Overview

Temporomandibular disorders (TMDs) are conditions that affect the movement of the jaw. There are many contributing factors to TMD and in most cases it usually gets better on its own. The most common type of TMD is related to the muscles, and causes myofascial pain.

Our film gives information about TMD, explains what the treatment options are, and gives advice about what you can do to try and manage the symptoms yourself.

If you have TMD, we might be able to use botulinum toxin-A injections to help you manage some of your symptoms.

The injections use a protein called botulinum toxin type A, and are sometimes known by the brand names Botox^® and Xeomin^®. Botulinum toxin-A is a natural substance that is made by a specific bacteria (Clostridium botulinum). It is used to relax muscles to treat lots of medical problems, including TMD.

The treatment usually reduces jaw-muscle pain for most people with myofascial TMD. You should see some improvement in up to 10 days, and the effects should last for 6 months on average.

There is no guarantee the desired effect will be achieved.

How it works

The injections relax the muscles by temporarily blocking the nerve signal to the muscle. This causes less activity of the overworked jaw muscle. In the areas treated, the muscles are weakened until the effects of the injection wear off.

These injections will not stop the habits that might be causing the TMD, but they might reduce the damage they cause.

Who can have botulinum toxin-A injections

You should not have botulinum toxin-A injections if you:

• have an allergy to botulinum toxin
• have an infection around the injection site
• are feeling unwell or have a fever (high temperature)
• are pregnant or breastfeeding
• have a pre-existing neuromuscular disease (such as myasthenia gravis)

If you take medicines to thin your blood, such as warfarin, we will talk to you about your suitability for the injections.

The number of injections needed is different for everyone.

Risks of botulinum toxin type A injections

Although these injections are generally well tolerated, like all medicines, they can cause side effects.

Common side effects

• Soreness and bruising at the injection site
• Flu-like symptoms, including a headache, for the first 24 hours after treatment
• Temporary weakness and droopiness of your face, for example lower lip, eyelids or eyebrows may drop
• Altered face shape or excessive muscle weakness
• Skin rash or itchiness
• If you have repeated treatment, you can develop resistance to the toxin so that it’s no longer effective
• The treatment may not be effective

In rare cases, serious problems can develop in the hours, days or weeks after treatment. These could be a sign of an allergic reaction and you must get medical help as soon as possible.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

Read more about our consent process.

Having the injections

We'll send you an appointment for a few weeks after you are seen in clinic and agree to have the treatment.

You must tell us if you have had any injections of botulinum toxin in the last 3 months.

You must not drink alcohol for 24 hours before the procedure, as it can increase the risk of bruising.

You should have a light meal before your injections.

Botulinum toxin-A injection procedure

The injections are given in the oral surgery outpatient's clinic, and the appointment takes about 45 minutes.

The skin around the injection site will be cleaned with antiseptic.

The practitioner will ask you to use certain face muscles to see how they work. They will use a surgical marker to mark the areas to be injected.

A needle is gently inserted into the affected muscle to deliver the toxin. Local anaesthetic is not used for this procedure, because we do not want to inject you twice in the same area.

It is normal to feel some discomfort while the injections are being given.

A cotton swab is put on the injection site for a few minutes to minimise any bleeding.

After the procedure

The injection site can be sore for a few hours afterwards. You can take regular painkillers for this, such as paracetamol or ibuprofen. Always read the instructions and never take more than the recommended dose (amount).

Keep the area clean and do not massage or rub the treated areas for 48 hours, as this can make the injections less effective.

You will not see any difference immediately. It can take up to 10 days for the toxin to start working, and up to 3 weeks for the full effect to be seen.

You should continue to wear any splints, if you have them, that you’re using for bruxism, and use any self-management strategies.

More treatment might be considered after 6 months, when the effects of the treatment start to wear off.

You will be offered 2 treatments of these injections for TMD. After this you will be discharged back to the care of your dentist or GP.