Treating TMJ with Botox
After years of jaw pain, I turned to needles for relief
Until about two years ago, I didn’t give much thought to my jaw.
I dutifully tended to my split ends and cuticles, flossed quasi-regularly and got yearly pap smears and all, but jaw care was not on the maintenance agenda.
Then one morning, after a few days of throbbing pain on the side of my mouth, I scheduled an emergency dental appointment, figuring the quasi-regular flossing might be to blame for a cavity or abscess or something.
It turned out my teeth were fine, but my jaw was not.
“You have TMJ,” my dentist announced. “And if you don’t do something about it soon, you’ll need a retainer or maybe even surgery.”
Wait, what?
That’s the first time I heard about temporomandibular joint disorder, the very complicated name for pain or dysfunction in the jaw joint (a.k.a. the TMJ) or surrounding muscles. According to the Temporomandibular Joint Society Of Canada (yes, that’s a real thing), it affects roughly 1,102,000 Canadians and can lead to a whole host of annoyances like headaches, ear aches, insomnia and lockjaw. This latter ailment prevents you from partaking in some of life’s greatest pleasures like eating burgers and French kissing.
There are many reasons one can develop TMJ issues, including trauma or injury or arthritis, but stress can also be a culprit, leading to long-term clenching or grinding. “It me!” as the kids say. While I convinced myself and those around me that I was cool as a cucumber, my jaw knew I was quite literally lying through my teeth.
After a while that jaw became very top of mind, radiating sharp pain from my ear canal down to my neck and keeping me up at night. I popped Advil every day to dull the tension headaches and Googled fun soup recipes when chewing became uncomfortable. Mostly, I was just frustrated something as trivial as jaw pain was overhauling my life.
“It’s been called ‘the master joint of the body,’” says Dr. Dennis Marangos, principal dentist at the Yorkville TMJ Center and president-elect of the American Academy of Craniofacial Pain. “If [your jaw] is out of alignment, it can affect your posture, your spine, your sleep, how you eat, how you speak, pretty much everything.”
Marangos keeps a box of tissues on his desk because patients tend to get emotional when discussing their condition. That’s how debilitating it can be.
“I tell them, ‘You know what? We can help you,’ and almost automatically, they start crying because finally somebody has validated that their pain is real, that there’s a reason for it, and there’s something we can do to get them out of pain.”
Curbing that pain, however, isn’t so easy. Marangos calls it a “team effort,” noting that the road to relief often involves several practitioners, from chiropractors and physiotherapists to dentists and oral surgeons.
To be honest, the thought of having to see three or four specialists every week for up to six months makes my jaw tense up even more. I don’t have time to deal with this, I tell myself. I’m frazzled enough as it is trying to keep up with work and maintain a social life and tend to the split ends and the cuticles. I have to clean my apartment and go to the gym and get groceries and do laundry and file my expense reports, and owwww, my jaw is killing me!
“I have that, too!” my friend exclaims, after I rant about my stupid jaw during a long overdue girls’ night (social life: check).
“Me, too,” a second friend says. “A girl at work gets that,” adds a third. It’s a freaking epidemic!
Well, kind of. TMJ affects more than twice as many women as it does men, and the 20- to 40-yearold range is particularly at risk.
Some experts have posited hormones could be at play, others say women are simply more likely to seek medical help, but Jaswinder Lamba has another theory.
“I think we as females have our hands full,” says the physiotherapist and founder of Etobicoke’s New Age Physio. “We’re playing multiple roles during the day, and we don’t have enough downtime, which our body needs. Not to say that men don’t have stress.”
So why are we women channelling that stress into our jawbones? It’s as though instead of speaking up about the problem, we’re keeping our mouths firmly closed. So firmly, in fact, it’s wearing down our bones and damaging our nerves.
“During situations of fight or flight, studies have shown the first thing we [women] clench is our pelvic floor, because we want to protect our reproductive organs,” explains Lamba. “The second is our jaw. Whether it’s to prevent us from screaming or to preserve energy so that we can run, I don’t know, but I’m sure there’s a reason.”
I’m not sure what my reason is. Probably something along the lines of feeling like acknowledging I’m overwhelmed is some kind of failure. But instead of treating the cause and “admitting defeat,” I go straight for the symptoms and start jaw physio (again, yes, that’s a real thing).
