BOTOX for TMJ

Your comprehensive guid for using BOTOX treatment for TMJ disorder, TMJ pain, headache, masseter muscle size reduction, jaw reduction and facial esthetics, explained by BOTOX for TMJ specialist in Los Angeles

Many health care professionals are promoting the use of BOTOX for TMJ pain, headaches, Orofacial pain and masseter muscle size reduction. Does it really work? This post will discuss this subject in details. Dr. Khalifeh recommends reading the full article for better understanding about using BOTOX for TMJ and other chronic pain conditions.

What is BOTOX?

BOTOX or Botulinum Toxin is a nerve toxic protein produced by bacteria Clostridium Botulinum (Group I, II, III & IV) and related bacteria.

BOTOX and other commercially available Botulinum toxins are widely used by medical professionals for facial esthetics to remove wrinkles and frown lines.

Dr. Khalifeh will be discussing the medical none-cosmetic uses of BOTOX and similar products.

BOTOX is the most potent toxin known to human, natural or synthetic. This toxin can cause a severe flaccid paralytic disease in humans and other animals called Botulism.

The BOTOX producing bacteria (C. botulinum) was first recognized and isolated in 1895 by a Belgian scientist Emile Van Ermengem from home-cured ham implicated in a botulism outbreak.

People get infected either by eating contaminated food or by open wounds exposed to contaminated soil.

In 1973, Dr. Alan B. Scott, of Smith-Kettlewell Eye Research Institute, used BOTOX type A in monkey experiments; in 1980. He used BOTOX type A for the first time in humans to successfully treat crossed eyes.

In December 1989, BoNT-A (BOTOX®) was approved by the FDA for the treatment of crossed eyes, abnormal contraction and twitch of the eyelid, and hemifacial spasm in patients aged younger than 12 years.

What are the Types of BOTOX?

There are 8 types of Botulinum Toxins:

A, B, C1, C2, D, E, F and G

Only Types A, B, E and F can cause disease in humans.

What is a BOTOX Unit (mouse unit)?

A BOTOX unit also called mouse unit (MU) is the amount of toxin required to kill a 20g mouse in 15 minutes via Intraperitoneal injection.

1 gram = 1000,000,000 ng

1 ng of BOTOX = 20U

What BOTOX Commercial Preparations are Available?

• OnabotulinumtoxinA (BOTOX®; Allergan; Irvine, Calif)
• AbobotulinumtoxinA (Dysport®; Ipsen; Paris, France)
• IncobotulinumtoxinA (Xeomin®; Merz Pharmaceuticals, Frankfurt, Germany)
• CS-BOT (Chiba Serum Institute; Chiba, Japan)
• Prosigne®; (Lanzhou Biological Products Institute, China)
• Nabota and Medytox (South Korea)

Which Medical Conditions can be Treated with BOTOX?

As of today, US FDA approved the use of BOTOX for the following medical conditions:

• Muscle spasm
• Muscle twitches
• Chronic migraine
• Cervical Dystonia
• Hyperactive bladder
• Severe underarm sweating
• Neuralgias and
• Crossed eyes.

Which Dental and Orofacial Conditions can be Treated with BOTOX?

BOTOX is used to treat the following conditions in the oral – facial region:

• Myofascial pain syndrome
• Muscles spasm
• Neuropathic pain
• Masseter muscle hypertrophy
• Hyper salivation (drooling) and
• Jaw line improvement
• Oromotor disorders (ticks and twitches).

Does BOTOX Help TMJ Disorder Pain?

A systematic review and meta-analysis authored and published in 2016 by Dr. Mohammad Khalifeh, et al., concluded:

“ In patients with myofascial pain in the head and neck regions, pain was reduced significantly in the group received BOTOX injection compared to placebo group at 2-6 months but not at 4-6 weeks after injection”. This can be translated to: BOTOX for TMJ give long term pain relief in patients with myofascial pain syndrome. In short term, BOTOX was not better than placebo.

Dose Botox Stop Sleep Bruxism, Teeth Clinching and Grinding?

