Should you do BOTOX for TMJ?

First let me say that I am not a dentist and I have limited knowledge of TMJ.  But, I do get asked this question on occasion.  Recently, I was at my Physical Therapy appointment (shout out to Country Roads in East Fairmont) and saw that they do physical therapy for TMJ.  This question came up and I realized I hadn’t done an article on this topic.

First a little background.  TMJ is an abbreviation for Tempomandibular Joint Dysfunction. This includes pain in the joint as well as improper function.  Most cases are associated with teeth clenching and grinding but also can be associated with disorders like fibromyalgia and arthritis.  

In our cheek we have a large muscle called the masseter.  This muscle is used to close our mouth, chew, and it is the muscle we use when we tense our jaw.  There are many reports of using BOTOX to relax this muscle to reduce TMJ symptoms. 

BOTOX is an injectable used to relax muscles.  It is successful used in many medical conditions.  We use it in the office to relax facial muscles to improve the appearance of lines and grooves in the skin.  While we often use the brand name BOTOX.  BOTOX is one of many botulinum toxins that are available for use.  In the office we use BOTOX, Daxxify and Xeomin. I will be using the name BOTOX in this article because it is the name most people recognize. 

In addition to using BOTOX in the masseter to reduce TMJ symptoms, masseter injections are done for cosmetic reasons to taper and slim the jawline.  For those with a bulky masseter muscle and a square jawline, this can help contour the face. Thickening of the masseter muscle is called Masseter Muscle Hypertrophy or Masseter Muscle Prominence.  Interestingly, it is approved for this use in China. 

But is this a good idea or something we do in the office? No.  

Although I am very comfortable with BOTOX injections in the face, I’ve done at least 10,000 visits, here’s my reasoning why we don’t offer that particular injection in our office.  

Number one – I am a dermatologist and have no business altering the function of someone’s jaw.  TMJ can be a debilitating disorder for some people, and I do not have the skill or knowledge to be messing with their jaw function.  

Number two – there can be adverse side effects to BOTOX injections in the masseter. This is not advertised in social media, but has been shown in several real scientific animal and human studies.

I could get on a soapbox here, but I repeatedly get frustrated with social media opinions being represented as real science.

The scientific medical literature shows that injection of BOTOX into the masseter muscle causes osteopenia (bone degradation and loss) of the mandible.  The mandible is the horseshoe shaped jawbone that runs the entire length of the of the jaw.  The majority of bone loss occurs in the manibular condyle, which is the portion of the bone that anchors it to the Tempomandibular joint and plays an important role in jaw movement. Which as you may guess, can make TMJ worse in the long run and make the mandible more fragile and more prone to fracture. 

A little common sense used here can help.  When we think of bone health, we have been told for decades that we need to do weight bearing exercise to strengthen both our muscles and our bones.  By weakening the masseter muscle, we remove the “exercise” of this muscle on the mandible leading to bone loss over time.  Makes sense.

So, no, we don’t do BOTOX injections for TMJ and we definitely don’t do masseter injections for facial contouring.  Injections of BOTOX in the masseter can weaken our bone structure over time and just aren’t worth the risk.  

Just in case you think I am anti-BOTOX.  Don’t get me wrong.  I LOVE BOTOX and have injected myself and other every 3-4 months for the past 20 years.  When used correctly BOTOX is a great product and produces great results. 

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