Beyond Wrinkles — Why Botox Works for Jaw Pain and TMJ

Contributor: Michael P. Horan, MD, DDS, PhD

Most people think of Botox® or botulinum toxin A as a wrinkle fighter, a toxin to turn back time. However, in recent years, it has become important for treating many problems that have nothing to do with looking good — and everything to do with feeling better.

In fact, it can help many patients with pain in the mouth and jaw, including temporomandibular joint (TMJ) disorders. It works especially well when used along with physical therapy, medication and splint therapy as needed. Together, these help address muscular jaw pain common in people with TMJ problems.

Breaking the chronic pain cycle

Botulinum toxin A works by blocking nerves in the muscles where it is injected, temporarily weakening them. While this agent can completely paralyze a muscle, the goal is only to substantially weaken it. This reduces the hyperactivity of jaw and related muscles working too hard, and helps break the chronic pain cycle.

It can help with pain on one or both sides of the mouth and jaw. It is also effective at treating dull, aching pain (rather than sharp pain, which is more associated with joint or disc-related problems). Trigger points can often be identified in these muscles.

Researchers also have found that botulinum toxin A can effectively reduce muscular jaw pain in people who had not responded to other conservative treatments. We have achieved similar results in our patients at Cleveland Clinic. In most cases, these patients have experienced a noticeable reduction in pain, with some even experiencing a complete resolution.

Effective for other jaw problems

More recently, we have begun using botulinum toxin injections for patients with chronic TMJ dislocation, which occurs when the joint moves out of place.

These injections have been effective in treating patients with this problem who:

• Are chronically ill.
• Habitually dislocate their TMJ.
• Are elderly and unable to tolerate surgical treatments.

The goal is to weaken the muscles that can cause TMJ dislocations.

To be sure we weaken the correct muscle in this sensitive area, we use special electromyographic guidance technology to target the muscle. This greatly reduces the chances of paralysis of the surrounding muscles and the associated complications. Several case reports have been published that support this as an effective, long-term treatment.

Botulinum toxin has been called “the poison that cures,” and this certainly holds true for many head and neck conditions involving muscles acting out of turn. It can offer benefits to many patients with jaw pain.