Case study: How one dentist relieved immobilizing TMD pain with Botox
How do you help the patient who has seemingly tried everything to relieve their severe TMD symptoms? Learn how MSPD Educational Director Dr. David Dana was able to finally provide pain relief to a patient who had suffered for years.
Summary
Patient: Monica
Chief Complaint: Intense pain in jaw muscles, morning headaches, fatigue
Condition: 4 years of severe TMD, taking Motrin with 24-hour splint use
Pain level before treatment (out of 10): 9, or 5 with splint
Pain level after treatment: 0 (occasionally 2, when maintenance tx is needed)
Treatment summary: 150 units of Botox® in facial, head and neck muscles
In 2012 Dr. Monica Duarte came to fellow dentist, Dr. David Dana, looking for advice on her chronic pain. She had been suffering with TMD issues for the past 4 years and reported that her symptoms grew progressively worse. After a full pain and TMD evaluation and treatment, Monica reports going from extreme pain to no pain. Here is her story.
Living With Pain Every Day
Monica was in chronic pain every day. She had a hard time dealing with the extreme pain in her jaw muscles, morning headaches and overall fatigue from managing this pain. She had sought out examinations from many other dentists, but there was no resolution to her TMD symptoms or daily pain.
When she was examined by Dr. Dana, she was “living on Motrin” and had been wearing a splint 24-hours a day for 8 months (including eating with the splint). She reported that the initial use of the splint was quite effective, reducing her symptoms and pain from around a 9 to a 5. However, by month 8, new pain and discomfort developed. Being a dentist, she was concerned when she noticed her new clenching habits and that the splint was changing the way her teeth fit together. She reported feeling dependent on her splint, and was growing tired of having to eat and talk with it. If she didn’t wear her splint, she would be in extreme pain around her head, jaw, neck and shoulders within 10 minutes.
A Possibility of Relief
Dr. Dana treating a patient with Botox (Dr. Monica not pictured)
When Monica discovered Dr. Dana’s Pain Management class, she decided that she needed to consult with him. She signed up to learn more about diagnosing orofacial pain, and also to see if he could provide a more effective treatment for her.
Dr. Dana did a full muscle evaluation. He was not surprised that every muscle of mastication and accessory muscle had severe pain just with gentle pressure. When doing a complete bite exam, he noted that her bite had been changing and opening from her 24/7 splint use. Her severe muscle hypertrophy led Dr. Dana to suggest Botox to bring the muscles to a more normal state of tonicity.
Dr. Dana first decided that Monica’s continual use of her splint was doing more harm than good, and that Monica didn’t need it so much with a full TMD treatment. He recommended to stop using the split completely and to not even sleep with it. When he told her this, she was terrified to stop using her splint since it gave her some moderate relief. Eventually Monica agreed to try his treatment plan.
Dr. Dana prescribed a full TMD treatment regime. He started treatment by injecting 150 units of Botox into her masseter, temporalis, glabella, orbicularis oculi, frontalis, occipitalis, sternocleidomastoid, spinalis capitis, and trapezius muscles. He also performed a limited occlusal adjustment. He told her about the maintenance treatment, which may be every 3-6 months as needed to maintain the effectiveness of the Botox treatment, which she would no longer need after her bite was fully corrected.
A New, Pain-Free Life
Within just 10 days, the Botox treatment successfully reduced Monica’s overactive musculature activity. From that day, she reports to be 100% pain free. Her overall quality of life is transformed. She not only lives a pain-free life, but as a dentist, also helps many of her patients fight their orofacial pain with Botox.
“I loved the Botox route and would really recommend it to be considered for chronic sufferers of TMD. My only regret is that I wished I learned about it 8 months earlier so I didn’t go through the hassle of living with a 24-hour orthotic device. Treatment was so much easier and faster with Botox. Being pain free has really changed my quality of life.” – Dr. Monica Duarte
If you have patients like Monica who have tried almost everything to relieve TMD pain, consider providing them with Botox treatment. Many patients have seen success with Botox when nothing else seemed to work.
If you’d like to add Botox treatment to your practice, consider attending our Botox® in Dentistry course to receive training (Aliso Viejo, CA – May 29/New York, NY – Sept 24). Dr. David Dana will help you to master this useful tool through extensive lecturing and hands-on exercises with live patients. Learn more about the course and see dates and locations here.
