Botulinum toxin injection, more commonly known as BOTOX® has been used as an alternative treatment for TMJ and related jaw pain. The treatment is injected into the muscles of the face and jaw where spasm and discomfort occurs. The injections relax the muscles and there by reduce the painful spasms.
A July 2024 study (1) evaluated the effects of low doses of botulinum toxin type A to control pain in patients with sleep bruxism, awake bruxism, and temporomandibular disorder (TMD) during a 180 day treatment period.
- thirty-five patients with chronic pain related to TMD, sleep bruxism, and awake bruxism received a single dose of 20 U of botulinum toxin type A in masseter and temporalis muscles. The pain was assessed with a visual analog scale (VAS recording pain scores from 0 – 10) before and after 15, 30, 60, 90, and 180 days of the application.
The three clinical conditions sleep bruxism, awake bruxism, and temporomandibular disorder (TMD) experienced decrease in pain after 15 days of treatment, the maximum pain relief persisted for up to 90 days after botulinum toxin type A application in patients with sleep bruxism and awake bruxism and 15 days for patients with TMD.
Conclusion: A low dose of botulinum toxin type A may be effective for controlling chronic pain related to sleep bruxism and awake bruxism, but TMD pain reduction was short-lived.
A September 2023 paper (2) assessed the effectiveness of myogenic (muscle-related) botulinum toxin injections. In this study involving 45 patients who received these injections in the temporalis and masseter muscles, the researchers observed a notable improvement in pain levels, functionality, and overall quality of life.
An October 2023 study (3) examined the effectiveness of botulinum toxin type A for patients suffering from temporomandibular disorders (TMDs) linked to masticatory muscle pain and headaches.
Twenty-one patients with myogenous (masticatory muscle) TMD were randomly divided into two groups. The experimental group received injections of botulinum toxin type A, while the control group was given saline, targeting areas that were tender after palpation across 16 muscle sites, which included each masseter, a temporalis, splenius capitis, sternocleidomastoid, and trapezius muscle.
During each appointment, the clinical outcomes were assessed based on the severity of orofacial pain, headache intensity, the number of tender points, maximum mouth opening, and headache frequency, evaluated before the injection and at 4, 8, and 12 weeks post-injection for both groups. In the botulinum toxin type A group, there were significant reductions in orofacial pain, tender points, headache severity, and headache frequency over time. However, no significant improvements were noted for maximum mouth opening.
In May 2024 research (4) doctors reviewed data from 15 studies involving 504 participants and found that botulinum toxin type A was more effective than a placebo in alleviating pain intensity, measured on a scale from 0 to 10, at both 1 month and 6 months. Additionally, a higher dosage of botulinum toxin type A (60-100 U bilaterally) was linked to a more substantial decrease in pain at the 6-month mark.
A June 2020 paper (5) critically investigated and assess the evidence relating to the use and efficacy of botulinum toxin in the management of temporomandibular joint disorders and masticatory myofascial pain. The researchers could not come up with a solid recommendation for botulinum toxin, writing: “Despite showing benefits, consensus on the therapeutic benefit of botulinum toxin in the management of myofascial temporomandibular joint disorders is lacking. Further randomized controlled trials with larger sample sizes, minimal bias, and longer follow-up periods are now needed.”
Is there a bone problem associated with botulinum toxin
A February 2020 (6) study aimed to clarify how masticatory muscle atrophy induced by botulinum toxin injection affects cortical bone quality of the mandible. A total of 39 young (average age about 27) and 38 post-menopausal (average age about 55) females were included. Computed tomography (CT) images were obtained before and after 12 months of treatment.
The patients had an application of a stabilization splint, and/or two times of botulinum toxin injection in the bilateral temporalis and masseter muscles within a six-month interval. In patients a decreased masticatory muscle thickness was noted that may lead to alterations of the mandibular cortical structures, especially in post-menopausal females. The botulinum toxin injection may induce muscle atrophy that damages the jaw bone.
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References
1 de Lima MC, Rizzatti Barbosa CM, Duarte Gaviao MB, Ferreira Caria PH. Is low dose of botulinum toxin effective in controlling chronic pain in sleep bruxism, awake bruxism, and temporomandibular disorder?. CRANIO®. 2021 Sep 16:1-8.
2 Hosgor H, Coskunses FM, Altindis S. Assessing change in functional outcomes and quality of life in myogenic temporomandibular disorders undergoing botulinum toxin injection: A before and after comparison. Journal of Stomatology, Oral and Maxillofacial Surgery. 2023 Sep 1;124(4):101434.
3 Kim SR, Chang M, Kim AH, Kim ST. Effect of Botulinum Toxin on Masticatory Muscle Pain in Patients with Temporomandibular Disorders: A Randomized, Double-Blind, Placebo-Controlled Pilot Study. Toxins. 2023 Oct 4;15(10):597.
4 Li K, Tan K, Yacovelli A, Bi WG. Effect of botulinum toxin type A on muscular temporomandibular disorder: A systematic review and meta‐analysis of randomized controlled trials. Journal of Oral Rehabilitation. 2023 Dec 27.
5 Thambar S, Kulkarni S, Armstrong S, Nikolarakos D. Botulinum toxin in the management of temporomandibular disorders: a systematic review. British Journal of Oral and Maxillofacial Surgery. 2020 Jun 1;58(5):508-19.
6 Hong SW, Kang JH. Decreased mandibular cortical bone quality after botulinum toxin injections in masticatory muscles in female adults. Scientific reports. 2020 Feb 27;10(1):1-2.