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Why You Need Botox for TMJ and Jaw Joint Pain

You may have heard about Botox, typically for cosmetic reasons—whether you have wrinkles, the “11s,” crow’s feet, laugh lines, or even sweaty armpits. There are lots of reasons people get Botox. While we don’t treat sweaty armpits in my office, Botox is a fantastic option for cosmetics. But one thing most people don’t know is that Botox is also a great treatment for jaw pain and TMJ disorders.

We treat a lot of patients with pain caused by clenching and grinding their teeth. This can lead to headaches, poor sleep quality, insomnia, tiredness the next day, and overall fatigue. Many of these issues can stem from clenching and grinding, and that’s where Botox comes in.

First-Line Treatment: Splint Therapy

My first go-to for patients who present with jaw joint pain is some kind of splint therapy, usually a night guard. This helps prevent the muscles from firing off during the night. But sometimes, whether it’s due to tension, lifestyle, or other factors, a night guard isn’t enough. In those cases, Botox can be a useful additional treatment.

Understanding the Jaw Joint and Its Muscles

The jaw joint, also known as the TMJ, is a very complicated joint. To explain it simply, your elbow is a hinge joint that moves in one direction. Your shoulder is a ball-and-socket joint, which rotates in a circle. The jaw joint is a combination of both. It has a sliding component, so it’s more complex. You have your skull, and then your bottom jaw (the mandible) comes up and sits in a little fossa. There’s a tiny disc that acts like a cushion, kind of like a shock absorber.

As your jaw moves, the ball of the joint slides around, and the TMJ capsule protects everything. But over time, the joint can really take a beating, and the little ligament can get worn down. This can lead to pain when opening your mouth, clenching, or even doing any strenuous activity with your mouth.

The Muscles of Mastication

There are four main muscles involved in chewing. The biggest one is the masseter muscle, located on the side of your jaw. Sometimes, people who clench or grind their teeth will develop enlarged or hypertrophied masseter muscles. This is similar to how a weightlifter’s muscles get bigger with constant use.
Another muscle that helps with opening and closing the mouth is the temporalis, which is located near your temples. People with tension headaches often experience tightness in this area, which can be caused by clenching. There are two other smaller muscles, but we won’t focus on those today.

How Botox Treats Jaw Pain

When we use Botox for jaw pain, we target the temporalis and masseter muscles, focusing mostly on the masseter. A lot of patients will come in and say, “My right side hurts more than the left; can we just treat that side?” But that’s absolutely not okay. It’s important to treat both sides of the jaw with Botox, because only treating one side can throw off the alignment of the jaw joint. So, if you ever go somewhere for TMJ treatment and they only want to treat one side, I would recommend getting a second opinion.

Is Botox Safe?

Another common question is, “Botox is a poison, right? You’re going to put poison in my mouth?” That’s not it at all. Botox essentially reduces the strength of muscle contractions. So, after Botox, you’ll still be able to chew, talk, and move your mouth. You won’t be slack-jawed or droopy. Botox just takes some of the intensity off the muscle contraction.
We typically inject Botox at the base and top of the masseter muscle (the big muscle responsible for opening and closing your mouth) and also in the temporalis muscle near the temples. These two muscles are the main culprits behind tension headaches and jaw pain.

Botox Dosage for TMJ

When we use Botox for cosmetic purposes, we generally use around 20 to 30 units. For TMJ, we use about 100 units—30 units for the temporalis muscles and 70 units for the masseter muscles (35 units on each side). It’s a significantly larger dose than what’s used for cosmetic Botox, but it’s necessary to overcome the strong contractions of these muscles. Don’t worry—Botox is very safe, and you would need about 100 bottles of Botox to even approach any toxic level.

What to Expect After Botox Treatment

Botox typically takes about two weeks to fully take effect and reduce muscle contractions. When combined with a night guard, it can almost completely eliminate nighttime clenching and grinding, as well as the muscle soreness that comes with it.

How long does Botox last? Most people notice the effects of Botox for about three months, sometimes up to six months. The first dose is usually the largest. After six months, if you notice clenching coming back, we can use a smaller dosage for maintenance since the muscles will already be weaker than before.

Cosmetic Benefits of Botox for TMJ

An added benefit of Botox for TMJ is that patients with overdeveloped masseter muscles often notice a slimming effect on their face. As the muscles shrink down over time, it can give the face a sleeker, more aesthetic appearance.

Botox for Limited Jaw Opening

Another use for Botox in TMJ treatment is for patients who have limited jaw opening. One patient had a severely limited ability to open her mouth, which affected her ability to eat, chew, and maintain proper oral hygiene. After just one Botox treatment, her range of motion improved significantly. That treatment was about three or four years ago, and she still has great range of motion to this day. While it may not seem like a big deal, this was life-changing for her.

Conclusion: Don’t Suffer from Jaw Pain

If you find yourself suffering from jaw pain, muscle soreness, or limited jaw opening, and even something as simple as touching the muscles inside your mouth causes pain, come see us. We’d love to talk with you and determine if Botox might be the right solution to get you back on track.
I’m Dr. Brett Langston, and we’re here to help you watch your mouth!

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