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Botulinum Toxin for Treating Temporomandibular Disorders
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This systematic review included 24 randomized controlled trials to study the clinical efficacy of botulinum toxin (BTX; N = 698 of whom 411 received BTX) in the management of various temporomandibular disorders (TMDs), namely, myofascial pain and/or myospasm (9 studies), temporomandibular joint (TMJ) articular TMDs (4 studies), bruxism (8 studies), and masseter hypertrophy (3 studies). BTX was found to be effective in the management of masseter hypertrophy. Evidence was equivocal and limited to support BTX in the management of myofascial pain and TMJ articular disorders, respectively.
- Given the lack of high-quality evidence, the authors recommend further studies with established diagnostic criteria and uniform clinical protocols. The authors also noted that BTX may not be superior to conservative treatments that are less invasive and less expensive than BTX.
abstract
This abstract is available on the publisher's site.
Access this abstract nowAIMS
To systematically review the scientific literature for evidence concerning the clinical use of botulinum toxin (BTX) for the management of various temporomandibular disorders (TMDs).
METHODS
A comprehensive literature search was conducted in the Medline, Web of Science, and Cochrane Library databases to find randomized clinical trials (RCT) published between 2000 and the end of April 2021 investigating the use of BTX to treat TMDs. The selected articles were reviewed and tabulated according to the PICO (patients/problem/population, intervention, comparison, outcome) format.
RESULTS
A total of 24 RCTs were selected. Nine articles used BTX injections to treat myofascial pain, 4 to treat temporomandibular joint (TMJ) articular TMDs, 8 for the management of bruxism, and 3 to treat masseter hypertrophy. A total of 411 patients were treated by injection of BTX. Wide variability was found in the methods of injection and in the doses injected. Many trials concluded superiority of BTX injections over placebo for reducing TMD pain levels and improving maximum mouth opening; however, this was not universal.
CONCLUSION
There is good scientific evidence to support the use of BTX injections for treatment of masseter hypertrophy and equivocal evidence for myogenous TMDs, but very little for TMJ articular disorders. Studies with improved methodologic design are needed to gain better insight into the utility and effectiveness of BTX injections for treating both myogenous and TMJ articular TMDs and to establish suitable protocols for treating different TMDs.
Additional Info
Disclosure statements are available on the authors' profiles:
Botulinum Toxin for Treating Temporomandibular Disorders: What is the Evidence?
J Oral Facial Pain Headache 2022 Jan 01;36(1)6-20, R Delcanho, M Val, LG Nardini, D ManfrediniFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The use of neuromodulators such as botulinum toxin (BTX) in clinical dentistry has expanded rapidly in the past few years beyond esthetics to include the management of facial pain, bruxism, muscular hypertrophy, and other temporomandibular disorders (TMDs). These dental interventions, similar to several other non–FDA-approved medical uses of BTX, remain off-label and controversial. As clinicians strive to expand and improve treatment modalities beyond the traditional management of TMDs, BTX, with its effects on reducing muscular contractions and pain, is now considered a pertinent co-therapy. This systematic review of 24 randomized controlled trials, using a variety of diagnostic tests, variable injection doses, and techniques, sought to determine whether the evidence supports BTX injections for the management of TMDs. Due to the variety of methods, small sample sizes, differences in the injection dosage or technique, and inconsistent follow-up, many articles were rejected. Of the articles selected, the majority concluded that the use of BTX can improve the pain levels and jaw movements, reduce the loading forces on the articular disc of the temporomandibular joint (TMJ), improve the range of mouth opening, reduce the scores of visual analog scale regarding pain levels, improve sleep time, reduce the number and duration of bruxism episodes, and reduce the volume of masseter hypertrophy. The use of BTX injections is supported for the treatment of masseter hypertrophy and myogenous TMDs but less so for TMJ articular disorders. Limitations in the availability of trained providers, standardization of injection protocols, and affordability of BTX pose challenges. Clinicians who performed BTX therapy for TMDs reported that patients return for subsequent BTX treatment and observed perceived value for the outcomes achieved. The conclusions of this article demonstrate that clinical applications using BTX therapy for TMDs are promising, and the evidence supports further investigation.