Today I'd like to discuss one of the more common oral afflictions, and a fairly new, somewhat controversial way to treat it.
The affliction I am talking about is Temporomandibular Joint Syndrome, more commonly known as TMJ. TMJ is when the temporomandibular joint, which connects the mandible to the skull, becomes inflamed. TMJ has a variety of causes, from grinding ones teeth (Bruxism) to trauma to the jaw, to arthritis to several others. It can be acute or chronic, and can vary from nothing more than minor discomfort to life-altering pain (and everything in between).
Symptoms of TMJ range widely, and include, but are not limited to: biting, chewing difficulty/discomfort, facial/jaw pain, earache/headaches (typically occurring in the morning), a clicking or "popping" sound in the jaw, hearing loss, reduced mouth opening, migraines, and even neck and shoulder pain. So as you can see, this is a serious issue for those who have it. Who wants to go through life with constant headaches?
There are a variety of treatments available for TMJ -- some cases can be remedied by a simple mouth guard one wears at night, others may need some dental work, jaw surgery, or some people may need a variety of approaches until relief can be found. To be honest, TMJ is one of those afflictions that can be maddening, as it's oftentimes not obvious as to the cause (and therefore, the cure).
As a NYC Cosmetic Dentist, I certainly see my share of TMJ patients. Generally, my ability to address this concern is dental in nature. If I feel your dental work (or lack of), or your bite in general, is causing your TMJ, we'll go in that direction. I don't specialize in TMJ, so I am not up on every available treatment. But in reading about TMJ recently, one somewhat newer treatment caught my eye, and it interested me enough to mention it here. That "new" treatment is Botox®.
I know ... Botox? Really? Yes, really.
For those who don't know, Botox is a brand name for Botulinum toxin. Botulinum toxin is a protein that is produced from a particular bacterium, which causes muscle paralysis. This is how it is used for cosmetic procedures -- by paralyzing certain facial muscles, it can prevent wrinkles and the visual effects of aging. But the paralysis is temporary (generally 4-6 months), so further injections are needed several times a year to continue the effect. This is why people who get Botox treatments are always going back for more -- it's a never-ending process.
In recent times, however, Botox has been used to treat other medical afflictions, like Cervical dystonia (a neuromuscular disorder involving the head and neck), Blepharospasm (excessive blinking), Achalasia (failure of the lower oesophageal sphincter to relax) and others. So it definitely does have its uses.
Because of these other afflictions that Botox can be used for, it's only natural that it be looked at for other uses. And one of them is TMJ.
Because of the muscle-paralyzing properties of Botox, it is thought by some that it can be used for certain types of TMJ disorders (those that are more muscular in nature). By causing the affected muscles to relax, Botox can help relieve the clenching and stress put on the mandible by these muscles, bringing about relief.
Now, as I've mentioned above, Botox is temporary, so if one was going to look into Botox as a TMJ treatment, they must be prepared for a return visit, perhaps on a permanent basis. Also, Botox for TMJ treatment is an "off-label" treatment, meaning it is not FDA approved yet. This does not mean it doesn't work, but it does mean that more information will be needed before the FDA gives it a seal of approval. This also means it's likely not covered under your insurance.
So does it work? Can Botox treat TMJ? My personal answer is "I don't know for sure, but it looks promising." From everything I have read, it would appear that yes, Botox can be a viable treatment component for TMJ. There are enough success stories to convince me that at least there's some merit to the claims.
That said, I do not believe that Botox can ever be the only treatment used to help TMJ, but rather it be used as an adjunct with more traditional and proven methods. Remember what I mentioned earlier: Botox is a temporary solution and does not address the causes of TMJ. So it will always be a secondary method of treatment, but for a lot of people it can provide relief while the root cause is diagnosed.
However, I would be remiss if I did not mention the other side. There are possible side effects to Botox. They are generally minor, and include headache, droopy eyelids, nausea, and others - if you wish, you can check out the Botox side effects yourself here. The other interesting fact is these side effects seem to be more pronounced when Botox is used for medical purposes (as opposed to cosmetic purposes). Lastly, and this is rare, but there have been cases where a Botox injection has affected muscles other than the ones intended, and has produced botulism-type symptoms.
The above is primarily why Botox can be somewhat controversial. I want to present both sides and let you make up your own mind.
So where does that leave us? Well, the same place it does with any "new" treatment for an old affliction. There's plenty of information out there both pro and con, and I encourage you to look it up. Again, the jury is still out, but I do have to say, it looks promising.
Until next time, keep smiling!
Follow Thomas P. Connelly, D.D.S. on Twitter: www.twitter.com/dr_connelly