Currently, medical insurance policies do not cover the use of BOTOX for TMJ issues. Because TMJ disorders are primarily a dental condition, it’s possible that insurance companies will eventually pay BOTOX injections as a way to prevent gum and tooth damage caused by excessive jaw grinding. Despite the fact that insurance companies have yet to cover this treatment, it is gaining popularity among patients, doctors, and dentists.
How much does it cost to get BOTOX for TMJ?
Botox has long been used in the beauty business to reduce wrinkles and provide the look of youth, but did you know that it can also be used for non-cosmetic purposes?
Botox can be used to improve your appearance as well as ease pain. Dentists are experts in the face and mouth, so they realize that pain and headaches can come from a variety of places. Botox is used to temporarily relax the muscles that cause chronic headaches and TMJ pain. In the locations where Botox is administered, there is no numbness or any pain. The majority of patients’ outcomes endure three to four months before requiring another application.
The photo to the right shows me getting a Botox injection in my trapezius muscle to ease pain that had been bothering me for several weeks owing to my own TMJ difficulties and bad posture while working with patients.
The pain went away around two days after the injection, and I’ve never felt better.
The same procedure can be used to treat TMJ / TMD pain, with injections around the jaw area to ease the discomfort.
A small amount of Botox is injected into the masseter muscle, which helps prevent clenching and contraction – which can cause severe jaw pain – by temporarily blocking signals from the nerves to the muscles.
Note that this Botox treatment for TMJ / TMD discomfort is NOT a long-term cure, and I always propose that we look into the cause of the pain and try to come up with a less intrusive / long-term solution.
Botox injections for TMJ pain cost $15 per unit.
Depending on how many units are used and the coverage area that will be handled, a typical session might cost anywhere from $350 to $600.
*Alternatives to Botox, such as Xeomin, are available for patients (incobotulinumtoxinA).
Prices will differ.
Is TMJ covered by insurance?
TMJ is a potentially debilitating jaw disorder. Although it may appear to be minor at first, if left untreated, it can progress to severe pain or even full jaw paralysis. Except in the eyes of insurance, it’s actually no different than other joint disorders from some perspectives.
The temporomandibular joint and related diseases are treated differently by insurance companies than other forms of joint ailments, and most insurance companies refuse to cover them unless the state requires it. Unfortunately, Colorado is not one of the states that requires TMJ therapy to be covered.
That isn’t to say that your insurance won’t cover TMJ therapy; it just means that it probably won’t.
How can I get my insurance to cover BOTOX?
It’s vital to remember that most insurance companies will only pay Botox treatments if you’ve already tried and failed two other migraine treatments. They may require you to file a prior authorization form with your healthcare physician to confirm this.
What type of insurance covers TMJ?
TMJ issues should be covered by insurance, according to most experts. Many people wonder whether it’s covered by medical or dental insurance, and where the boundary is that separates the two types of coverage.
Medical insurance is usually the primary source of coverage for TMJ issues. The reason for this is that a joint, like muscle, tendons, and ligaments, can be found everywhere in the body. Physical therapy coverage is normally straightforward, although coverage conflicts are common when orthotics, appliances, or splints are created.
Blue Cross and Red Crescent Societies When used to treat a TMJ patient, Blue Shield will generally classify TENS as experimental, but will pay treatment for other purposes.
It’s worth noting that treating TMJ issues saves both patients and insurance companies money.
TMD sufferers used healthcare at 200-300 percent higher rates than non-TMJ patients, according to Shimshak et al’s findings published in Cranio.
My personal experience with saving money for insurance companies dates back to the 1980s when I worked for Chicago HMO. I had a patient who really required treatment, but her insurance didn’t cover it. I struggled for coverage and eventually met with Dr Mitchell Trubitt, the Medical Director of Chicago HMO Ltd.
I described the treatment to him, and he agreed to the non-surgical treatment, which proved to be effective. We agreed to a trial period after I assured him I could save the insurance company money while also benefitting the patients. Six patients were sent to me by a Chicago HMO, all of whom were told they needed TMJ surgery.
I handled the first six patients, and after reviewing the records, Dr. Trubitt estimated that the non-surgical approach had saved the Chicago HMO over $250,000.
Dr. Trubitt then negotiated a preferred provider agreement with Chicago HMO, under which Chicago HMO would cover 100% of phase 1 TMJ treatment with no deductible. Because of the cost savings to the corporation, he also cut the physician’s referral fee to the same level as cancer and cardiac treatment, which was the lowest available.
The end product was fantastic. Almost all of the patients who were tentatively scheduled for TMJoint surgery were able to avoid it. It was less politically acceptable because many oral surgeons objected to their surgical patients being referred to a general dentist for non-surgical treatment. Dr. Bruce Douglas, who was a Board Certified in OMS and a prior editor of their magazine, and I developed a very good relationship since he was an amazing oral surgeon who did not like TMJ surgery.
This arrangement allowed me to work with Chicago HMO and Mitch Trubitt for many years until United Health Care purchased the company. I met with their medical director and Dr. Trubitt, but they informed me that they were not interested in continuing the program because they did not pay for surgery and would not see any savings.
