Botox (botulinum toxin injections)

What does botulinum toxin have to do with it?

If you have predominantly myofascial pain and have not responded to the simple management techniques encompassed within conservative treatment (e.g. exercises, analgesia, occlusal devices) I will often discuss the following treatment options:

• a hard bite-raising appliance with complete occlusal coverage as a habit breaker;
• the use of a low dose tricyclic antidepressant such as amitriptyline or nortriptyline;
• a trial of botulinum toxin A injections into the muscles around the joint

Botulinum toxin A (e.g. Botox®) is best known for its role in non-surgical cosmetic treatments, smoothing out wrinkles. It works by paralyzing muscles so can help immensely in relaxing the tension in the muscles around the jaw. Beyond this, it has analgesic (painkiller) properties independent of its neuromuscular action that are the subject of ongoing research. My preference tends to be to use Dysport® within my TMJ practice.

How is it administered?

Dysport® injections are given in the outpatients setting and appointments only take 15 minutes including all the paperwork. We will go through a written consent form and answer any outstanding questions first. After that, the Dysport® is reconstituted (mixed up) and injected. I will treat the areas of your muscles that feel most painful, most frequently injecting into the masseter and temporalis muscles.

The masseter muscle is a large muscle on the side of your jaw that clenches your teeth together and helps you bite and chew. The other muscle, your temporalis, is attached from your lower jaw to the side of your head as a fan shaped belly. One or both of these muscles might be sore and targeted injections will be given as appropriate. I use fine bore needles to minimize the pain and discomfort, and the injections take only seconds to give.

Are there any potential risks or side effects?

Dysport® is a very safe treatment but all interventions have risks. There is a risk of bruising and swelling that is fairly minimal. In addition, as it acts by paralysing muscles, it is possible to find it a little more difficult to chew food for a few days to weeks. It is important to note that is has a delayed onset of action of a few days, so will not have an immediate impact on your symptoms.

A minority of patients will find no significant benefit, but the majority in my practice see a 70-80% resolution in symptoms, with some patients describing it as nothing short of miraculous in resolving clenching with associated muscular pain and headaches. Dysport® may very occasionally cause weakness of the muscles of facial expression with resultant asymmetry, although this is exceedingly uncommon in my experience. Finally, the effects of the drug may be temporary and require repeating at intervals of around 6-9 months on average in my clinical practice.