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WILDERMAN MEDICAL CLINIC
Botulinum Toxin Injections for Bruxism and Temporomandibular Joint Disorder
Botulinum toxin injections (BTI), most commonly known as Botox, are best known for their use as a cosmetic treatment. In the medical field, BTIs are used to treat chronic pain and severe muscle spasms when other treatments have not provided adequate pain relief (Padda & Tadi, 2023).
BTI works by relaxing muscles through paralysis and blocking pain in the nerves. It lasts about 3 months and is considered a safe treatment for people who have chronic pain related to a muscular or nervous disorder.
The use of BTI for bruxism and/or temporomandibular joint disorder (TMJ) is considered an off-label treatment, meaning that it is not a formally approved use of BTI.
How Does Botulinum Toxin Work?
BTI is essentially the introduction of a safe, purified bacterial strain of Clostridium botulinum, which is responsible for botulism food poisoning, into the body through an, or a series of, injection(s). The bacteria create a substance that prevents acetylcholine, a neurotransmitter responsible for movement, from binding to a muscle’s receptors.
Through this mechanism, BTI prevents those muscles from contracting, forcing them into a state of relaxation or paralysis. By preventing acetylcholine from attaching to its receptors, the nerve’s ability to send pain signals to the brain is also reduced. Since fewer signals are being sent, the level of pain felt is reduced as well. The state of paralysis allows the muscle(s) to rest and heal from any muscular injury.
This is why BTI is a good pain management option for people with muscle- or nerve-related pain issues, especially if other treatments haven’t provided good results. It provides long-term pain relief with a minimally invasive procedure and few side effects.
Bruxism
Bruxism, more commonly known as teeth grinding, is a disorder that can lead to significant teeth damage (Lal et al., 2022). An estimated 8% of people suffer from or have suffered from bruxism in their lives.
Stress, anxiety, and/or a heightened emotional state can trigger teeth grinding. In some cases, medications, caffeine, and/or upper-type recreational drugs can cause bruxism. Bruxism can also happen due to other health conditions such as Parkinson’s disease, reflux (gastroesophageal reflux disorder), epilepsy, and/or sleep apnea.
Bruxism is defined by teeth grinding, which may be hard enough to cause an audible sound, cracked or chipped teeth, exposed tooth nerve due to enamel deterioration causing pain or sensitivity, tension headaches, and/or jaw soreness. The usual treatments for teeth grinding are lifestyle changes, psychotherapy to address any source of anxiety or stress, a CPAP (for apnea), a mouthguard, or dental work to address existing damage.
Temporomandibular Joint Disorder
TMJ is defined as pain or soreness caused by the temporomandibular joint, located on either side of the jaw (Prevalence of TMJD and Its Signs and Symptoms, 2018). It affects an estimated 8-12% of people, with younger women/AFAB being more likely to report TMJ. It can be caused by a traumatic injury, a joint infection, or another disorder such as an autoimmune disorder or bruxism. Its main symptom is pain at one or both sides of the jaw, which may be accompanied by clicking noises when moving the jaw, headaches, or earaches.
Treatment options range from physiotherapy to medications to, in extreme cases, surgery.
Botulinum Toxin Injections for Bruxism and Temporomandibular Joint Disorder
The use of BTI to treat bruxism and TMJ is a new treatment option that is still being researched. As such, BTI is recommended only when more conventional and well-researched treatments do not provide adequate relief, but before more invasive treatments are offered.
When used to treat bruxism, BTI has been shown to help reduce the frequency, intensity, and pain associated with teeth grinding (Fernández-Núñez et al., 2019). By injecting the jaw muscles with botulinum toxin, the muscles are unable to clench tightly or in the motion that is characteristic of bruxism.
However, there needs to be more research to determine the best dosage, location, and frequency of BTI treatments (Patel et al., 2019). There is limited research on the effectiveness of BTI for TMJ (La Fleur & Adams, 2020; Chen et al., 2015). Other treatment options for TMJ should be considered before any consideration is given to the use of BTI for this disorder.
What to Expect
BTI is a series of injections in and around a specific area, usually at the source of pain, by a trained medical professional (Padda & Tadi, 2023). It can take 3 to 4 days to show its effect, with the optimal benefits taking up to 2 weeks to be felt. The pain relief from BTI usually lasts about 3 months, but this may change from one individual to another.
Side Effects
The side effects of BTI are usually mild and disappear on their own. The most common side effects are mild headaches, fatigue, nausea/vomiting, pain or discomfort at the injection site, and/or flu-like symptoms.
Some side effects can take longer, up to 2 weeks, to disappear, including drooping eyelids, excessive salivation, and mild facial paralysis. Some more serious side effects may require medical assistance, mainly long-term dry eyes or an infection.
However, some rare but serious side effects require immediate medical attention. If you experience any difficulties breathing, swallowing, or speaking; sudden generalized muscle weakness; and/or sudden issues with your vision, please call your emergency services.
Reference
Chen, Y., Chiu, Y., Chen, C., & Chuang, S. K. (2015). Botulinum toxin therapy for temporomandibular joint disorders: a systematic review of randomized controlled trials. International Journal of Oral and Maxillofacial Surgery, 44(8), 1018–1026. https://doi.org/10.1016/j.ijom.2015.04.003
Fernández-Núñez, T., Amghar-Maach, S., & Gay‐Escoda, C. (2019). Efficacy of botulinum toxin in the treatment of bruxism: Systematic review. Medicina Oral Patologia Oral Y Cirugia Bucal, 0. https://doi.org/10.4317/medoral.22923
La Fleur, P., & Adams, A. (2020). Botulinum Toxin for Temporomandibular Disorders: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines. Canadian Agency for Drugs and Technologies in Health.
Lal, S. J., Sankari, A., & Weber, K. K., DDS. (2022, October 12). Bruxism Management. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482466/
Padda, I. S., & Tadi, P. (2023, November 6). Botulinum toxin. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK557387/
Patel, J., Cardoso, J. A., & Mehta, S. B. (2019). A systematic review of botulinum toxin in the management of patients with temporomandibular disorders and bruxism. British Dental Journal, 226(9), 667–672. https://doi.org/10.1038/s41415-019-0257-z
Prevalence of TMJD and its Signs and Symptoms. (2018, July). National Institute of Dental and Craniofacial Research. https://www.nidcr.nih.gov/research/data-statistics/facial-pain/prevalence