The physiotherapist presses her latex-gloved fingers against my gums, popping my jaw back into its socket. It hurts like hell, but I actually do feel better a few days later. She gives me exercises to practise at home and sends me video demos of a guy sitting up straight and opening his mouth
verrrrrryyyyy slowly over and over. Weird stuff.
She insists I see her twice a week for a month or two. I think about all the time I’ll spend commuting and the work I’ll miss and all the insurance claims I’ll have to file.
“I’m afraid that won’t be possible,” I finally say.
Weeks later, as I’m getting my hair trimmed (split ends: check), Tony Pham of Lac + Co hair salon tells me about a very posh version of jaw physio that’s decidedly not covered by my insurance. French facialist Joëlle Ciocco’s “buccal” treatment is essentially a 75-minute mouth massage designed to relieve muscular tension and boost collagen. It’s offered at Pham’s other salon, Lac + Beauty, at the cost of $350.
“You’re going to think about me tomorrow,” says Taisiya Toroptseva as she tenderizes the insides of my cheeks. The skin specialist studied under Ciocco herself in Paris.
“What do you mean?” I ask. “Sores. In the mouth.” Cool. I leave the Davenport Road beauty parlour feeling blissfully relaxed as faint notes of apricot and passion fruit linger on my tongue (Ciocco’s face oils are all edible, of course, and taste way yummier than latex). The next morning, there are no sores to be found, though my mouth does feel like it’s had a bit of a “workout.” On the bright side, my jaw’s looser than it’s been in months and my skin’s all plump and juicy. Colour me impressed!
Now, yes, I’m well aware $350mouth-facials aren’t exactly a sustainable solution to my problem. But maybe I can treat myself to one once in a while, I tell myself. It sure helped on the stress front. And my skin!
“My dentist suggested I try Botox,” my co-sufferer friend tells me after I rave about my expensive facial (mouth-cial?). “You do it a few times a year and all your pain goes away.”
I book a consult faster than you can say mouth-cial.
“Botox relaxes the muscles of the jaw and can really make a difference in your quality of life,” explains Dr. Anatoli Freiman of the Toronto Dermatology Centre.
“You have less pain and fewer migraines and you sleep better. Does it work for everybody? No. But for a vast range of people, it can really help, especially those who’ve tried all sorts of things like chiropractors, dental interventions and pain medicine.” Or, you know, mouth-cials. As Freiman gently pokes me with the tiny needle, I ask him what kinds of people come in to see him for “therapeutic Botox.”
“Typically people who tend to clench more, people who are more stressed, more anxious, Type A personality types,” he says.
Touché, Dr. Freiman.
The whole thing’s over in about five minutes and there’s absolutely no downtime. Improvements usually start around the two-week mark and can last up to six months. And good news: it’s covered by many insurance plans.
Eureka, I think to myself, after the tension has subsided and I realize I haven’t even thought about my jaw in weeks. I’m probably not the first to say this, but, boy, Botox is magical! A fast, pain-free solution that doesn’t involve twice-weekly appointments or taking out a line of credit to fund my fancy French gum massages? Count me in.
Plus, I’m in good company. Socialite Tinsley Mortimer got Botox to “relieve jaw stress” on a recent episode of “The Real Housewives of New York City.” Her co-star Bethenny Frankel has also spoken in the past about how it helped her following years of teeth grinding.
But not all experts are riders of the Botox bandwagon.
“It’s a Band-Aid,” says Marangos, who’s actually received training to administer the injections, but has chosen not to include them in his practice. “It can possibly give you temporary relief, but you’re not treating the root of the problem.”
I get it, of course. But in the words of my friend’s text yesterday “My jaw hurts so much. I’m
sooooo sick of this!” (insert angry red-faced emoji). TMJ pain, or “overachiever mouth” as I’ve come to affectionately call it, sucks big time.
And sure, I should probably reconsider Marangos’s multipronged treatment plan, which, FYI, he says sets patients back about $3,500 to $5,000 (it’s usually not covered by insurance), or at least try physiotherapy again or give acupuncture, which Lamba is a fan of, a shot.
And I will do one or more of these things, I promise. But when the pain becomes unmanageable and adulting gets stressful, I won’t deny myself the sweet relief of a quick fix and a good night’s sleep. Because part of dealing with anxiety, I’ve found, is learning to do what feels right for you and not giving a damn about what others might think. If getting Botox for my jaw is the easy way out and admitting I can’t juggle it all is akin to failure, it sure feels a lot like winning to me.