My crash course into the mysterious world of Temporomandibular joint disorder began one fateful fall evening, during my junior year of college. The day started off, as usual, packed with classes and followed by a seven-hour shift at one of my two part-time jobs. What began as a dull ache early in the day, suddenly turned into a searing hot pain that shot through my head as the lights from oncoming traffic flashed across my field of vision during my drive home. It was my first migraine.
At that point, I’d been experiencing jaw pain for a while but didn’t ever associate the two. Soon after the migraine hit, my jaw became so swollen and lopsided that I decided to go to a doctor who thought I had a lump that needed a biopsy. Turns out, I had a super-strong masseter muscle (the muscle that helps facilitate chewing) after years of stress-induced clenching, which was like weight-lifting my jaw muscles for eight hours every night. Many doctor’s visits, X-rays, and CAT scans later one doctor said, “You might have TMJ.” It wasn’t definitive, but at least it was something to work with.
What’s TMJ? The temporomandibular joint (TMJ) is where the jaw bone (mandible) connects to the skull (temporal bone). “When people say TMJ, they are often referring to pain or discomfort anywhere along the jaw, which may also include some neck muscles,” says Jennifer P. Bassiur, doctor and director of the Center for Oral, Facial and Head Pain at Columbia University. But because the pain isn’t just located at the joint, a more accurate term for the condition may actually be “TMD,” or temporomandibular disorder. This refers to the conditions involving pain or dysfunction in the jaw point and/or surrounding tissues, she says.
The National Institute of Dental and Craniofacial Research estimates that more than 10 million Americans are affected by the disorder, reporting pain in and around the ear and jaw — on one or both sides of the face — as well as headache, tension, inability to open and close the mouth comfortably, and painful clicking, popping, or grinding sounds when speaking, chewing, or yawning.
Curing, well, managing, TMD first depends on identifying the underlying cause. For me, it was clenching, which only worsened when I was stressed (i.e. always). For TMD, doctors advise avoiding sticky or chewy foods (like gum), applying ice and/or heat to the jaw, medications (steroids, nonsteroidal anti-inflammatories, and muscle relaxants), a custom-fitted orthotic that fits over the upper or lower teeth, injections into the muscle or joints, physical therapy, cognitive behavioral therapy, or in severe cases, surgical intervention may be required.
And, unfortunately, TMD is often a chronic condition. There’s no cure for my pain. After attempting several treatments, I decided to get a night guard and start what I affectionately refer to as “the mush diet,” which is exactly what it sounds like — eating without chewing. I had a bit of relief (and an excuse to eat avocados and smoothies all day), but I knew the diet would only be short-lived because eventually I wanted to, well, chew while eating. I’d lost all hope until I was working on an article with New York City-based plastic surgeon David Shafer, when our conversation turned to my horrible TMJ.
“You know, Botox is good for that,” he told me. “I’ve injected patients (and myself), and there’s relief from the pain and swelling. Shafer explained that eight years ago, he went to Japan with Allergan (the makers of Botox) to help teach the doctors U.S. techniques. During his time there, he noticed doctors were injecting Botox into the jaw to slim the lower part of the face. But a happy accident occurred after patients started reporting that they felt relief from jaw pain. By injecting directly into the muscle, Shafer says, Botox limits muscle function, and decreases TMD symptoms. Thrilled at the chance to (gently) sink my teeth into a new remedy — without the pain, swelling, and a lopsided jaw — I immediately booked an appointment with Shafer and began researching this new treatment.
As it turns out, the treatment isn’t that new in other countries, according to Melissa Kanchanapoomi Levin, a board-certified dermatologist and clinical professor at New York University Langone and Mount Sinai Hospital in New York City. “I grew up in Thailand and saw Botox being injected into hypertrophic masseter muscles over 15 years ago,” she tells Allure. “Asian aesthetics sometimes will favor an ovoid facial shape that can be accomplished either by surgical reduction or botulinum toxin, which offers a less invasive approach.”
Kanchanapoomi Levin injects Botox into the masseter muscle for two reasons. For those like me, who experience chronic facial muscle pain and headaches from persistent grinding/clenching, Botox can relax the muscles involved and relieve pain, and people with an enlarged muscle near the angle of the jaw for sculpting the lower face. She also notes that although there are more than 600 studies evaluating injecting botulinum toxin into the masseter muscle, this treatment is not approved by the Food and Drug Administration and is considered an off-label indication.
If it is performed by someone that doesn’t know what they are doing you can have functional impairment, pain, spasms, lockjaw, and difficulty chewing, Kanchanapoomi Levin says. It’s important to go to a board-certified dermatologist or facial plastic surgeon who understands the anatomy, is well-trained, and performs this procedure routinely.
Sitting in the chair at Shafer’s office, armed with my new arsenal of knowledge, a wave of fear hits me. The thought of injecting a toxin that will cause partial muscle paralysis in my jaw is terrifying. Shafer assures me that the procedure will be just three little injections on each side of my jaw, and swelling or bruising occurs in less than 1 percent of his patients. I hardly felt the tiny injections in my jaw and have no visible mark.
Now, following the procedure, I sometimes notice my jaw getting tired while chewing gum — something I haven’t been able to do in years, so I’m okay with that. “One of the great things about Botox is, if for whatever reason you don’t like it, it goes away,” says Shafer. “But one of the bad things about Botox is, if you like it, it still goes away.”
Generally, Botox lasts anywhere from three to five months, depending on how each person metabolizes it. As for how quickly I can expect relief, when Botox is used for cosmetic purposes, it’s injected into smaller muscles so it works quickly. The masseter muscle is much larger, so it may take up to one to two weeks.
After one week, I notice that my headaches are not as frequent and my jaw hurts less, but it’s still swollen and lopsided. By week two, I’m sleeping better and can chew real food without wanting to rip my face off. I still have some swelling and occasional pain, which Shafer explains will get better over time. Since it took many years to create this issue, I am excited to see such a big change after only one treatment. Who would have thought that the life-changing solution to my chronic TMJ pain would be Botox? Spoiler alert: Not me.
For more Botox:
Now, watch as a dermatologist explains lip injections: