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How Botox and Buccal Massage Helped Me Finally Find Relief From a Decade of Jaw Pain

Photos: Lauren Caruso, Getty Images; Artwork: Brooke Frischer/Fashionista

A little more than a decade ago, I started waking up with constant jaw pain that reverberated through my head and down my neck and would last for the first three or four hours of the day. I figured it was just something that happened as you got older: At first I blamed my face-down sleeping position, and then my pillows, until a friend's mom — a dentist — told me that constant jaw pain isn't something that just sets in once you turned 25 — and that I almost certainly have TMJD.

What is TMJD?

TMJD is a condition that nearly 12 million people suffer from, according to the National Institute of Dental and Craniofacial Research, though it doesn't always look the same from case to case. Generally, the temporomandibular joints (TMJ), which are responsible for chewing, talking, yawning and swallowing, among other smooth muscle actions, can become misaligned and result in temporomandibular disorders, also known as TMDJ. This can cause anything from clicking, to limited mouth opening, lock jaw and significant pain in the jaw, neck and surrounding muscles, according to the Dovi Prero, DDS, MS Board Certified Orthodontist with a practice in Beverly Hills, Calif.

"Nowadays, it's fairly common for patients to present to the orthodontist with some complaints of TMJD symptoms," says Dr. Prero, who says that there's been a small increase in cases throughout Covid, likely due to increased stress levels. "We know that TMJD symptoms are multifactorial, which means there are many components at play, like muscle tightness, tendons and habits like grinding, clenching, even stress." Dr. Prero adds that a patient's bite and teeth positioning can also cause TMJD.

What causes TMJD, and what are the treatment options?

My dentist at the time said I was likely grinding my teeth at night due to stress, leading to my head, neck and jaw pain. Of course, this was before terms like "buccal massage" were in the collective lexicon, so my options were limited to getting fitted for a mouthguard or talking to my dermatologist about getting Botox in my masseter muscle. Within days, I was sitting in my derm's chair, happily getting a neurotoxin injected straight into my jaw — and much to my delight, it provided sweet, sweet relief within a week, which is the typical onset time to see the effects of Botox.

"Botox relaxes the enlarged jaw muscle," says Lisa Goodman, a PA and the founder of GoodSkin Clinics, a practice that values long-term results over short-term fixes. "Pain isn't necessarily a requirement for its administration, but I typically [treat] patients every three to four months, similar to treating other areas with Botox. With time, frequency may decrease if muscle function and habits are retrained."

Before I knew it, I was getting Botox in my masseter regularly, but the moment it metabolized (about three or four months later), I was in pain again. Unfortunately, the effects of my last injection happened to coincide with the start of Covid, when in-person appointments were hard to come by. I'd tried to compensate with DIY massages I found on YouTube, but without proper training — or the proper angles — I ended 2020 with worse pain than ever, along with newly crooked teeth from all the grinding. I knew at that point that the Botox was just a Band-Aid, not a fix.

Goodman says that Botox in the masseter shouldn't be seen as a be-all, end-all solve, even if it does provide short-term relief. That's in part due to aesthetic concerns: "For individuals with lower face tissue laxity or predisposed to jowling, toxin injection into the muscle could worsen those conditions," says Goodman, who treats patients holistically at her practice. "When I treat TMJ, I will also consider the long-term effects of the toxin use in that area and will use other modalities to combat any jowling, such as Morpheus8, Ellacor, Evoke, Ultherapy or CO2 laser. I recommend massage in conjunction with Botox. Mindfulness and stress-relieving techniques can also be beneficial treatments for TMJ."

That recommendation, along with my newly crooked teeth, led me back into Dr. Prero's chair in 2022 to get fitted for aligners, rather than just a mouthguard. "A properly designed custom mouthguard is thought of as a protective measure, as it can distribute forces of biting evenly and take pressure off the joint — but it can't change the teeth position or bite," says Dr. Prero, who often recommends Invisalign to make structural changes to the bite.

While I waited for my bite to realign, I got to Googling: As it turns out, "buccal massage" has more than 4 million hits — and it's a technique that places like FaceGym and medi spas offer in droves. In fact, FaceGym's Buccal Tension Release massage was the first stop down my rabbit hole.

"The term 'buccal massage' is actually newer term," says Cyndi Ortolano, a certified massage therapist with more than 30 years of experience, who adds that the correct term for relieving TMJD is actually "intraoral work." The terms are sometimes used interchangeably now, but "intraoral massage can go much deeper than buccal massage and be more effective for relieving TMJD," Ortolano says. "When I was introduced to intraoral massage, it was strictly on how to release the lateral pterygoids — the muscle that helps move the jaw — inside the mouth. Even with something like TMJD, it's never just one thing, just one muscle that's being affected. It's usually a whole family of muscles overcompensating and undercompensating, and can affect areas well outside of that muscle family, too."

How can massage help to relieve jaw tension?

Ortolano, who studied and now teaches at Integrative Psycho Structural Bodywork in Santa Monica, Calif., says that throughout her decades of work, she's realized that the neck and jaw are two places in the body where we often hold onto anger — even long after we don't think we feel that way anymore.

"Once I started teaching buccal massage in the classroom setting, I noticed a lot of students having strong emotions when they were being worked on," she says. "There was a lot of realization that stored emotions are generally stored in the jaw. Bruxism — also known as teeth grinding and jaw tension — can only be stopped by addressing the underlying issue. It could be mental, emotional or physical. Anything that's not a physical injury, like a degraded joint capsule, intraoral massage can help work through."

FaceGym offers a custom intraoral Buccal Tension Release add-on to many of its signature "workouts" (or sculpting facials); it often includes masseter and nasolabial massage, kneading on the orbicularis oris — the muscle that helps you pucker your lips — as well as light under-eye drainage and jawline lymph channel drainage, among other types of massage based on any one customer's needs. In layman's terms, they stick their (gloved!) fingers in and around your mouth for about 15 minutes, and while it feels a bit uncomfortable, it's the same type of discomfort you'd feel when stretching a sore hamstring.

While my Invisalign — which I'm now a year into — has vastly improved my bite and alignment, nothing has helped so quickly and satisfyingly as a good buccal massage, which I treat myself to monthly.

"Relief can be quick and clients will notice it almost immediately — right after the first couple minutes of the session," says Ortolano. "Still, it all depends upon what the actual issue is. If it's true TMJD, I'll be able to feel clicking when they're opening and closing." For that, Ortolano recommends seeing a medical professional. "If the pain is not in any way relieved after a session, I will also recommend seeking medical attention. It's possible that there could be a crack in the joint capsule and cartilage. If this cartilage gets really worn down, it starts to degrade the bone around it, which can be serious."

Are there aesthetic benefits to relieving jaw tension?

One of my favorite unintended consequences of getting buccal massages to relieve TMJD-related pain is that it can define the jawline more obviously — something I noticed after my third buccal massage.

"My approach is therapeutic first, and the aesthetic side is just a benefit that comes naturally from the therapeutic approach," says Ortolano. "This work goes so much deeper than most people think, the aesthetic and TMJD benefits are just at the tip of it."

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