Does Botox injected into the masseter muscle help with TMJ?

Question

Hello. When I was a child I had bruxism for some years. Now, at age 20, I don't have it anymore but I still grind my teeth sometimes, feel lot of tension all day in the jaw, and have a click when I open my mouth. I was diagnosed with TMJ, and I use a mouth guard. The problem is that I feel no release in my pain, and still feel tension. I heard that some people benefit from botox to this problem. I'd like to know if I am too young fot botox, what are the risks and is there anoher alternative.

Young R. Cho, MD, PhD · Answer

Thank you for your question. Botox in the masseter region usually takes longer than in the standard areas to take effect. I tend to use anywhere from 15 units (conservative treatment) to 50 units (for someone with really strong masseters) on each side to get the desired result. It may start within the first week but I tell my patients to wait three weeks before doing a more thorough evaluation. The treatment typically lasts longer than the forehead/crows feet/frown regions. It is also a gradual onset of the return of masseter function. I have tried the masseter injections myself and space the treatments around 4 months apart, but use smaller doses to maintain the effect. I normally know the effects are wearing down when I start to clench my teeth more heavily at night when asleep.  Once you stop using Botox, the masseter muscles will return to their original baseline when the effects of Botox  wears off completely.

Jerome Edelstein, MD · Answer

Botox injected into
the masseter muscles helps to relax the muscles so that you do not clench
tightly during the day or night. It will help to alleviate the muscle pain and
tension you feel from excessive clenching. It will not  get rid of the clicking sound as that is from
the temporomandibular joint itself.

You are not too young
to have the treatment done, and I think this is a good option for you to try
next. Generally, this treatment is well tolerated. One potential side effect
could be that it takes more effort for you to chew harder or tougher foods as
the masseter muscles are more relaxed; this sensation usually resolves within a
few weeks.  You may also notice that the
shape of your jaw becomes more sleek and less square, as the masseter muscles
in people who clench are very prominent and result in a square jaw appearance.
I would suggest that you try this treatment, as it has the potential to improve
your symptoms.

William Numa, MD, FACS · Answer

Botox applied to the masseter muscles works very well in adults with bruxism. It's effects last 3-5 months and some patients even report that they don't find the need to use their custom mouthguards during this time period.

Daniel Yamini, MD, FACS · Answer

Your problem is very common and I regularly inject Botox in the masseter muscles.  There is no age limit for this type of medically necessary treatment.  The injections are very effective and very simple to perform in experienced hands.  I have never had any side-effects or complications other than rare cases of temporary bruising or swelling.  Start with a mild dose and gradually work your dose up to an effective dose.

Karen Stolman, MD · Answer

I treat patients with Botox for Bruxism, TMJ pain, and jaw pain.  Reading your letter, I am not aware of another alternative that you haven't tried.  It is very effective for all ages and usually lasts 3-4 months.   Some of my patients find that they may not even need to keep up the treatment that often, because of a lasting improvement in tension once the masseter muscle is atrophied.  In my opinion, you are not too young at age 20, and Botox has been used in children for muscle spasms.

Does Botox injected into the masseter muscle help with TMJ?

Answers (5)

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