A published clinical research by Dr. Ondo et al. found that:

“BOTOX for TMJ effectively and safely improve sleep bruxism by reducing the force of muscles contraction but it does not eliminate or reduce the number of bruxism events”. In conclusion, the answer to this question is: No. You should not use BOTOX for TMJ  as your first choice to treat teeth grinding.

Does BOTOX Treat Trigeminal Neuralgia (TN) and Post Herpetic Neuralgia (PHN)?

A systematic review by Dr. T. Shackelton, et al, found that BOTOX-A is effective in the treatment of TH and PHN with moderate evidence. Therefore, BOTOX is a valid treatment choice for TH and PHN. 

Does BOTOX Treat Migraine Headaches?

Several studies revealed that BOTOX can be effective in the treatment of chronic migraine headaches. However, the BOTOX injections usually need to be repeated every 4 months. In addition, you should know that the Zytase, a Zinc-supplement if taken few days before the treatment could increase the treatment duration of BOTOX. Generally speaking, you should not use BOTOX as first choice for treating migraine. 

How Does BOTOX for TMJ Reduce TMJ Pain?

The neurotransmitter Acetylcholine which is made and stored in the motor nerve endings that innervate the skeletal muscles should be released and reach the muscle fibers in order for these fibers to contract. BOTOX prevent the release of Acetylcholine. In other words, no acetylcholine release means, no muscle contraction and less pain. 

How Does BOTOX Reduce Migraine Headache and Myofascail Pain?

In 2017, Dr. Khalifeh reviewed and approved the publishing of an animal study done by Dr. C. Fan, et al., The study revealed an important discovery that BOTOX injected in the muscles, skin or any other body structure travels through the peripheral nerves to the second order neurons in the central nervous system (CNS). These nerves located in the dorsal root ganglia of the spinal cord and corresponding structures of the brain. This animal study found that BOTOX exert its effect by blocking pain receptors in the CNS.

How Long After having BOTOX for TMJ Till You Start Feeling the Results?

The initial effect start 3 to 5 days after treatment, but it can take up to 14 days after treatment for the full results to become apparent. 

How Long Does BOTOX for TMJ Treatment Last?

In general, the effects of the BOTOX will last for 3-4 months after injection. However, some TMD patients reported that the positive effects last for longer than 3-4 months.

How Many Units of BOTOX for TMJ Do I Need?

In most cases, an average of 20-50 units is used for each side of your face injected into the temporalis and masseter muscles. On your follow up appointment, Dr. Khalifeh might increase or decrease the dose during your next BOTOX session based on your condition.

Does Masseter BOTOX Help Face Slimming and Jaw Muscles Size Reduction?

BOTOX causes partial paralysis of the injected muscles, the muscle size will be reduced. This will cause muscles size reduction. The injected temporalis or masseter muscle loose volume and become smaller and weaker. However, this is a good side effect of BOTOX for TMJ.

Masseter BOTOX Before and After, Los Angeles, CA

These photos are for the same patient who was given BOTOX in her masseter and temporals muscles by Dr. Khalifeh to treat her TMJ and facial pain. She has an enlarged masseter muscle that was reduced in size after BOTOX injection. Notice, the right masseter muscle was larger than the left one. Generally speaking, Dr. Khalifeh recommends BOTOX for TMJ pain for patients with both pain and masseter muscle enlargement.

What are the Contra Indications for Using BOTOX for TMJ?

You shouldn’t get BOTOX if you have any of the following conditions:

• Allergic to the Botulinum toxin or the human Albumin.
• Medical conditions such as Myasthenia Gravis, Eaton-Lambert Syndrome, bleeding disorders.
• However, some medications like Aminoglycosides, Penicillamine, Quinin, and calcium channel blockers can increase the effect of Botulinum toxin and should not be used cat the same time.

Are There Any Side Effects Associated With Using BOTOX for TMJ?

Generally speaking, BOTOX is considered very safe if used correctly. Some minimal side effects can occur after treatment, including redness in the injection site and muscle weakness. The most common side effects of Botox for TMJ treatment are:

• Mild pain in the injection site.
• Nausea.
• Headaches.
• Flue like symptoms.
• Muscle weakness.
• Masseter muscle size reduction.
• Bruising of the injection site.

