There are instances where Botox can facilitate treatment for TMD. However, in some cases Botox can cover the underlying problem causing pain and hinder rehabilitation. Knowing when to use Botox is the most important question.
TMJ problems, or TMD, involve usually joint symptoms such as clicking, locking, dislocated cartilage, etc.
Joint damage and dysfunction triggers reactions in the muscles of the jaw, neck and face that are painful or limit mobility. With chronic joint damage, sometimes the muscles will remain in a tightened or contracted state and for those situations, Botox can be of help. That’s why it is used for chronic migraine sufferers as a means to decrease the muscle component of pain.
In treating TMJ problems I focus on rehabilitating the joints, which will typically “shut off” the muscle contraction and pain. In cases where we can’t completely eliminate muscle pain, Botox can be used.
Botox works by chemically “paralyzing” a muscle for up to 90 days. Botulism Toxin is a serious poison in its pure form. Scientists estimate a gram of pure Botox could kill 1 million people! Botox is diluted in its treatment of migraines, muscle contraction conditions (such as chronic neck spasms), vocal cord spasms, and other painful conditions associated with muscle spasms. Its primary use in recent years is for the cosmetic removal of wrinkles. The chemical effects slowly fade over time and re-injection is needed to maintain the muscle “paralysis”, which either helps with pain or maintains the “wrinkle-free” skin. The muscles can still contract, obviously, but at a lower force and a lowered quantity of “muscle cells” per muscle.
In my approach, Botox can be effective to help alleviate painful muscles associated with TMD. My preference is to start with joint traction/decompression with orthotics, use physical medicine to restore mobility in the neck if needed, and then re-evaluate whether there is non-responding muscle pain that might benefit from Botox. In some cases, where the muscles of the head and neck are so tight and painful, Botox can be helpful in eliminating pain and allow the other therapies to restore joint mobility during that period of Botox action.
As a sole means for treatment, Botox can alleviate pain, but may mask the underlying conditions that contribute to the pain, such as a “dislocated” disc in the Temporomandibular joint or problems in the upper neck. As a sole means of treatment Botox wouldn’t be my recommendation any more than a prescription for “pain pills” or “muscle relaxants” as “treatment”.