Botox Treatment for TMJ Myofascial Muscle Pain

For potential patients who do not know me yet, please note that I strongly dislike the term “TMJ.” Why? Because it is an anatomical feature of everyone and is not a diagnosis. A doctor telling you that you have “TMJ” is like a doctor telling you that you have “knee.” TMJ stands for temporomandibular joint, which is the joint that attaches the jawbone, called the mandible, to the skull. So, if TMJ is not a diagnosis, what is the diagnosis for people who suffer a lot of pain in the jaw? The pain is usually due to myalgia, which is a technical term for muscle pain. What is a good treatment for muscle pain? I like to start by having my patients stretch using the gentle jaw, a passive jaw-stretching device I invented. If that does not help enough, patients can elect to try a muscle relaxer, a 6-day taper of an oral steroid,  trigger point injections, which involve injecting plain lidocaine into the painful muscles to see if that provides a benefit, and Botox.

Treatment for the Temporalis, Superficial and Deep Masseters

Typical treatment with Botox involves the injection of 10 sites on each side with 5 units of Botox into these muscles

  • Temporalis 20 units in 4 sites. This is the large fan shaped muscle on the side of the head
  • Superficial and deep masseter 30 units in 6 sites. These are the muscles of the outside part of the jaw.

Treatment for the Temporalis, Superficial and Deep Masseters, and Medial Pterygoid

If the medial pterygoid is causing pain, I follow the protocol shown in the images below.

  • Temporalis 15 units in 3 sites. This is the large fan shaped muscle on the side of the head
  • Superficial and deep masseter 25 units in 5 sites. These are the muscles of the outside part of the jaw.
  • Medial pterygoid 10 units in each site. This is a closing muscle on the inside of your jaw.

Botox FAQ

No. Botox does not stop clenching and/or grinding, but it does help reduce the forces involved.

Botox typically lasts about three months. However, not all patients need retreatment after three months. If you need Botox for your jaw-closing muscles, you should use the gentle jaw to stretch your jaw muscles for 30 seconds every two hours, make sure your teeth are apart during the day, and wear your nightguard every night to help decrease the forces on your jaw muscles and jaw joint.

You should repeat Botox if and when the pain returns.

No. I treat pain. If you don’t have pain, then you don’t need treatment.

Botox blocks the chemical signals that tell a muscle to contract. This allows tight or overworked jaw and head muscles to relax, reducing pain and improving function for several months or more.

In most cases, Botox is placed on both sides—even if your pain is only on one side. Treating both sides helps maintain muscle balance. If only one side is weakened, the untreated side may work harder to compensate, which can lead to new or worsening pain on the previously “good” side.

 Yes, I only use Botox manufactured by Allergan. AbbVie now owns Allergan. You might be interested to learn that all Botox is manufactured in Ireland.

Learn about the muscle referral patterns of the muscles that refer pain into teeth.
Learn about the muscle referral patterns of the muscles that refer pain into the TMJ. ​
Learn about Botox treatment for migraine.
Learn about appliances for TMJ.