Botox: And a New Approach to TMJ Pain and Relief?

“I have extreme pain in my jaw, especially at night. Someone mentioned that I might have TMD or TMJ disorder (Temporomandibular Disorder). What causes TMJ? Is there a cure and how is it treated?”

Temporomandibular Disorders (TMD) is jaw pain that occur as a result of problems with the jaw joint (TMJ) and surrounding facial muscles that control chewing and moving the jaw. Like any joint in the body, the TMJ’s are subject to wear and tear, trauma, disease and degeneration due to aging.

What Causes TMJ Pain or Jaw Pain?

The temporomandibular joint (TMJ) is the joint that connects your jaw to your skull. When this joint is injured or damaged, it can lead to a disorder called temporomandibular disorder (TMD). The causes of TMJ disorders include injury (to teeth or jaw) misalignment of the teeth or jaw, teeth grinding/ clenching (bruxism), poor posture, life stress, arthritis and even repeated gum or seed chewing . More often than not, a collection of these causes lead to TMJ Pain.

Location of the TMJ
Location of the TMJ

Signs and symptoms of temporomandibular joint (TMJ) syndrome include jaw clicking and pain and a jaw locking sensation,, ear pain / popping, headaches, neck pain and sore jaw / neck muscles. Bruxism is the most common cause of TMJ Pain.

What is Bruxism?

The most common connection to TMJ disorder is bruxism (grinding of the teeth), during the day or while we sleep. The causes of bruxism is uncertain, but it is reported to be associated with heredity, structural, and psychosocial factors. Long term repeated chronic clenching of the jaw leads to enlargement of the masseters and temporalis (our chewing muscles) and this results in accelerated aging of the lower face and therefore a degeneration of the TMJ.

Teeth and jaw clenching
Teeth and jaw clenching

Many people who routinely grind or clench their teeth and jaw (bruxing) will experience soreness or pain in the jaw muscles, especially upon waking in the morning. Most of us don’t realize that our upper and lower teeth should never really come in contact except lightly during chewing. When teeth are held together, or the jaw is held tense over a period of time, such as when concentrating (stress), the facial and neck muscles become fatigued and painful. Morning and afternoon headaches, difficulty chewing, neck pain, and sore facial muscles are symptoms most commonly reported. Our unconscious clenching at night causes the most pressure on the jaw and, therefore, is the most damaging.

Sleep Bruxism? Am I Clenching my Jaw at Night?

Current research shows that poor airway alignment and sleep disorders are major factors that contribute to patients developing a TMD or TMJ pain and chronic facial pain and jaw pain problems. In those people who snore or have Obstructive Sleep Apnea (OSA), excessive tooth grinding may occur as the jaw is constantly pushed forward during sleep in an attempt to open the airway. This condition is known as Sleep Bruxism. Over time, there may be tooth loss and the constant forces on the facial muscles and TMJ’s can lead to pain and dysfunction.

The New Aesthetic Medicine Treatments of Bruxism

Traditionally, patients with this TMJ pain would turn to dentists or chiropractors to help with management of this condition, but recently there have been advancements in the aesthetic medicine arena. A recent research article written by Dr. Shino Bay Aquilera (published in the Journal of Clinical and Aesthetic Journal) reports that patients with undiagnosed bruxism will commonly present to an aesthetic or dermatology office with the complaint of appearing too masculine or having a squared jaw.

Masculine Jaw line treated Before and After
Masculine Jaw line treated Before and After

Although not often recognized, bruxism will also lead to a premature aging face and facial volume loss. This is the first paper to discuss aesthetic treatment options for complications of bruxism including masseter and temporalis hypertrophy and the associated accelerated aging of the lower face.

In the researchers own clinical practice, they include self-care steps, botulinum toxin (botox) and fillers as part the treatment for bruxism and TMJ pain.

1. Self-Care Tips:

  • applying ice and heat
  • avoid hard foods and gum chewing
  • drink lots of water
  • physical therapy to help restore the action of the muscles and joints on each side of the head to get back to normal.
  • relaxation techniques are paramount to manage stress
  • make facial relaxation a habit
  • get plenty of sleep (further to this important advice, we would also suggest an investment in a TMJ relief pillow that will minimize pressure on your jaw )
  • wear a properly fitted mouth guard at night while sleeping.
  • recommend taking L-theanine 100 to 200mg orally daily to help cope with stress
  • recommend magnesium-containing teas or table (for muscle relaxation at night)

2. Botulism Toxin: Strategic placement of muscle relaxing botox to relax the muscle and help improve the symptoms of pain, fatigue, and spasm.

Neurotoxin treatment locations for TMJ
Neurotoxin treatment locations for TMJ

3. Facial Fillers: To further support the structure in the lower face (where age causes volume loss), derma fillers are an excellent choice to address this part of the equation.

Support your TMJ treatment with Supportive Sleep

Sleeping in proper alignment will assist in body posture issues, help correct airway and jaw-joint position, and improve overall well-being. Choosing a pillow with an “off your face” design such as the enVy Pillow that allows you to sleep comfortably, without putting pressure on your jaw area, will allow the inflammation to reduce more quickly. The enVy pillow has been trialed and tested by a TMJ support group called “TMJ Hope” who observed that,

“The V shape of the Envy pillow takes the pressure off the jaw and I find that I sleep much better. ” ~ Sue F, Chronic TMJ sufferer

The key to TMD or TMJ pain is managing it early and conservatively, The above self-care tips are an important primary treatment approach to bruxism and TMJ pain. The new Aesthetic treatments aim to improve jaw muscle enlargement as well as restore facial volume loss to allow the aging face to do so gracefully.

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