Can Botox Be Used to Treat TMJ?

I am a TMJ sufferer and had botox injected into the masseter muscle a little over a month ago. Prior to this, I have worn a night guard and taken a variety of pain medication/muscle relaxers/anxiety medications. I've found that the botox has been effective in reducing my headaches. I still have headaches that stem from tightness in my neck muscles, but overall my headaches have been reduced by targeting the jaw muscle (and it's possible to receive botox in some of the neck muscles responsible for headaches). I haven't had the TMJ headaches that were causing me nausea/dizziness for the past three weeks whereas before they were nearly a daily occurrence. That being said, I think botox will have different results depending on what factors are contributing to your headaches. My TMJ problems stem from 1) having a misaligned bite and 2) the fact that I subconsciously CLENCH (not grind) my jaw both during the day and at night. My bite is a result of having too many teeth taken out because I had braces twice and each time the orthodontist removed 4 permanent teeth due to crowding. After my teeth were straight, the second orthodontist told me I had a "deep bite" and that it couldn't be corrected. This, combined with the fact I constantly (subconsciously) clench my jaw has caused problems in the TMJ. Because botox works to weaken the muscle that is doing the clenching, I can't exert as much force on the joint anymore, and the masseter muscles have atrophied considerably since I've had the injections done. Wearing a mouth guard at night really didn't help me because I clench my jaw during the day as well. However, with botox, you physically cannot clench (or at least as hard), so you 1) break the habit of clenching and 2) reduce the pressure on the joint. Your outcome and botox's effectiveness may be different depending on what factors contribute to your disorder. However, I think there is little risk in receiving botox injections, so it may be a Hail Mary worth trying if you haven't found anything else that helps. Obviously, I'd add the caveat that you should go to an injector that has had experience in providing botox to TMJ patients. I saw a nurse practitioner, since she had the most experience in my area doing this type of injection. I don't buy into the idea that MDs are always better and prefer practitioners with the most experience whether they're an MD, NP, or DDS . The masseter muscle is quite large, especially in TMJ sufferers, so the practitioner would have to seriously screw up to inject the wrong muscle. I would also make sure they have a good idea of how many units to inject (I think around 20 on each side is standard, but it will depend on how large the muscle is). Overall I spent about $430 on the botox and I think it was definitely worth it considering the misery I was experiencing with TMJ. I guarantee the $400 I spent on botox is less than what my insurance company would pay for surgery or more orthodontic work that my dentist suggested to me. Botox is probably even less than all the medication I've been prescribed. Not to mention the fact that taking pain medication for the rest of my life isn't a very appealing option. Some other things I've found that have helped are to make sure I avoid sleeping on my stomach, as this causes tension in the neck and jaw. I also try to schedule upper body massages to relieve tension in the upper shoulders and neck. I hope you find relief soon!

Jerry, We encourage you to read a recent scientific publication: Efficacy of botulinum toxin type A for treatment of persistent myofascial TMD pain: a randomized, controlled, double-blind multicenter study by Ernberg M., Hedenberg-Magnusson B., List T., Svensson P. In press, Pain (2011). The authors recommended against the use of Botox as an adjunct to conservative treatment of persistent myofascial pain on the basis of its high cost and lack of efficacy. TMJ Disorders are also comorbid with other pain conditions such as fibromyalgia, chronic fatigue syndrome, headache, etc.