Efficacy of Botulinum Toxin in Temporomandibular Disorders

Summary

Temporomandibular disorders (TMDs) represent a multifactorial pathological group that gives rise to a varied and complex symptomatology that includes decreased jaw movement, muscle and joint pain, joint crepitation and limitation or functional deviation of the jaw opening. All this is sometimes accompanied by headache and other painful symptoms in the neck musculature, incapacitating for many patients and at considerable public health expense. Intramuscular and intra-articular injections of botulinum toxin are a simple treatment that has proven to be effective in the treatment of the painful symptoms of these disorders, being a therapeutic option in situations of failure of conventional treatments, without presenting adverse effects. Our study presents the preliminary results of twenty patients treated with this therapy

Timeline

Start

2021-03-01

Primary completion

2021-03-30

Completion

2021-07-30

Publications

• Background Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF; International RDC/TMD Consortium Network, International association for Dental Research; Orofacial Pain Special Interest Group, International Association for the Study of Pain. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Groupdagger. J Oral Facial Pain Headache. 2014 Winter;28(1):6-27. doi: 10.11607/jop.1151.
• Background Okeson JP. Current terminology and diagnostic classification schemes. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Jan;83(1):61-4. doi: 10.1016/s1079-2104(97)90092-5.
• Background Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am. 2013 Jul;57(3):465-79. doi: 10.1016/j.cden.2013.04.006.
• Background Kobayashi FY, Gaviao MB, Montes AB, Marquezin MC, Castelo PM. Evaluation of oro-facial function in young subjects with temporomandibular disorders. J Oral Rehabil. 2014 Jul;41(7):496-506. doi: 10.1111/joor.12163. Epub 2014 Mar 24.
• Background Baba K, Tsukiyama Y, Yamazaki M, Clark GT. A review of temporomandibular disorder diagnostic techniques. J Prosthet Dent. 2001 Aug;86(2):184-94. doi: 10.1067/mpr.2001.116231.
• Background Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. Am Fam Physician. 2015 Mar 15;91(6):378-86.
• Background Lomas J, Gurgenci T, Jackson C, Campbell D. Temporomandibular dysfunction. Aust J Gen Pract. 2018 Apr;47(4):212-215. doi: 10.31128/AFP-10-17-4375.
• Background Shoohanizad E, Garajei A, Enamzadeh A, Yari A. Nonsurgical management of temporomandibular joint autoimmune disorders. AIMS Public Health. 2019 Dec 12;6(4):554-567. doi: 10.3934/publichealth.2019.4.554. eCollection 2019.
• Background Ta LE, Dionne RA. Treatment of painful temporomandibular joints with a cyclooxygenase-2 inhibitor: a randomized placebo-controlled comparison of celecoxib to naproxen. Pain. 2004 Sep;111(1-2):13-21. doi: 10.1016/j.pain.2004.04.029.
• Background Herman CR, Schiffman EL, Look JO, Rindal DB. The effectiveness of adding pharmacologic treatment with clonazepam or cyclobenzaprine to patient education and self-care for the treatment of jaw pain upon awakening: a randomized clinical trial. J Orofac Pain. 2002 Winter;16(1):64-70.
• Background Hersh EV, Balasubramaniam R, Pinto A. Pharmacologic management of temporomandibular disorders. Oral Maxillofac Surg Clin North Am. 2008 May;20(2):197-210, vi. doi: 10.1016/j.coms.2007.12.005.
• Background Park J, Park HJ. Botulinum Toxin for the Treatment of Neuropathic Pain. Toxins (Basel). 2017 Aug 24;9(9):260. doi: 10.3390/toxins9090260.