In conclusion, the procedure is considered painless, some patients might experience mild discomfort in this area.

BOTOX treatments for TMJ pain is promising but is not approved by the FDA, it’s an “off-label use”. It is important that TMJ treatment using BOTOX performed by an experienced dentist such as an Orofacial Pain and TMJ specialist, to ensure the safety and effectiveness of the procedure. Dr. Khalifeh is a TMJ specialist, he is experienced in the use of Botox for TMJ pain treatment.

What are the Advantages of Using BOTOX for TMJ ?

One of the advantages of BOTOX for TMJ is that normal functions such as speaking, swallowing, and eating will not be affected. In addition, treating TMJ can also prevent serious teeth and gum problems from occurring later. You should know that BOTOX is:

• Safe if used as indicated
• Can be used with other TMJ treatments
• Treatment effect last 3-4 months
• Effects are very localized and dose dependant

How Much Does TMJ BOTOX Cost in Los Angeles?

BOTOX for jaw pain is not the first TMJ treatment option. However, the cost for using BOTOX for TMJ pain is relatively expensive. In Los Angeles area, the average cost for jaw BOTOX is $800 to $2,000 per treatment visit.

Most TMJ patients require 3 treatment sessions. You may search for “BOTOX for TMJ near me” so that you get better idea about location-specific cost.

Does Insurance Cover BOTOX for TMJ?

This will depend on your insurance policy. Medical insurance may cover BOTOX for Headache if you meet certain criteria. Contact your insurance company to get a clear answer about this topic. 

Medical insurance companied cover BOTOX for chronic migraine only if a patient show no relief after trying 3 other migraine medications for 6 months. 

What to Expect During the Procedure?

BOTOX for TMJ pain is a nonsurgical procedure. Dr. Khalifeh can do it right in his office. Each treatment session takes 10-20 minutes.

• We will decide the number of injections you will need.
• You will likely receive several injections throughout your jaw muscles.
• You may return to your normal daily activities as soon as you leave the office.
• Don’t rub or massaging your face for a few hours after treatment to prevent the BOTOX from spreading to other muscles.
• You’ll begin to feel some improvements within a day or two after treatment.
• You should start feeling the effect of BOTOX in 3-5 days after the injection.

That’s it! It’s really quite simple and the treatment will last about 3-4 months. 

What Other Things I Need to Know Before Getting BOTOX for TMJ?

• BOTOX is not the first treatment choice for TMJ or orofacial pain. Generally speaking, Dr. Khalifeh recommend BOTOX for TMJ whenever other treatment options fail. 
• BOTOX is relatively more costly when compared to other commonly used treatment options.
• Not all TMJ patients respond to BOTOX treatment.
• BOTOX for TMJ might weaken the chewing muscles and could reduce the density of the jaw bone specially if used frequently.
• Only an experienced medical professional should recommend and administer BOTOX for TMJ and masseter muscle. 

In conclusion, BOTOX is just one tool Dr. Khalifeh use to treat TMJ disorders. He’ll determine the cause for your TMJ pain and work to treat the source of your pain, not just the symptoms. If you have jaw trauma, a bad bite, or poor posture, Dr. Khalifeh will work on a treatment protocol to correct your problem. You need a dentist who is highly trained in treating TMJ problems. For additional questions on BOTOX for TMJ, BOTOX for migraine headache and BOTOX for myofascial pain, ask the Los Angeles TMJ specialist and BOTOX expert, Dr. Khalifeh.

What Other Treatment Options for TMJ Disorder Pain?

BOTOX is not the only treatment for TMJ. Other treatments and recommendations for TMJ include:

• Work on relaxation techniques.
• Physical therapy.
• Heat and cold treatment.
• Ultrasound.
• Medications.
• Acupuncture.
• Message. 
• Surgery.
• Mouth guards. 
• Posture training.
• Keep your teeth apart when not eating.