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Temporo-mandiubular joint pain can be debilitating. A recent study examined whether the properties of Botox effectively reduce jaw pain for individuals with severe, treatment-resistant TMJ.
The temporo-mandibular joints are among the most complex joints in the body. Located on each side of the jaw, these joints, along with several muscles and ligaments, allow the jaw to open and slide forwards, backwards, and side to side. They allow us to eat, talk, smile, and make a range of facial expressions.
As a result, these joints undergo heavy daily use and stress. If there is a problem with the muscles, ligaments, or small discs inside the joint that cushion them from pressure and wear, the joint can “dislocate” causing sharp jaw pain and headaches.
To help individuals get healthy again, it is important to identify the root causes for temporo-mandibular (TMJ) joint pain. Dentists, oral-maxillofacial specialists, and otolaryngologists can help diagnose TMJ and recommend appropriate treatment options.
In most cases, TMJ discomfort can be well-managed with oral pain medicine and by minimizing the stress on the temporo-mandibular joints. This can involve avoiding hard foods such as nuts or carrots and not biting into foods that require opening the mouth widely.
People suffering from TMJ can also be shown techniques and exercises to relax the facial muscles. Doctors may prescribe tongue splints or advise individuals to resist using drinking straws or sleeping on their side to minimize pressure on the jaw. In cases where TMJ pain is severe and resistant to the treatments mentioned above, Botox treatments may provide an effective alternative to surgery.
Botox treatments for TMJ
Botulinum toxin, often referred to as Botox, is a neurotoxic protein that temporarily paralyzes muscles. While it is often associated with smoothing facial wrinkles, it can also be used to treat other medical conditions involving muscles. For example, low doses of Botox can be used to reduce muscle spasms in individuals with cerebral palsy or muscular sclerosis.
Recently, Botox has been used to treat jaw pain. Injecting Botox into the masseter, temporal, and lateral pterygoid facial muscles can help to reduce jaw tension and reduce discomfort and pain. Additionally, relaxing facial muscles can help to restore a more rounded jawline and normal facial expression in TMJ sufferers.
Botox is not a permanent fix and may cause side effects
Nonetheless, Botox is not a permanent fix and it can cause side effects such as headaches, respiratory infection, flu-like illness, or nausea. If the Botox is not well-placed, or if it migrates, the toxin can spread and cause additional complications such as muscle weakness and double vision. To date, the safety, efficacy, and long-term consequences of Botox to treat TMJ is not well documented.
In a recent study published in the Journal of Stomatology, Oral and Maxillofacial Surgery, researchers from France investigated the efficacy of Botox for treating severe, unresponsive TMJ. From 2007 to 2016, 77 patients (52 females; 25 males; 21 to 78 years of age) were recruited to participate in this study. Each had TMJ for at least one year, had undergone a battery of conventional treatments, but were still experiencing severe pain.
To reduce any possible risks for participants, individuals with botulinum toxin allergy, myopathy, central neuropathy, or uncontrolled diabetes were excluded from participation in this study. Women who were pregnant or breastfeeding were also excluded.
Since preliminary trials indicated that Botox doses of 20 units were not effective, 30-unit doses were used for the intra-articular (in joint) injections. Each patient received the Botox treatment on one joint and pain and symptom data (such as the ability to open and move the mouth, eat, and accomplish other activities of daily living) were gathered before the Botox injection, after two weeks, one month, and finally, after three months.
Botox injections had good but temporary results
No participant reported experiencing more pain after receiving the Botox injection. At the three-month mark, 95% of these patients reported low pain scores (0 or 1 on the VAS pain scale). Interestingly, 66% of the participants said that the pain in their other joint was also better. While most participants were able to open their mouths somewhat wider without experiencing pain, this result tended to last just one month. However, with respect to quality of life, 62% of the participants reported lower levels of disability and 75% reported improvements in their physical, mental, emotional and relational health. Few adverse events occurred. Five individuals experienced post-injection headaches, but none was severe and all were relieved within 48 hours.
Botox may be safe and effective in treating severe TMJ pain
The results of this study indicate that Botox is both safe and effective for treating severe, unresponsive TMJ. Overall, additional research on Botox injections for treating TMJ pain can confirm these findings and help guide both patients and healthcare providers. In addition, longitudinal research would be useful to determine if there are long-term consequences of Botox treatments for TMJ.
Written by Debra A. Kellen, PhD
(1) Batifol, D., Huart, A., Finiels, P. J., Nagot, N., & Jammet, P. (2018). Effect of intra-articular Botulinum Toxin injections on temporo-mandibular joint pain. Journal of stomatology, oral and maxillofacial surgery. https://doi.org/10.1016/j.jormas.2018.06.002
(2) American Academy of Facial Esthetics. Botox treatment for jaw tension and tmj. Retrieved on June 20, 2018 from https://www.facialesthetics.org/tmj-treatments/
(3) The TMJ Association. Is botox safe for tmj?. Retrieved on June 20, 2018 from http://www.tmj.org/site/page?pageId=296