• Background Fallah HM, Currimbhoy S. Use of botulinum toxin A for treatment of myofascial pain and dysfunction. J Oral Maxillofac Surg. 2012 May;70(5):1243-5. doi: 10.1016/j.joms.2012.01.015. No abstract available.
• Background Patel J, Cardoso JA, Mehta S. A systematic review of botulinum toxin in the management of patients with temporomandibular disorders and bruxism. Br Dent J. 2019 May;226(9):667-672. doi: 10.1038/s41415-019-0257-z.
• Background Serrera-Figallo MA, Ruiz-de-Leon-Hernandez G, Torres-Lagares D, Castro-Araya A, Torres-Ferrerosa O, Hernandez-Pacheco E, Gutierrez-Perez JL. Use of Botulinum Toxin in Orofacial Clinical Practice. Toxins (Basel). 2020 Feb 11;12(2):112. doi: 10.3390/toxins12020112.
• Background von Lindern JJ, Niederhagen B, Berge S, Appel T. Type A botulinum toxin in the treatment of chronic facial pain associated with masticatory hyperactivity. J Oral Maxillofac Surg. 2003 Jul;61(7):774-8. doi: 10.1016/s0278-2391(03)00153-8.
• Background Munoz Lora VRM, Del Bel Cury AA, Jabbari B, Lackovic Z. Botulinum Toxin Type A in Dental Medicine. J Dent Res. 2019 Dec;98(13):1450-1457. doi: 10.1177/0022034519875053. Epub 2019 Sep 18.
• Background Kim NH, Park RH, Park JB. Botulinum toxin type A for the treatment of hypertrophy of the masseter muscle. Plast Reconstr Surg. 2010 Jun;125(6):1693-1705. doi: 10.1097/PRS.0b013e3181d0ad03.
• Background Ho KY, Tan KH. Botulinum toxin A for myofascial trigger point injection: a qualitative systematic review. Eur J Pain. 2007 Jul;11(5):519-27. doi: 10.1016/j.ejpain.2006.09.002. Epub 2006 Oct 27.
• Background Sidebottom AJ, Patel AA, Amin J. Botulinum injection for the management of myofascial pain in the masticatory muscles. A prospective outcome study. Br J Oral Maxillofac Surg. 2013 Apr;51(3):199-205. doi: 10.1016/j.bjoms.2012.07.002. Epub 2012 Aug 4.
• Background Laskin DM. The Use of Botulinum Toxin for the Treatment of Myofascial Pain in the Masticatory Muscles. Oral Maxillofac Surg Clin North Am. 2018 Aug;30(3):287-289. doi: 10.1016/j.coms.2018.04.004. Epub 2018 Jul 5.
• Background Soares A, Andriolo RB, Atallah AN, da Silva EM. Botulinum toxin for myofascial pain syndromes in adults. Cochrane Database Syst Rev. 2014 Jul 25;2014(7):CD007533. doi: 10.1002/14651858.CD007533.pub3.
• Background Freund B, Schwartz M, Symington JM. The use of botulinum toxin for the treatment of temporomandibular disorders: preliminary findings. J Oral Maxillofac Surg. 1999 Aug;57(8):916-20; discussion 920-1. doi: 10.1016/s0278-2391(99)90007-1.
• Background Freund B, Schwartz M, Symington JM. Botulinum toxin: new treatment for temporomandibular disorders. Br J Oral Maxillofac Surg. 2000 Oct;38(5):466-71. doi: 10.1054/bjom.1999.0238.
• Background Nayyar P, Kumar P, Nayyar PV, Singh A. BOTOX: Broadening the Horizon of Dentistry. J Clin Diagn Res. 2014 Dec;8(12):ZE25-9. doi: 10.7860/JCDR/2014/11624.5341. Epub 2014 Dec 5.
• Background Hoque A, McAndrew M. Use of botulinum toxin in dentistry. N Y State Dent J. 2009 Nov;75(6):52-5.
• Background Al-Wayli H. Treatment of chronic pain associated with nocturnal bruxism with botulinum toxin. A prospective and randomized clinical study. J Clin Exp Dent. 2017 Jan 1;9(1):e112-e117. doi: 10.4317/jced.53084. eCollection 2017 Jan.
• Background Satriyasa BK. Botulinum toxin (Botox) A for reducing the appearance of facial wrinkles: a literature review of clinical use and pharmacological aspect. Clin Cosmet Investig Dermatol. 2019 Apr 10;12:223-228. doi: 10.2147/CCID.S202919. eCollection 2019.
• Background Srivastava S, Kharbanda S, Pal US, Shah V. Applications of botulinum toxin in dentistry: A comprehensive review. Natl J Maxillofac Surg. 2015 Jul-Dec;6(2):152-9. doi: 10.4103/0975-5950.183860.
