Botox – Treatment for TMJ and Bruxism

By now, everyone in the world has heard of Botox.  There are countless commercials on television touting the many cosmetic advantages of Botox to reduce fine lines and wrinkles.  It is highly sought for its many cosmetic applications and little more is ever discussed.   However, there are so many other applications for Botox that can be life changing for those that need it.  

WHAT IS BOTOX?

Botox is a class of drug known as a neuromodulator.  Neuromodulators modify synaptic communication through a number of mechanisms which can be broadly divided into effects that target synapses directly and those that indirectly modify synaptic interactions by changing the excitability of neurons. In layman’s terms, neuromodulators block a nerve impulse or modify the impulse.  In the case of Botox, it prevents or reduces the nerve impulses that cause muscle contraction by inhibiting the chemical called acetylcholine.  In the face, many of the lines or wrinkles are caused from the contraction of the underlying muscle.  If you reduce or eliminate the contraction of that muscle, this allows for the overlying skin to relax thereby reducing or eliminating the lines.  Similarly, in larger muscles, you can modify the muscle’s ability to contract as forcefully.  Without acetylcholine, the muscle atrophies.  It takes 3 to 4 months for the old nerve terminal activity to be restored.  But let’s not get ahead of ourselves.  Let’s review a little bit about the history of Botox.

HISTORY OF BOTOX

Surgeons first tested botulinum toxin A in humans in 1978, when Alan B. Scott, MD, received permission from the FDA to study the drug’s effect on strabismus. Ten years later, Allergan acquired the rights to distribute the drug, marketed first as Oculinum, and conducted additional trials for indications including benign essential blepharospasm and cervical dystonia.

Allen M. Putterman, MD, SC, who participated in the first FDA trials at the University of Illinois, noted that early studies focused on treating eye muscle hyperactivity and blepharospasm, and researchers “absolutely [did] not” realize the potential for other applications with Botox.

“At that time, I think the main [concerns] were not knowing where to inject or how much to inject,” said the Chicago-based surgeon, who has been administering Botox for more than 20 years. “There was a lot of trial and error in determining the sites and the dosages.”

In 1992, Alastair Carruthers, MD, MRCP, FRCPC, and his wife Jean Carruthers, MD, FRCPC, issued the first report suggesting that Botox could be used for cosmetic purposes.

“From functional patients, they made the transition to actually begin treating for cosmetic indications,” said William Lipham, MD, FACS, of Bloomington, Minn. “Since that time, a number of individuals in a variety of disciplines, including outside of ophthalmology, have noted that Botox can be used to inactivate muscles that cause lines to develop.”

TMJ AND BRUXISM

TMJ disorder (also referred to as TMD) and bruxism are two different conditions that can both have a negative effect on the proper functioning of the mouth and oral health. People that suffer from bruxism grind their teeth.  TMJ Disorder is a condition that involves pain and improper functioning of the muscles and joints that attach the lower jaw to the skull. Bruxism can be caused by TMD, but bruxism can in turn also cause or worsen TMD.

What is Bruxism?

You suffer from bruxism when you unconsciously grind your teeth. This usually occurs at night, though some people also grind their teeth during the day, often during stressful periods. While you might be unaware of your grinding, your dentist should notice signs of bruxism during regular visits. Symptoms of bruxism include:

  • Abnormal teeth wear and chipped teeth.
  • Sensitive teeth caused by enamel wear.
  • Pain and tension in the jaw and ears.

It’s difficult to diagnose the cause of bruxism, but often it is related to misalignment of the teeth, stress or anxiety. Bruxism is a serious disorder that can lead to severe damage to the teeth and enamel, constant pain in the jaw and ears and could even cause the loss of a tooth.

What is TMJ?

Symptoms of TMJ disorder are very similar to those of bruxism. They include:

  • Pain in the jaw, ears or face.
  • Pain or tension in neck or shoulders.
  • Constant headaches.
  • Teeth grinding.

Since both conditions have very similar symptoms and are often related, it is important to see a dentist who is trained in all aspects of TMJ disorder if you suffer from any of the TMD symptoms. 

