Botox Information for Grinding, Clenching, and TMJ

How does Botox work for TMJ, grinding, and clenching?

  • Botulinum A Toxin ("Botox" for short) is a muscle relaxant. It temporarily reduces the muscle contraction and therefore “relaxes” muscles. For TMJ treatment, Botox is used to relax the masseter muscle and possibly the temporalis muscle. The masseter muscles are found at the angle of the lower jaw. You can feel these muscles contract when you bite down hard on your teeth. These are the muscles that become well developed and enlarged in patients that have long-standing grinding and clenching of the teeth. The goal of Botox for TMJ issues is to relax the masseter muscles, relieve the clenching/grinding pressure, and reduce pain and/or headaches.

 

What are alternative treatments?

  • Most patients grind (bruxism) or clench their teeth at night on a subconscious level. An orthodontist should be consulted to see if there are bite problems that can contribute to bruxism. If the bite is not correct, then certain muscles will spasm/contract more and this can lead to TMJ pain. Bite correction can be done with Invisalign or braces. In some patients, bite correction is not possible for a variety of different reasons.

  • The first line of treatment is usually a nightguard. A nightguard will help protect the teeth and theoretically should minimize muscle contraction to reduce bruxism and clenching. While a nightguard can be effective for some patients, in long-standing cases, Botox can be used to supplement and remove the underlying muscle contraction issue.

 

What are the downsides of Botox for TMJ, grinding, and clenching?

  • Botox in any part of the face has a temporary effect and results last from 3-6 months. If a patient is happy with the results, then Botox treatments will need to be done when effects wear off. Since the masseter muscles are large and strong facial muscles, quite a few units of Botox are needed per treatment. There are financial considerations for the on-going treatments.

  • Rarely, the Botox can migrate to unwanted muscles and cause a temporary unwanted effect. While very rare, there can be mouth or facial asymmetry when smiling since these muscles are close in proximity. The effects wear off when the Botox wears off in 3-6 months.

 

What are other effects of Botox in the jaw muscles?

  • The masseter muscles targeted during the Botox treatments are at the angle of the jaw. Botox will cause these muscles to shrink in size, which is the goal of the TMJ treatment. Esthetically, the lower jaw will look more “slim” at the angles and give the face more of an oval shape. Most patients like the facial slimming effect and the same treatment is used for this esthetic result.

 

Who is a candidate:

  • Patients with long-standing grinding and clenching of the jaws and teeth

 

Who is NOT a candidate:

  • Pregnant patients or patients currently breast feeding

  • Currently taking antibiotics

  • Patients with diseases of the nerves or muscles (ALS, MS, Lambert-Eaton)

What does the procedure involve?

  • Botox is diluted to a very controlled solution and when injected into the muscles with a very thin needle, it is almost painless. Patients may feel a slight burning sensation while the solution is being injected. The procedure takes about 15 mins. There might be some bruising or redness at the injection sites afterwards. Botox takes about 2 weeks to fully start working, so you will not experience any immediate results after treatment but need to wait at least 1-2 weeks to notice changes.