Painful Treatment-Resistant TMJ Disorder? Botox May Help

Although people with TMJ disorders (TMDs) have a lot in common with each other, each person’s case is different enough that there’s no one course of treatment that will work for everyone.

Sure, there’s overlap among the customized treatment plans that Dr. Abdulla develops for patients who come to her seeking long-term relief from painful, even debilitating TMDs. Most will involve some sort of splint therapy, for instance, or dietary changes to reduce the inflammation that accompanies these disorders.

But every so often, we’ll see a patient for whom the more common therapies fail. This doesn’t mean nothing can be done, though. Treatment-resistant TMDs can sometimes be successfully resolved with a procedure that might surprise you: Botox injections.

As we’ve discussed before, Botox works by blocking signals from the nerves to targeted muscles to keep them from contracting. This is how it’s able to smooth out lines and wrinkles, and reduce some forms of joint and muscle pain.

Sometimes, just one shot is enough to bring relief from temporomandibular pain. In other cases, a series of injections is needed over time to bring about lasting improvement.

Since our earlier post, a good deal more research has been published on the matter, including a new review and analysis of previous scientific studies, which was released by the Journal of Oral Rehabilitation just before the turn of the new year.

Its authors began by searching five major medical databases to identify relevant studies that had been published through March 2023. Specifically, they sought randomized controlled trials that evaluated the efficacy and safety of Botox in treating muscular TMD.

Fifteen studies involving just over 500 patients made the cut. Analysis of the data showed that Botox was “significantly more effective than placebo in reducing pain intensity” after 1 month and 6 months. Opening the mouth was easier and less painful. The ability to move the upper jaw normally was also improved. No safety issues were identified.

“Overall,” the authors concluded,

the results suggest that [Botox] holds promise in reducing muscular TMD pain and alleviating pain-related disability without causing significant adverse effects.

Similarly positive results were found by studies published earlier in 2023 but after the review’s cutoff date, the first of which involved 45 patients who had been diagnosed with muscular TMJ disorders. A variety of evaluations were made before each patient received Botox injections in both the masseter and temporalis muscles. These included measurements of pain intensity, maximum mouth opening, and the impact of treatment on the patient’s quality of life. The evaluations were made again three months after the injections.

Analysis of the data showed that the injections indeed reduced pain and improved both maximum mouth opening and overall quality of life.

The injection of [Botox] into the masticatory muscles is beneficial for improving the clinical and quality of life parameters in the management of myogenic TMD.

The second study was published around the same time in the journal Toxins. In this case, 21 patients with muscular TMD were randomly assigned to one of two groups. Members of one group received Botox injections, while the others were injected with a saline solution as a placebo. Sixteen different areas were palpated, and those that were tender were the spots that were injected.

Before the injections and then again at 4, 8, and 12 weeks later, each patient was evaluated for orofacial pain, headache, tender points, maximum mouth opening, and headache frequency. While there were significant improvements among those in the Botox group for all measures but mouth opening, none were observed in the placebo group.

According to our study results, after [Botox] injection, significant values were observed in the experimental group over time, and [tender points] decreased. Therefore, [Botox] injection can be suggested as a relatively effective treatment for patients with TMD presenting with [masticatory muscle pain] and headache compared to saline placebo.

If you’ve been living with TMJ pain that’s been unsuccessfully addressed by the usual splint therapy, we encourage you to give us a call to find out if Botox – or other alternative treatments that address your unique needs – might be a suitable alternative for you. TMJ pain isn’t something you just have to live with.

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