The Shimshak study, which found a 300 percent increase in medical utilization among individuals with TMJ issues, had not yet been published. With the sale of Chicago HMO to United Health Care, a scheme that helped patients and physicians while also saving money came to an end.
The future of health care and coverage for TMD problems is still up in the air.
I am the current chair of the American Alliance of TMD Organizations, which works to represent the majority of dentists who treat TMJ issues in obtaining insurance coverage and protecting patients’ rights to receive adequate treatment.
Can masseter Botox be covered by insurance?
Botox injections are mostly aesthetic in nature, hence they are not covered by insurance. Botox is unlikely to be covered by insurance because it isn’t approved by the FDA as a TMJ treatment. Insurance may cover Botox as a treatment if the TMJ is severe enough to produce migraines.
Do dentists do Botox for TMJ?
Botox can be administered by dentists who have completed specific Botox training for cosmetic purposes or to relieve discomfort from TMD or migraines.
Dentists are an ideal candidate for these treatments because of their skill and knowledge of facial anatomy. They also have a solid awareness of oral systemic health, allowing them to provide treatment that is both safe and effective.
Another reason why dentists are superior Botox and dermal filler providers is that they have more experience injecting anesthetics into the facial region and making the injection process as painless as possible.
Botox in a dentist’s office doesn’t seem so unusual or wild now, does it?
How many units of Botox do you need for TMJ?
With a starting dose of 1025 units for each temporalis muscle, 2550 units for the masseter muscles, and 7.510 units for the lateral pterygoids, we commonly employ a concentration of 2.55.0 units per 0.1 mL of Botox. Following that, doses are adjusted based on the patient’s response. Botox diffuses to around 1 cm at each injection site, and if an insufficient number of sites are infiltrated within a single muscle group, affected portions may go untreated. We recommend using lower doses at various sites with higher injection volumes to avoid an incomplete response.
How long does Botox last for TMJ?
The majority of Botulinum toxin A injections for TMJ will last 3-4 months.
You should be able to return to normal function right after your therapy. You may be given the following instructions:
- To prevent botox from spreading beyond the injection site, sit upright for many hours.
- Use a cold pack to relieve any stinging or pain around the injection site.
What happens if you leave TMJ untreated?
If you don’t get your TMJ condition treated, a lot of things can go wrong. The following are some of the most prevalent health issues related with untreated TMJ:
Jaw Problems
Untreated TMJ can lead to a variety of jaw disorders. It’s possible that the cartilage in your jaw will break down, resulting in dislocations.
If you don’t treat your TMJ, you’re more prone to acquire lockjaw. It’s also possible that your jaw will become permanently jammed, necessitating hospitalization.
Tinnitus
If left untreated, TMJ issues can lead to tinnitus (ringing in the ears) and vertigo. The inner ear might become impaired and possibly permanently harmed due to the temporomandibular joint’s placement below the ears.
Poor Dental Health
Teeth grinding and clenching on a regular basis can cause tooth fractures and wear down the enamel on your teeth. You may also develop jaw swelling and unbalanced jaw muscle growth.
Other Health Problems
If you don’t undergo TMJ treatment, it can get to the point where you can’t chew or eat normally. This can make getting all of the nutrients your body requires more difficult.
People with untreated TMJ are more likely to experience sleep problems and insomnia, both of which can have a detrimental influence on different parts of their lives, including job performance and relationships.
Is Botox FDA approved for TMJ?
Many TMJ sufferers are considering Botox for TMJ therapy as a way to relieve their pain and discomfort. Botox is effective because the facial muscles play a significant impact in the amount of pain caused by TMJ. Botox works by relaxing the muscles in the affected area, resulting in little to no pain for the patient. Botox injections must be administered by a TMJ expert, who has been specially trained in how to do so safely. TMJ issues can be caused by arthritis, tooth and jaw misalignment, tension from teeth grinding, dislocation, or other injuries, according to the American Dental Association.
About Botox safety
Botox is a toxin-based medicine, which makes people who are interested in utilizing it wonder how safe Botox injections for TMJ treatment are. When administered by a qualified TMJ specialist, Botox therapy is considered a safe technique. Botox injections were approved by the FDA for TMJ treatment in 2002, therefore TMJ sufferers who are contemplating this alternative can rest assured that Botox injections are safe to use for TMJ treatment.
Botox is generally safe, although it can have unwanted side effects in some people. Swelling, bruising, headaches, and flu-like symptoms are just a few of the negative effects. Any negative effects that a patient may suffer are usually minor and only last a short time.
How Botox relieves pain
Botox works by paralyzing muscles for a short period of time. Botox is a muscle relaxant, which means it can assist lessen pain-inducing muscular spasms. Botox is especially effective for TMJ sufferers whose TMJ is caused by teeth grinding or clenching since it relaxes muscles. Muscle relaxation specifically aids in the relief of jaw tension as well as the prevention of headaches associated with jaw disorders.
How long Botox injections last
Many individuals who select Botox to treat their TMJ issues should expect their treatment to last three to five months. It will ultimately be determined by a patient’s genetic makeup as well as the severity of their TMJ. It’s vital to remember that the longer a patient is under therapy, the longer they can go between injections. This is because the muscles are constantly relaxed as a result of Botox treatment.