Trigger point injections and botulinum toxin (Botox) injections are both used for jaw muscle pain, but a 2023 BMJ clinical practice guideline made conditional recommendations against both for chronic TMJ pain, so neither is a first treatment. This article explains how they differ, what the evidence shows, and when an injection may still be reasonable.
What is the difference between the two injections?
A trigger point injection places a small amount of local anesthetic, such as lidocaine, into a tender, tight spot in a jaw muscle. It is meant to relieve muscle pain and break a pain cycle, and it can also help confirm where pain comes from. Botulinum toxin weakens the injected muscle for several months by blocking the nerve signal to it. Botulinum toxin is not FDA-approved for TMJ disorders; its use there is off-label.
What does the evidence say about trigger point injections?
For chronic TMJ pain lasting three months or more, the BMJ guideline made a conditional recommendation against trigger point injection, while making a strong recommendation in favor of manual trigger point therapy by a therapist (Busse 2023). A small randomized trial in patients with jaw muscle pain found that lidocaine injections into the masseter, with or without an occlusal splint, reduced pain and improved mouth opening over three months (Saglam 2024). Small trials like this one do not outweigh the guideline, but they show injections can help some patients.
What does the evidence say about Botox for clenching and jaw pain?
The BMJ guideline made a conditional recommendation against botulinum toxin injection for chronic TMJ pain (Busse 2023). For bruxism, an overview of 14 systematic reviews found that botulinum toxin was reported to reduce pain, grinding events and bite force, but every review was rated low or critically low in quality, so firm conclusions cannot be drawn (Coelho 2025).
Does ultrasound guidance make injections better?
Ultrasound lets the clinician see the muscle and nearby structures and place the needle under direct view. High-quality trials showing that ultrasound guidance improves pain outcomes in the jaw muscles are lacking, so it is a matter of accuracy and safety in placement rather than proven extra benefit.
When might an injection still be reasonable?
When the treatments with the strongest evidence, such as education, supervised jaw exercise, manual therapy and cognitive behavioral therapy, have been tried and pain persists, an injection may be discussed as part of a shared decision. The discussion should cover the evidence, the expected duration of effect, side effects, and cost. See TMJ treatment without surgery and Botox for TMJ and jaw muscle pain.
Where can I discuss this in West Hills?
Dr. Masudian, DDS, MPH, an orofacial pain specialist who completed a two-year CODA-accredited residency at USC, evaluates jaw muscle pain and clenching at 23101 Sherman Pl, Suite 415, West Hills. The office is expected to open in mid-January 2027. Call (818) 877-0118 or request an evaluation.
References
- Busse JW, Casassus R, Carrasco-Labra A, et al. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. BMJ. 2023;383:e076227. PMID 38101929. doi:10.1136/bmj-2023-076227
- Saglam R, Delilbasi C, Sayin Ozel G, Subasi ID. Evaluation of the effects of occlusal splint and masseter muscle injection in patients with myofascial pain: a randomised controlled trial. J Oral Facial Pain Headache. 2024;38(3):64-76. PMID 39800573. doi:10.22514/jofph.2024.028
- Coelho MS, Oliveira JMD, Polmann H, et al. Botulinum toxin for bruxism: an overview. Toxins (Basel). 2025;17(5):249. PMID 40423331. doi:10.3390/toxins17050249
