Botox (Botulinum Toxin A) in the Treatment of Temporomandibular Joint Disorder


Temporomandibular Joint Disorder

The Temporomandibular joints are those that connect the lower jaw to the skull and are composed of bone, muscle and joint structures. There are two matching joints, one on each side of the head, located just in front of the ears. These joints are some of the most frequently used joints in the body, put to use when we talk, chew, yawn, swallow and sneeze.

Temporomandibular joint disorder is an alteration of the structures that compose the temporomandibular joints. The disorder occurs when these joints, or muscles and ligaments that support them, are injured, causing dysfunction and pain. It is widely regarded as the second most common cause of facial pain, after toothache. Studies reflect a higher incidence of the disease in younger adults, especially in women aged 20-40 years of age.

Symptoms of temporomandibular joint disorder include bruxism (the tightening or grinding of the teeth), loose or fragile teeth perception, discomfort while chewing or a dry, hot or scalded mouth. Joint noises or snaps are frequently experienced, with accompanying jaw muscle pain, limitation in the mouth’s openness, jaw displacement while opening the mouth and dislocations and locks while opening and closing the mouth. Secondary to the pain in the joint, the disorder can cause front area headaches, false migraines and nasal obstructions.

Temporomandibular joint disorder is regarded as a ‘multifactor syndrome’, meaning that is it has a number of contributory factors that might have caused the condition. Some of these include a genetic predisposition, a habit of grinding the teeth, trauma to the joint or jaw clenching due to anxiety.


Botox (Botulinum Toxin A)

Patients that have easily identifiable trigger points, permanently contracted muscles, or headaches that are associated with muscle spasms are very good candidates for Botulinum Toxin A injections. Botox is the industry name for Botulinum toxin type A, which is derived from a strain of bacteria called Clostridium Botulinum. When Botox is injected into a muscle, it blocks the signals sent from the brain which tell the muscle to contract. Botox targets the muscles involved by effectively disarming them and ensuring that they do not send panic signals throughout the body. The body believes that there is no pain being experienced. Botox can help to keep the muscle relaxed for anywhere from three to six months, after which it is hoped that the muscle will be able to contract normally without pain or spasms.



Botox injections are performed as an outpatient procedure at the London Pain Clinic, with patients free to leave as soon as the treatment has been administered. Initially, the treating doctor will spend time identifying the individual trigger points, sometimes with the help of a physiotherapist, and will mark the areas with a pen. The located areas will then be sterilised with a chlorhexidine antiseptic spray and a fast acting local anaesthetic will be will injected through a small cosmetic needle.

The Botox can then be administered by one of three different ways, depending on the case. Small cosmetic needles are usually preferred, but a Stimuplex nerve stimulator or ultrasound guidance are sometimes necessary if the trigger points are more difficult to access. 100 units of Botox are usually administered, but this can increase up to 200 units depending on the affected area.


Procedure Outcomes

One of the major advantages of Botox is that there is little or no recovery time, and most people feel fine and can return to their normal life immediately. The results of treatment should last around 3-6 months and the procedure can be repeated after this time.