Botulinum Toxin for TMD relief: Can it help?

Key takeaways:

• Botulinum Toxin (e.g. Botox®) is sometimes used for muscle-related TMD (known as myalgia) by reducing muscle activity and altering how pain signals are processed — but results are mixed, and not everyone benefits.

• It’s not a cure — Botox® can offer temporary relief (often up to 3 months), but it does not address the root causes of TMD or reliably help with teeth grinding or clenching.

• There’s no clear evidence about who it helps most or how many injections are beneficial — which is why large-scale studies (like the one from Newcastle University) are underway.

• Higher doses don’t mean better outcomes, and repeated injections may reduce effectiveness or slightly affect jawbone thickness over time (though not enough to weaken it).

• Side effects can include pain, bruising, or — in rare cases — the spread of toxin to surrounding areas. These risks make proper provider training essential.

• If you’re considering Botox®, start with self-management first. Tools like relaxation, splints, and stress reduction build a strong foundation — making it easier to assess whether further treatment is needed.

Botulinum Toxin (e.g. Botox®) for TMD:

Botulinum Toxin A, commonly known as Botox®, is a neurotoxin that can temporarily alter muscle function and the way pain messages are processed from the muscles and pain nerves. 

In the management of Temporomandibular Disorders (TMD) related to myalgia (muscle pain sub-type of TMD), it is uncertain whether or not it provides help with some studies suggesting it may have a positive effect and some studies suggesting it doesn’t exert any effect. The bottom line is it is likely to be that it may help some people and not others but we simply can’t identify who the people are who are most likely to benefit from it.

In the treatment of myalgia or muscle-related TMD, Botox® is injected into specific muscles responsible for jaw movement, often the masseter and temporalis muscles. Higher doses are not suggested to have any more benefit than moderate-lower doses.

It's important to note that while Botox® can provide temporary symptom relief, it is not thought to be a ‘cure’ for myalgia or muscle-related TMD. It is also not proven to cure or help manage teeth grinding and clenching. The effects of the neurotoxin are temporary, usually lasting up to 3 months but some people gain longer benefit than this. Again, it remains uncertain if it is beneficial to have repeated injections and if so, how many. This uncertainty has led to the funding of the world’s largest ever trial of Botox® against other usual treatments for TMD being led by Newcastle University in the United Kingdom. You can read more about this trial by visiting its website here.

Moreover, we don’t know if Botox® treatment directly addresses the many different factors that combine together to create myalgia TMD or bruxism. For a more holistic approach to managing TMD and or bruxism it's crucial to address as many factors as possible that may influence their outcome. Depending on individual factors this could include self-management, use of a mouthguard (dental splint) or professionally-guided interventions from a physiotherapist or psychological therapist. 

Botox®, like all treatments, has potential risks and side effects. These could include pain or bruising at the injection site, and in rare cases, the toxin may spread beyond the treatment area. Also, repeated treatments may lead to reduced effectiveness over time and there is some limited evidence that repeated injections may decrease the thickness of the outer parts of the jawbone a little, but not so much that it would weaken its structure.

When considering Botox® you should ensure the individual administering it is a healthcare professional who is trained in TMD. It is possible for clinicians practicing aesthetic medicine to provide Botox® for TMD, but it may be that following this they cannot provide more holistic care or further care outside of this, so it is worth checking with the person you are choosing for treatment. Equally, it is important to note that due to the unclear evidence base on who benefits from Botox® that its provision may not be covered or approved by either state-funded or insurance-funded healthcare systems. All systems vary so you may have to pay outside of the state-funded or insurance-funded healthcare systems.

References:

1. Ataran, R., et al. "The Role of Botulinum Toxin A in Treatment of Temporomandibular Joint Disorders: A Review." Journal of Dentistry (Shiraz, Iran), vol. 18, no. 3, 2017, pp. 157–164.

2. Chen, Y.-W., et al. "Botulinum Toxin Therapy for Temporomandibular Joint Disorders: A Systematic Review of Randomized Controlled Trials." International Journal of Oral and Maxillofacial Surgery, vol. 44, no. 8, 2015, pp. 1018–1026. https://doi.org/10.1016/j.ijom.2015.04.003.

3. Zhu, Mengjiao, et al. "Effects of Botulinum Toxin Type A in Patients with Painful Temporomandibular Joint Disorders: A Systematic Review and Meta-Analysis." Annals of Medicine and Surgery, vol. 86, no. 7, July 2024, pp. 4112–4122. https://doi.org/10.1097/MS9.0000000000002183.