Does Insurance Cover Botox for TMJ and Bruxism?

How do Botox and TMJ relate to each other? The fact is that Botox injections are a known treatment for TMJ disorders and bruxism. Botox injections given over a series of months can help reduce some of the most common symptoms of these disorders. A doctor can help determine whether Botox is the right treatment method for you. Here’s what you need to know.

Key Terms to Know

Here are a few related terms. 

Botox

Botox is a drug that is made from the same toxin that causes botulism. Doctors use it in small-dose injections to treat a variety of health problems. It can also be used for non-medical cosmetic procedures. 

TMJ or TMD

TMJ stands for the temporomandibular joint. Humans have one TMJ on each side of their jaws, and it connects your jawbone to your skull. 

TMD stands for temporomandibular disorder. A TMJ disorder is a type of TMD. This disorder causes pain in your jaw joint as well as the muscles that control the movement of your jaw. 

It’s usually difficult to pinpoint the cause of TMJ disorders. It can be from a combination of factors, including genetics and arthritis. It can also develop following a jaw injury or because of bruxism. In most cases, pain related to TMJ disorders is only temporary and can be managed at home or with nonsurgical treatments. In some more severe cases, surgery may be used as a last resort. 

Bruxism

Even if you don’t recognize the term, bruxism, in which a person grinds or clenches their teeth, is a condition that you are likely familiar with. Some people with bruxism may absentmindedly clench their teeth when they’re awake. Others may do it only while they’re sleeping. Known as sleep bruxism, it is classified as a sleep-related movement disorder. 

Bruxism can lead to TMJ disorders. It can also cause headaches and dental damage if it’s not properly managed.

How Is Botox Used to Treat TMJ and Bruxism?

Botox injections can provide relief for the most common TMJ disorder symptoms. This treatment includes jaw tension and headaches caused by bruxism. It may even be able to help treat lockjaw, which can occur in cases of severe stress. 

Though studies have shown positive results from Botox treatment for TMJ disorders, it is still considered an experimental treatment. The FDA has not approved Botox as a treatment for TMJ disorders. 

Botox is a non-surgical, outpatient procedure. Healthcare providers can usually provide Botox as a TMJ disorder treatment right in their office. The treatment sessions only take 10 to 30 minutes in most cases. Most patients can expect to receive three or more injections over the course of several months. 

When used to treat TMJ disorders, Botox is injected into your forehead, temple and jaw muscles. It may also be injected in other areas, depending on your symptoms. The doctor treating the TMJ disorder will decide how many Botox injections are necessary. 

With a Botox injection, normal activities can be resumed as soon as you leave the doctor’s office. Some patients feel improvement within a day or two after the injections, but it can take several days before you start to feel a difference. 

Common Uses of Botox

Botox isn’t only used to treat TMJ disorders. It can also be used to treat other medical conditions and disorders or for cosmetic reasons, including:

• Neck spasms (cervical dystonia)
• Excessive sweating (hyperhidrosis)
• Overactive bladder
• Lazy eye
• Chronic migraines
• Facial wrinkles

Insurance Coverage and Botox

If you have a TMJ disorder or other condition that could be helped by Botox, you may be wondering if your health insurance will cover it. Unfortunately, it’s hard to say. Since Botox is not approved by the FDA as a treatment for TMJ disorders, it may be difficult to get insurance to cover the procedure. 

That being said, in some cases, your insurance may cover Botox injections. The FDA has approved Botox as a treatment for some other conditions, such as migraines. So if your TMJ disorder causes migraines, you may be able to get insurance coverage that way. If your TMJ disorder causes dental problems, your dental insurance may also be able to contribute toward the treatment of the condition.

Average Cost of Botox for TMJ

The cost of Botox treatments for TMJ disorders varies based on your location and the seriousness of your symptoms. If you have severe symptoms and your doctor recommends a higher number of injections, you can count on this increasing your costs.

On average, you can expect to spend anywhere from $500 to $1,500 on Botox treatment. 

How to Know if my Insurance Covers Botox

If you want to find out if your insurance covers Botox, the first thing you should do is review your policy documents. It might have a general list of conditions and treatments that are covered as well as exclusions. There likely won’t be a definitive answer in your documents, though, so you’ll also need to reach out to your insurance provider. Most insurance providers offer a customer service phone line and email that you can reach out to with questions. 

Your insurance provider will need to identify what the Botox treatments would be used for. Since the FDA does not approve Botox as a treatment for TMJ disorders, your insurance likely won’t cover that. But if your disorder is causing migraines, your insurance provider should be able to tell you what steps you need to take to receive coverage for your Botox treatment. Some insurance providers require their members to try out other treatment methods before covering Botox injections. 

Should I Consider Botox?

Botox and TMJ disorders can be a confusing relationship to figure out. If you suffer from TMJ symptoms, you should talk to your doctor about whether Botox injections might be beneficial to you. Your doctor should also be able to tell you an estimated cost of Botox treatment and advise you about whether it thinks insurance will cover the treatment. 

Frequently Asked Questions