While commonly known for its cosmetic use in reducing the appearance of frown lines
and wrinkles, Botulinum toxin (Botox) was initially developed as a muscle relaxant to alleviate
chronic muscle spasms at the site of injection. Botox was clinically used by ophthalmologists in
the mid-1900s to treat eye muscle disorders and alleviate facial tics by relaxing the muscles in
the appropriate areas. In 1989, Botox was approved by the FDA for therapeutic use, and in 2002
the FDA approved Botox solely for cosmetic use as well.

Recently, an increasing number of dentists have begun to offer Botox treatments for
cosmetic as well as clinical purposes. These conditions include TMJ discomfort, dystonia
(uncontrolled muscle contractions), hyperactive lip, fistulas, Frey’s Syndrome (redness and
sweating on the cheek area next to the ear), and bruxism (teeth grinding). For edentulous patients
with dentures, Botox may be used to relax the lip muscles and improve the fit of their dentures.
Cosmetically, Botox may be a noninvasive alternative to reduce the appearance of a gummy
smile without crown lengthening or gum surgery. While the occurrence of serious complications
are relatively rare, one common side effect of Botox injections for treating TMJ disorders may be
dysphagia (difficulty swallowing), although the symptoms are usually mild and temporary.
For patients with headaches and migraines resulting from TMJ dysfunction, Botox may
be used to relax an overactive masseter or temporalis muscle and subsequently reduce the
occurrence of headaches caused by bruxism. However, Botox is only FDA-approved for chronic
migraines (at least 15 days per month), so this may be considered an “off-label” use. For patients
with neck pain, Botox is commonly used to treat torticollis (twisted neck) that may be the result
of family history or trauma to the neck. In a recent comprehensive long-term study titled
Botulinum toxin type A for the treatment of head and neck chronic myofascial pain syndrome: A
systematic review and meta-analysis, Botox was actually tested in the treatment of
temporomandibular disorders. There were 253 patients who participated in the clinical study, and
it showed a statistically significant improvement among patients treated with BoTN-A over the
long-term (2 to 6 months) compared to those who received a placebo. On the contrary, the results
were not significant in the short-term (4 to 6 weeks). The study is inconclusive whether any
improvements in long-term pain management outcomes are specifically the result of Botox or
rather from a placebo effect.

Botox is a short-term treatment that needs to be repeated every few months, so it may be
a good option to try on a patient if more conservative treatments have failed to reduce TMJ
symptoms in the past. At our office, we do offer Botox treatments to treat an array of conditions.
Each patient will be evaluated on an individualized basis before making a determination as to
whether they would be a good candidate for Botox injections. If you believe you may be a
candidate for Botox, please contact Cranio Associates to schedule a comprehensive TMJ
evaluation with Dr. Federman.