What’s TMJ/ The temporomandibular joint (TMJ) is where the jaw bone (mandible) connects to the skull (temporal bone). The joint was crucial in our evolution as it allows us to do movements other than just vertical chewing. As with every joint, there is a pad or disc that separates and cushions the two articulating bones. Just imagine how this little disc has to move around to keep up with the movements of the jaw.
Adduction of the mandible, or mouth closing, is performed by the actions of the masseter, temporalis, and medial pterygoid muscles. Abduction, or mouth opening, is performed by the lateral pterygoids and digastrics musculature.
The Problem
With the complexity, here comes the problem. The joint essentially can “dislocate” and move up and down a ramp at the base of the skull. Even though there are just two joints at each side of our heads, we can wiggle our jaw back and forth.
When people say TMJ, they are often referring to pain or discomfort anywhere along the jaw, which may also include some neck muscles. But because the pain is not just located at the joint, a more accurate term for the condition may actually be Temporomandibular Disorders. This refers to the conditions involving pain or dysfunction of the joint and/or surrounding tissues. These disorders may interfere in the overall quality of ones’s life.
Bruxism indicated clenching or grinding of the teeth, either in sleep or when the patient is awake. Chronic teeth grinding can cause headache, earaches, facial pain, and even migraines. Dental problems from bruxism include lose of tooth enamel, increased tooth sensitivity, and flattening and/or chipping of the teeth. The cause is believed to stem from brain signals that lead to involuntary and forceful contraction of jaw muscles. Some evidence suggests a genetic predisposition, but bruxism may also stem from stress and anxiety, an abnormal bite or crooked or missing teeth. In addition, the effects of some drugs, including caffeine, may play a role. Bruxism may also affect the facial appearance of the patient.
The Symptoms
- Increased tooth sensitivity
- Jaw or face pain or soreness
- Tired or tight jaw muscles
- Teeth that are flattened, fractured, chipped or loose
- Wearing off tooth enamel/dentin.
- Pain that feels like an earache, though it’s actually not a problem with your ear
- Dull headache originating in the temples
- Indentations on your tongue
- Enlarged masseter muscles
The Solution
Treatments for TMD range from non-pharmacologic therapy, conservative pharmicotherapy and open surgery. Botox injections can be indicated in such patients where other treatment plans have failed to work.
Botox injections for TMJ uses botulin toxin type A injected into the joint or the affected muscles to essentially paralyze whichever areas are causing pain and damage.Botox injection causes partial paralysis of muscle so that the patient will not be grinding his teeth.
The effect may appear after a gap of two to three weeks.
NOTE – It is especially important to note that this treatment, although effective for pain, does not address the cause of your TMJ.
The Procedure
- Inject a small dose of botox directly into the corresponding muscle, which will ultimately get relaxed and grinding will itself reduce.
- Damage to the TMJ (temporomandibular joint) and headaches should be reduced or eliminated as well. Voluntary movements, such as chewing and facial expressions, are not effected at all by botox.
The Side Effects
- Headache
- Respiratory infection
- Flu-like illness
- Nausea
- Temporary eyelid droop
- Fatigue
- Double vision
- Skin irritation
- Rash at injection site
- Pain
- Redness at the site of injection
- Muscle weakness
- Bruising at the injection site
The Type of Patients That Botox Therapy Helps
Botox is not suitable for every patient. Care must be taken as to when to use it, how to use it, and who is a good candidate. There are times when muscles hurt even though they have not been overused. For patients who are in extreme stress, botox therapy won’t help much. Instead, counseling, talk therapy, cognitive behavioral therapy, may be better options.
Ideal patients may be fitting into the following categories.
- If One Currently Wears a Night Guard, and still have morning symptoms of muscle pain or tightness, joint noises, locking, and/or pain, they may be a good candidate for Botox.
- If You Can’t Tolerate A Night Guard and have tried various types, with your dentist’s guidance, Botox injections for TMJ may provide meaningful benefit.
- If your jaw muscles are just too big and visibly over-built, Botox may be an option. One of the predictable things that Botox does is reduce muscle bulk when used over time thereby giving one a more natural look.
FAQ
Q: How does Botox help lessen grinding teeth at night?
A: Because teeth grinding occurs as a result of a clenched jaw muscle, Botox helps to lessen the muscles ability to clench tightly, therefore resulting in a decrease in the amount of grinding.
Q: What is the cost of Botox for teeth grinding?
A: Though the cost is very dependent upon the individual, seriousness of your teeth grinding will play a part in determining how many injections you’ll need.
Q: Can a pregnant patient get Botox Injections?
A: It’s ideal to have an experienced Botox injector perform your treatment. Because I am a board certified head and neck surgeon with a specialty in facial plastics, I can bring a unique knowledge of both function and aesthetics to my patients difficult to find elsewhere.
Q: Can anyone perform Botox Injections?
A: No, It’s ideal to have an experienced Botox injector perform your treatment, probably a board certified dentist.
Q: Where is Botox injected?
A: To help prevent Bruxism, Botox is injected into the masseter muscles located in the jaw and the temporalis muscle in the scalp. This helps reduce the amount of grinding while sleeping.
Q: Why to prefer Botox over Conventional Therapy?
A: The best part about using Botox for either conditions is that the toxin doesn’t interfere with voluntary jaw movements; patients can speak, eat, and make the same facial expressions just as they normally would without the treatment. Along with the diminished appearance of wrinkles and a slimmer jawline
References
- Ayes Milanlıoglu Paroxetine-induced severe sleep bruxism successfully treated with buspirone. Clinics (Sao Paulo). 2012 Feb; 67
- Persaud R, Garas G, Silva S, Stamatoglou C, Chatrath P, Patel K (February 2013). “An evidence-based review of botulinum toxin (Botox) applications in non-cosmetic head and neck conditions”. JRSM Short Reports.
