and found overwhelming evidence that patients experienced profound and lasting pain relief.
How long does Botulinum last for TMJ?
The pain-relieving effects of Botulinum for TMJ vary from patient to patient. People metabolize Botulinum at different rates, resulting in different durations of pain relief. Most people find their symptoms significantly reduced for three to six months. The more often patients receive Botulinum injections (up to a point), the longer their periods of relief will be.
In some cases, even a temporary reprieve from pain is enough to give additional treatments a chance to work. Patients using Botulinum in conjunction with stress-relieving therapies like yoga and meditation may find that their stress relief is able to take hold with a little physical respite from pain.
What can I expect during a Botulinum for TMJ procedure?
A Botulinum for TMJ procedure is a nonsurgical, outpatient procedure. For most patients, the entire process will last between ten and 30 minutes. When beginning this treatment, plan on receiving injections once every three months for best results.
Your doctor will explain the procedure before beginning and answer any questions you may have. When you are ready, they will begin a series of injections into the targeted muscles. You can expect several injections, but the number and placement are dependent upon your treatment goals and the muscles targeted. In general, injections occur at several spots at the temporalis and masseter muscles. Your doctor may be more conservative to begin, as the least number of injections necessary is best.
Each injection may feel like a small pinch or a sting (like a bug bite), but shouldn’t be too painful. Your doctor may offer a topical analgesic if the pain persists. You can also soothe the sting with a cold compress or over-the-counter numbing cream. Some patients find that the anticipation of the sting of injection is worse than the actual injection itself!
Patients are advised to remain upright for at least four hours after their injections to prevent the injection from migrating to other areas of the body. Unlike other cosmetic treatments like Juvederm, there is no known counter-acting injection to reverse the effects of Botulinum. Once it is injected, the Botulinum must run its course.
Avoid massaging or rubbing the injection site to prevent migration of the Botulinum to other sites in the body.
Patients should expect to cover the entire cost of Botulinum for TMJ, as Botulinum is not an FDA-approved treatment for TMJ and many insurance companies will not pay for it. Your costs may vary depending on who performs the injections and your geographic location.
Is Botulinum for TMJ safe?
Botulinum injections for TMJ have the potential to vastly improve your overall quality of life. However, there are some side effects and complications that it is important to understand before your first injection.
Common side effects of Botulinum for TMJ include:
- Respiratory infection
- Flu-like illness
- Temporary eyelid droop
- Double vision
- Skin irritation
- Rash at injection site
Other side effects that are related to the injection itself may occur within the first week after treatment before gradually disappearing. These include:
- Redness at the site of injection
- Muscle weakness
- Bruising at the injection site
There are risk factors that come with Botulinum injections for TMJ. The dosage for TMJ is much higher than is approved for other cosmetic procedures (e.g., wrinkle reduction), and too much Botulinum too frequently can cause permanent paralysis. Always work with a highly-qualified doctor who errs towards less invasive and fewer injections to manage your pain.
Other potential complications include:
- Functional impairments
- Unresolved or increased pain
- Difficulty chewing (due to paralyzed chewing muscles)
- Bone atrophy (as muscle stops developing, so, too, does bone)
Further, because Botulinum injections for TMJ are not approved by the FDA and are referred to as “off-label use,” injections are performed at your own risk.
All of that said, working with a trained, compassionate physician who understands all treatment options for TMJ can offer you the best results. For most patients, these potential side effects and risks are not enough to deter them from seeking the potential pain relief of this treatment.
Botulinum for TMJ is generally reserved for recalcitrant cases that do not respond to more conservative, pain-relieving treatments.
At Pain Doctor, we know how TMJ affects your life. By working with a highly-qualified pain specialist, you can find how Botulinum for TMJ can help you manage your pain and get back to your life. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.