Botox for TMJ?

Botox should not be your first line remedy for TMJ pain, despite some claims to the contrary. While I do have a handful of patients who are receiving regular injections of Botox and doing well, I have two primary objections: First, I consider Botox a band aid that simply reduces muscle contraction pain without necessarily discovering the cause. And second, Botox often fails to reduce muscle spasm enough to effectively address the pain. A new patient I saw just yesterday illustrates the point. Renee W. a 40 year-old new mom with complaints of jaw pain, clicking, and pain when chewing said she had suffered years of occasional pain beginning in her teenage years. A few months ago, she stated that she had even locked closed once, although with physical therapy she had been able to open and that severe limited opening had not recurred. She has also had recent Botox injections into the masseter muscles on both sides and this has provided some relief. And so you might logically say, let’s just do Botox every few months for the rest of her life. While that might be appropriate, I’d like to find out why she has the symptoms. What is the cause? Since this is a TMJ focused practice, one of our first steps is to obtain joint images. I was somewhat surprised to see that Renee had textbook perfect joint alignment with excellent disc spacing and condyles well centered in the glenoid fossae. She also had normal range of motion. “So, you’re telling me that these problems have been going on for years. Did you have braces as a youngster?” I asked her. “Yes.” “And your problems started then or shortly after?” “Well, I guess so. I don’t remember exactly when it started, but it has been years. It’s just been getting worse lately.” If her joints look normal, where else should we look? How about occlusion?