Both of these conditions can cause a person significant discomfort, pain, but it can also lead to major issues with the teeth that can be extremely expensive to fix.  If the underlying problem isn’t addressed, any expensive dental work will ultimately fail leading to even more expense.  Often, with proper diagnosis and planning, both of these issues can be reduced or eliminated.

BOTOX TREATMENT FOR TMJ AND BRUXISM

Bruxism is the medical term for unconscious teeth clenching and grinding, either while awake or asleep, which can lead to physical painful and severe dental problems.  Chronic teeth grinding can cause headache, earaches, facial pain, and even migraines. Dental problems from bruxism include loss of tooth enamel, increased tooth sensitivity, and flattening and/or chipping of the teeth. Bruxism sufferers who grind and clench their teeth while sleeping frequently wake up with a sore jaw. Hypertrophy of the masseter muscle, which may lead to the appearance of a severe square jaw, is another side effect of bruxism. Treatments with Botulinum Toxin Type A., commonly known as botulinum toxin, can provide tremendous relief from jaw soreness, headaches, and other unpleasant problems associated with Bruxism. Botulinum toxin treatments for Bruxism can also soften the appearance of the jaw line.

Recently, botulinum toxin has proven to be an ideal treatment option for targeting and treating excessive muscle activity and spasticity. Many other treatments, such as anti-inflammatory medications and dental devices, do not address the source of the problem. Although dental devices can successfully protect teeth from damage at night for bruxism sufferers, they are ineffective in stopping the painful side effects of teeth grinding.  Also, the level of compliance with devices, such as night guards, is extremely low.  So these devices are worthless if not being used.

By injecting small doses of botulinum toxin directly into the masseter muscle (the large muscle that moves the jaw), the muscle is weakened enough to stop involuntary grinding of the teeth and clenching of the jaw. This significantly relaxes the muscle and reduces the wear and tear on the teeth due to grinding. Damage to the TMJ (temporomandibular joint) and headaches should be reduced or eliminated as well.  Voluntary movements, such as chewing and facial expressions, are not effected at all by Botox.

Although botulinum toxin injections are not a cure for bruxism, they can effectively control the uncomfortable symptoms better than a night guard for some patients. Botulinum toxin used for treating bruxism typically lasts for three to four months.

The beauty of this procedure is that the muscles that are problematic, bulky and over working are trained to relax.  This allows the jaw to eventually get to the position it wants to be in and not being forced in positions it doesn’t want to be.  The more you continue to re-train the muscle, the more it atrophies.  This is good in two ways.  First, it helps reduce or stop the deleterious habits to prevent damage.  Secondly, the muscle atrophies or shrinks.  This has benefit in that as the botox wears off, the muscle is weaker and smaller making it incapable of producing as much damage.  It also, often, allows the time between injections to be extended.  So if someone begins getting injections every three months, they can start spreading the time out to every 4 to 5 to 6 months, eventually.

A welcomed side effect of Botox in the masseters is that it can create a slimming effect to the face.  In some patients, the muscle grows the longer they brux giving the face a very squared off appearance.

TYPES OF NEUROMODULATORS

Most everyone asks for Botox.  Botox is just one of the drugs used for neuromodulation.  It is owned by Allergan and was the first on the market in the USA approved for cosmetic applications.  Today, there are multiple drugs approved.    Some of the major brands approved in the US are:

Botox by Allergan

Dysport by Galderma

Xeomin by Merz 

Jeuveau by Evolus

Each is differentiated by what surface protein it has or lack of a surface protein.  They all have extremely similar results.  Some begin working slightly faster than another on certain people.  However, the effects are all the same, and the duration of the effects is also very similar in all of the different products.

Dr. Culley is a clinical instructor for the American Academy of Facial Esthetics and helps train MDs, FNPs, RNs and DDS practitioners across the United States, from Miami to New York and California in  the art of facial cosmetics and orofacial pain management with neuromodulators and dermal fillers for cosmetics.  Call us today to schedule your appointment for a consultation at (731) 660-6244.  

 

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