Now don’t get too excited – I’m not talking about your dentist smoothing the wrinkles on your face, but some dentists have been looking to botox for the treatment of temporobandibular disorders (TMJ).  Your temporomandibular joints (TMJ) are the joints that slide and rotate just in front of your ear.  They are the points at which the lower jaw (mandible) attaches to your skull and are among the most complex joints in the human anatomy.  If you place your fingers on the sides of your face, just in front of your ears, open and close your mouth, you can feel the movement of the mandible in the temporomandibular joints.

The joint works properly when the lower jaw and its joint (both right and left) are synchronized during movement.  They are very complex joints in that unlike other joints of the body, they can move in all directions while functioning in harmony with the joint on the other side.  Because of this, several muscles are involved: some to close, some to open, some to move forward and others to pull back.  Normal function for this group of muscles allows you to chew, swallow, speak and communicate with little or no thought.  When the joints are not functioning properly and there is associated muscle pain, some practitioners feel botox has a legitimate place in the regimen of treatment.

Botox is a protein (Botulinum Toxin type A) derived from the Clostridium botulinum bacteria, the toxin responsible for food poisoning.  When injected into a muscle, botulinum toxin prevents the release of the chemical acetylcholine, which triggers the muscle contraction.  Researchers found the protein to be especially useful in treating muscle spasm and, eventually, in rendering certain muscles that cause facial wrinkles immobile. 

Botox has been approved by the U.S. Food and Drug Administration (FDA) for certain muscle disorders and the reduction of a patient’s frown lines between their eyebrows, but to date it has not been approved for the treatment of Temporomandibular Disorders (TMD).  In the dental community opinions on use of the medication are divided.  Some practitioners praise its use in treatment while others question its validity because of the lack of well-designed, long-term studies to support such applications.  Likewise, the company who produces Botox apparently has no plans on pursuing government clearance for TMD applications and at the present time there are little avenues for practitioner training on its use.  I can see how botox could potentially have a use in the treatment of TMD, but I would want to see further studies on its use before considering adding it to the variety of treatment therapy we presently have.  I am not saying Botox won’t have a place in dentistry, but careful consideration should be given prior to its use.  While not discounting Botox’s apparent effectiveness in alleviating muscle pain with TMD (it has no effect on actual problems with the temporomandibular joint), there are several proven treatments that have been tested and are readily accepted as proper treatment of the joints.  Initially, I still prefer these more conservative measures for treatment.

OK, I know everyone has been thinking it;  Well, if dentists end up using it for treatment of the muscles in the TMJ, why couldn’t they just smooth out a few wrinkle while they are there?  Believe it or not, there is growing interest among some dentists to treat patients’ facial wrinkles with Botox.  Don’t expect it any time soon though; this introduces a whole new question as to the legality of a dentist providing treatment that many feel this is not within the scope of practice of dentistry.  As for me, I’m happy to treat the oral health complex and leave the wrinkles to plastic surgeons and other medical practitioners who provide the service!