This leaflet answers common questions about the use of neurotoxin (botulinum toxin) as a treatment option for temporomandibular joint dysfunction (TMJD).

If you would like further information, or have any worries, please do not hesitate to ask your nurse or doctor.  In all cases, a doctor will explain the procedure to you and answer any questions you may have.

How does neurotoxin therapy work?

Neurotoxins temporarily relax muscles by blocking nerve signals. Many different brands exist; one of the most common is “Botox.” It is also commonly used in cosmetic procedures, such as reducing wrinkles. Neurotoxin injections are used to reduce muscle overactivity in TMJD, helping to relieve jaw pain and clenching. Specific areas of the face and neck can be injected to manage conditions related to TMJD such as jaw ache due to clenching.

This treatment may be suitable for people who experience jaw pain, clenching, or teeth grinding that has not improved with other treatments, such as physiotherapy or a mouthguard

When neurotoxin is injected into the muscles that require treatment, they become temporarily inactive. Depending on the individual and the dose, the effect can range from relaxation to an inability to move the muscles.

What does the procedure involve?

This is a quick procedure, provided as an outpatient service, meaning you will be able to leave the hospital after the treatment. During the procedure small quantities of the neurotoxin will be injected into the muscles.

You may be asked to use certain muscles of the face to observe how they work, or asked which areas cause the most pain. Specific areas will be marked with a pen. The injection is given with a fine needle and may cause a mild stinging sensation, like a small scratch. Most patients find it tolerable.

Is the procedure safe?

The procedure is carried out by a trained healthcare professional using neurotoxins which are well-established and safe. You will be assessed prior to the procedure to ensure you are suitable. However, treatment is not recommended in pregnant or breast-feeding women, or those with myasthenia gravis.

How soon will I see the effects and how long will this last?

Initial effects can be seen 48 to 72 hours post procedure, but it can take up to 14 days to see the full effects. These effects are not permanent. Movement will begin to return from 8 to 12 weeks; however, this can vary depending on the individual.

After your neurotoxin

Aftercare following neurotoxin is minimal and you should be able to return to your normal activities within a day or two. Post-operative instructions will be explained after your procedure, this is summarised below:

  • Avoid touching, rubbing, or massaging the area that has been injected
  • Temporary swelling, bruising or tenderness is to be expected – this should resolve within a couple of days
  • No strenuous activity for 24 hours post-procedure
  • Do not lie down flat for 3 to 4 hours post-procedure
  • For the first 24 hours, avoid hard or chewy foods that put extra strain on your jaw.

Risks and side-effects

Side-effects are uncommon and temporary, these may include:

  • Bruising/ tenderness/ swelling at the injection site
  • Mild headaches
  • Allergic reactions (rare)
  • Facial weakness – drooping/ asymmetry (rare)

If you experience unexpected side effects, such as severe swelling or difficulty swallowing, contact your healthcare provider immediately.

Occasionally, the treatment may not work as intended. Some people can be immune to the effects of neurotoxins, this is more likely in people who have had this procedure many times.

If neurotoxin is injected close to the eye, there is a small risk (less than 1%) of developing a temporary drooping of the eyelid. If this happens, this may last a few weeks but will always resolve. If this occurs, eye drops can be used to lessen the effects until this wears off.