Overview of TMD and MMP
Temporomandibular Joint Disorder (TMD) and Masticatory Myofascial Pain (MMP) are conditions where there is dysfunction of the temporomandibular joint (TMJ) and surrounding muscles often presenting as pain or limitations in movement. TMD is a disease of the bones and ligaments associated with the TMJ and definitive treatment requires alteration of these structures. MMP on the other hand is associated with the muscles of mastication – masseters, temporalis, and pterygoid muscles – and the goal of treatment is to alter how the muscles function. Both TMD and MMP presents as facial pain and patients often have a combination of the two conditions.
The initial step in treatment of TMD/MMP is seeing your general dentist. Your dentist will perform an exam and may order x-rays to determine what degree TMD and MMP play a role in your facial pain. Conservative treatment options include:
- stress reduction
- soft food diet
- cold or warm compresses to your face
- jaw opening stretches and exercises
- anti-inflammatory medications
- referral to a physical therapist to help retrain your jaw
- a prescription for a muscle relaxant
- fabrication of bite splint or mouthguard
Conservative therapies are reversible and depending on the severity of your TMD/MMP, may resolve your pain and symptoms.
Neurotoxins (Jeuveau, Botox) for Myofascial Pain
You have probably heard of Jeuveau and Botox – they are both brands of neurotoxins (NT) to help limit the movement of muscles. They are often used cosmetically to help with facial wrinkles, but they play a role in MMP as well. One of biggest contributors to MMP is bruxism – clenching and grinding your teeth. Bruxism often occurs unconsciously both when we are awake as well as asleep. Some signs and symptoms of bruxism are flattening of your teeth, large masseter muscles (square jaw line), and soreness of your jaws and temples.
If you continue to have jaw pain despite conservative therapy and your dentist has diagnosed you with bruxism, neurotoxins may be a good option for you. NTs work by limiting the activation of some of your muscles. You will still be able open, close, and chew food, but the forces used for these actions will be less. The effects of NT treatment last for approximately 3-6, but some patients report longer results with repeated treatments. It is important to understand that neurotoxins should be used in conjunction with other treatments.
Will Neurotoxin Help with TMD?
If your pain and symptoms are primarily from TMD, neurotoxins will have limited benefit for you. As mentioned, NT help deactivate muscle function and TMD is primarily a bone and ligament issue so will not directly help your symptoms. If you continue to have pain due to TMD despite conservative management, you will need to seek out an oral and maxillofacial surgeon that treats TMD. We do not treat TMD at South Austin Oral Surgery.
What Can I Expect After Neurotoxin Injections for Bruxism?
You can return to you regular activities after your injections. The injections themself take only a couple of minutes. You may have some soreness initially and apply ice to the area. NT to the masticatory muscles take a little bit longer to take effect compared to other facial muscles, but the muscles should feel more relaxed within 1-2 weeks. For your first visit, Dr. Raju prefers to use a smaller dose and repeat the injections at 3-4 weeks to better tailor the appropriate dose for you. Too much NT can result in a change in your facial shape so a balance between esthetics and function must be found.
Will Insurance Cover Neurotoxins for TMD/MMP?
Insurance will likely not cover neurotoxin injections for TMD/MMP. Neither Jeuveau nor Botox are FDA approved for TMD or MMP, however both have been effectively used for myofascial pain. FDA approval takes some time and effort by the manufacturers and hopefully approval will happen in the future. Most insurances do not cover treatment for non-FDA approved procedures. You will need to contact your insurer directly to see if they cover your treatment and ask what is their criteria for medical necessity.
What is the Cost of Neurotoxin Injections for Bruxism?
At South Austin Oral Surgery, the cost of evaluation, treatment with neurotoxins, and follow-up care will likely range from $600-1200 depending on the amount and brand of neurotoxin used. With a referral from your general dentist, we will schedule you a free consultation to make sure you are a good candidate for neurotoxin injections as well as develop the appropriate treatment plan for your needs. Depending on the availability of the medication, you may receive treatment the same day as your consultation.