Jaime Herndon is a freelance health/medical writer with over a decade of experience writing for the public.

David Snyder, PharmD, BCPP, is a board-certified clinical pharmacist and psychopharmacology expert at McLean Hospital in Belmont, Massachusetts.

The acronym "TMJ" is often used for "temporomandibular disorders" (or "TMDs"), but "TMJ" merely refers to the temporomandibular joint. TMD encompasses more than 30 disorders that can cause pain and dysfunction in the joint and the muscles that help with jaw movement.

There are various treatments for TMDs. One that has been of recent interest is Botox (botulinum toxin type A). This article will discuss this treatment and what you can expect from it.

There are three main categories of TMDs:

Symptoms of TMDs can include:

It’s thought that a mix of genetics, life and emotional stressors, and pain perception all play a part in TMDs.

Botox can help by temporarily reducing jaw tension and can ease pain or other symptoms of TMDs. This can improve jaw movement and even the ability to chew. However, it is not a cure for TMDs.

It’s important to note that Botox for TMDs has not been approved by the Food and Drug Administration (FDA), so it is considered an alternative treatment.

Common side effects of Botox for TMDs include:

Botox is administered by injection. Effects around the injection sites, where the Botox is placed, may include:

Treatment with Botox may also cause a “fixed” smile if it diffuses into surrounding facial muscles.

People who should avoid Botox include those who are pregnant, nursing, or those with a history of a neurological disease. Talk with your healthcare provider about whether it is safe for you to use Botox.

In multiple studies, Botox has proven effective in treating pain and reducing symptoms associated with TMDs. More studies are needed, however, to better assess the effects of Botox and its effectiveness.

While Botox is effective, other, more established and conservative treatments should be tried first. If there is no response to these treatments, then Botox may be an option.

Knowing what to expect before any procedure can help reduce any anxiety you may have about the procedure and give you an idea of what to prepare for. The procedure is usually done in the healthcare provider's office.

Your healthcare provider will go over your symptoms, where your pain is, and all the risks associated with the procedure. The provider will determine how many injections are necessary, and where they need to go.

Your provider may apply numbing cream to the proposed injection sites or numb the area with a cold pack. You should only feel pricks like bug bites when the injections are given.

Injections are done with electromyography (EMG) guidance, using an electrode injection needle. The temporalis and masseter muscles (muscles at the side of the head that move the temporomandibular joint for chewing) are injected transcutaneously (through the skin). The pterygoid muscle is reached with an intramuscular injection.

The length of the procedure can vary, depending on how many injections you are getting, but it usually takes between 10 and 30 minutes.

You’ll notice that the muscle tenderness associated with TMD will disappear very quickly after the procedure. At that time, you can resume normal activities, but don’t rub or massage the area of the injections for several hours, and stay upright; this helps to avoid spreading the Botox to other muscles.

The effects should last for 12 weeks. You may be asked to return after three to four weeks for evaluation and to see if booster injections are needed.

Because Botox is not FDA approved to treat TMDs, most insurance companies will not cover the procedure. You may want to call your insurance company and ask what their coverage is, if any.

Prices for the treatment vary depending on how many injections are needed, where you live, and the facility you go to. In general the out-of-pocket costs can range from $500 to $1,500, or even more.

Your healthcare provider may recommend several other treatments for TMDs before offering Botox. Many times, TMD symptoms go away without treatment, too.

Many treatments lack substantial evidence that they are effective, so it is recommended that people not use treatments involving surgery or treatments that permanently change jaw joints, teeth, or bite.

Treatments for TMD can include:

TMDs can be uncomfortable and painful. Botox can be used as an off-label, alternative treatment for TMDs, but it is not approved by the FDA for this use. The effects of Botox can last several months, but then its therapeutic effects go away.

Botox for TMDs does not cure the disorder or address the underlying causes; it just relieves symptoms. Because Botox for TMDs is not approved by the FDA, it may not be covered by insurance, and can be expensive to pay for out of pocket.

If you’re interested in this treatment, talk to your dentist or other healthcare provider about your options for your specific situation, and the benefits and drawbacks in your specific situation.

Botox does not actually address the causes of TMDs, and can cause adverse effects. Ask your healthcare provider about more conventional treatments for TMDs first, and try those to see if they work for you. Botox for TMDs is typically considered after other treatments are explored and found to not be effective.

The effects last about 12 weeks. Botox is not a cure, nor does it address any of the actual causes of your TMD. It merely provides relief from pain and other symptoms.

Clinicians typically use a starting dose of a concentration of 2.5–5.0 units per 0.1 milliliters of Botox and 10–25 units for each temporalis muscle, 25–50 units for the masseter muscles, and 7.5–10 units for the lateral pterygoids.

Your healthcare provider will talk with you about your symptoms and review what they think is necessary to address your symptoms. 

While Botox is, overall, safe, there are risks associated with it. Not everyone may be comfortable with some of the risks. It’s not approved by the FDA for TMDs and so is considered off-label use.

Talk with your healthcare provider about the possible side effects and risks of using Botox, as well as any medical history you may have.

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