Botox & Temporo-Mandibular Disorder

JCO/January 2022 Dr. Tamburini  Comparison of Three Options for Neuromuscular Deprogramming Treatment

A recent study in the JCO looked at TMD (Temporo-Mandibular Disorder) treatment using appliance therapy alone versus appliance therapy (NDA - Neuromuscular Deprogramming Appliance) in conjunction with Botox (botulinum toxin type A BTX-A). Botox has been used for years to inhibit nerve impulses and prevent the injected muscle from contracting and so it has been useful in TMD, especially in patients who clench. In cases of myofascial pain associated with masseteric hypertrophy (common in TMD), injection with BTX-A into both masseters resulted in a state of relaxation, reduction of bite forces, and improvement in cases of disc displacement. The aim of this study was to compare the effectiveness and efficiency of neuromuscular treatment alone versus neuromuscular treatment in conjunction with botox injections.

In the study, patients who received botox injection, were injected with 80 units of BTX-A in each masseter muscle and 20 units in each temporal muscle on the day the NDA was fitted. Masseter and Temporalis are the primary elevator muscles for the mandible, and often involved in hyperactivity in patients with TMD. Reducing the activity and contraction force of those muscles reduces the force of the patient’s clench, thereby reducing overall activity causing muscle pain and tension in those patients.

The interesting finding of this study was the treatment time needed to results in reduction of symptoms. Patients injected with BTX-A had a significantly reduced treatment time and showed a significant reduction in pain and other symptoms related to their TMD. The reduction in treatment time was attributable to the relaxation of the masseter and temporal muscles but most patients in the study needed a second dose of botox 3 months later in order to maintain the muscle relaxation in order to have relief of TMD symptoms.

Many of our patients have benefited from Botox for their muscle pain including headaches and migraines. Considering the new research, we have found that incorporating botox into our TMD protocols is a great way to speed up symptom resolution and reduction in pain in many of our TMD patients.

For more information, call our office to set up a consultation.