There is an alarming trend for treating the symptoms of TMD with the neurotoxin botulin toxin type A or botox.  Those who administer botox for myofascial (muscle) pain either do not understand the underlying cause of the muscle pain or do not know how to treat it.  As a neurotoxin the prolonged use of botox can cause severe weakening of the muscle.

Yet another potential problem with Botox injections results from its paralyzing effects on the muscles. In some patients, the long period of decreased muscular activity resulting from repeated botox injections leads to muscle atrophy (wasting away) and even facial deformity.

There is also some evidence that it can result in decreased density of the jaw bone (osteopenia). Studies have shown that Botox used to induce paralysis in animals can cause enduring bony (osteopenic) changes. Because of this, a recent clinical study in humans was undertaken to examine bone-related consequences of Botox injections in the masticatory (chewing) muscles. The study was controlled, meaning that one study population was given Botox and the other wasn’t. The Botox recipients showed evidence of bony changes consistent with osteopenia. Researchers noted decreased bone density in all participants exposed to Botox, but no bone-density decrease in the unexposed participants.

In addition to muscle weakness and even destruction of the muscle, there are other significant cons to botox therapy for TMD that include:

  1. The misplacement or migration of the injection can lead to severe symptoms
  2. A number of patients suffer allergic reactions to the botox
  3. About one percent of patients develop severe headaches that can persist for weeks afterward
  4. Some patients also develop antibodies against the toxin, meaning that it will take more and more of the drug to produce any noticeable effect
  5. Another drawback to Botox treatment is that rather than being a permanent solution, it offers at best a temporary fix. Botox injections typically become ineffective after a period of weeks or months, and generally need to be repeated each time with diminishing efficacy
  6. These findings should be tested in a larger sample, and over a longer time period, to ensure safety of TMD patients receiving multiple Botox injections for their pain

If there were no other treatments available for jaw muscle pain, the argument for trying Botox injections might be stronger. However, there are presently a number of less invasive treatments that get to the root cause of the pain and that treat that cause rather than the symptom!!

Here are the remarks of another TMJ specialist on the use of botox for TMD:

“TMJA1 – Thursday, July 17, 2014
I found the report by Dr. Raphael about studies that seem to show the potential of Botox injections into the masticatory muscles to treat myofascial pain causing decreased bone density in the temporomandibular joint very informative. However, it is important for patients to understand that there are also other reasons why one should be cautious about having such injections (1). It has been shown that some patients who received multiple Botox injections into the temporalis muscle for the treatment of headaches developed so-called disuse atrophy (wasting or loss of muscle tissue), resulting in a disfiguring depression on the side of the head (2). In fact, this adverse effect of Botox injections has actually been used to treat masseteric hypertrophy (bulging masseter muscles), so it could also occur in patients with myofascial pain who have normal-shaped masseter muscles. Secondly, some patients may develop an immune response (antibodies) to Botox that would then block its action and make the injections ineffective. Finally, and perhaps most importantly, such injections are being used to treat the symptoms of myofascial pain but not the cause of the problem, which is an illogical way to approach this situation. Daniel M. Laskin DDS, MS Clinical Advisor, The TMJ Association 1. Botulinum toxin A in the treatment of myofascial pain and dysfunction: the case against its use. Laskin DM. Oral Maxillofac Surg 70; 1240-1242, 2012. 2. Hourglass deformity after botulinum toxin type A injection. Guyuron B et al. Headache 44; 262, 2004.”

A properly trained TMD dentist who has taken significant post graduate training in TMD can properly diagnose and in most cases treat the condition and eliminate the source of the pain via a minimally invasive course of therapy.

If someone is recommending botox injections to alleviate TMD associated pain, I would strongly encourage you to seek a second opinion from a properly trained TMD dentist.