• Background Laskin DM. Botulinum toxin A in the treatment of myofascial pain and dysfunction: the case against its use. J Oral Maxillofac Surg. 2012 May;70(5):1240-2. doi: 10.1016/j.joms.2011.05.030. No abstract available.
• Background Pihut M, Ferendiuk E, Szewczyk M, Kasprzyk K, Wieckiewicz M. The efficiency of botulinum toxin type A for the treatment of masseter muscle pain in patients with temporomandibular joint dysfunction and tension-type headache. J Headache Pain. 2016;17:29. doi: 10.1186/s10194-016-0621-1. Epub 2016 Mar 24.
• Background Chikhani L, Dichamp J. [Bruxism, temporo-mandibular dysfunction and botulinum toxin]. Ann Readapt Med Phys. 2003 Jul;46(6):333-7. doi: 10.1016/s0168-6054(03)00115-6. French.
• Background Hosgor H, Altindis S. Efficacy of botulinum toxin in the management of temporomandibular myofascial pain and sleep bruxism. J Korean Assoc Oral Maxillofac Surg. 2020 Oct 31;46(5):335-340. doi: 10.5125/jkaoms.2020.46.5.335.
• Background Patel AA, Lerner MZ, Blitzer A. IncobotulinumtoxinA Injection for Temporomandibular Joint Disorder. Ann Otol Rhinol Laryngol. 2017 Apr;126(4):328-333. doi: 10.1177/0003489417693013. Epub 2017 Feb 1.
• Background Thomas NJ, Aronovich S. Does Adjunctive Botulinum Toxin A Reduce Pain Scores When Combined With Temporomandibular Joint Arthroscopy for the Treatment of Concomitant Temporomandibular Joint Arthralgia and Myofascial Pain? J Oral Maxillofac Surg. 2017 Dec;75(12):2521-2528. doi: 10.1016/j.joms.2017.04.011. Epub 2017 Apr 19.
• Background Batifol D. [Different types of injection in temporomandibular disorders (TMD) treatment]. Rev Stomatol Chir Maxillofac Chir Orale. 2016 Sep;117(4):256-8. doi: 10.1016/j.revsto.2016.07.005. Epub 2016 Aug 23. French.
• Background Gadhia K, Walmsley D. The therapeutic use of botulinum toxin in cervical and maxillofacial conditions. Evid Based Dent. 2009;10(2):53. doi: 10.1038/sj.ebd.6400654.
• Background Blumenfeld AM, Stark RJ, Freeman MC, Orejudos A, Manack Adams A. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain. 2018 Feb 5;19(1):13. doi: 10.1186/s10194-018-0840-8.
• Background Binder WJ, Brin MF, Blitzer A, Schoenrock LD, Pogoda JM. Botulinum toxin type A (BOTOX) for treatment of migraine headaches: an open-label study. Otolaryngol Head Neck Surg. 2000 Dec;123(6):669-76. doi: 10.1067/mhn.2000.110960.
• Background Freund BJ, Schwartz M. Treatment of chronic cervical-associated headache with botulinum toxin A: a pilot study. Headache. 2000 Mar;40(3):231-6. doi: 10.1046/j.1526-4610.2000.00033.x.
• Background Freund BJ, Schwartz M. Treatment of whiplash associated neck pain [corrected] with botulinum toxin-A: a pilot study. J Rheumatol. 2000 Feb;27(2):481-4.
• Background Ihde SK, Konstantinovic VS. The therapeutic use of botulinum toxin in cervical and maxillofacial conditions: an evidence-based review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Aug;104(2):e1-11. doi: 10.1016/j.tripleo.2007.02.004. Epub 2007 Jun 7.
• Background Blitzer A, Sulica L. Botulinum toxin: basic science and clinical uses in otolaryngology. Laryngoscope. 2001 Feb;111(2):218-26. doi: 10.1097/00005537-200102000-00006.
• Background Sari BC, Develi T. The effect of intraarticular botulinum toxin-A injection on symptoms of temporomandibular joint disorder. J Stomatol Oral Maxillofac Surg. 2022 Oct;123(5):e316-e320. doi: 10.1016/j.jormas.2022.04.019. Epub 2022 May 14.
• Background Lora VR, Clemente-Napimoga JT, Abdalla HB, Macedo CG, Canales GT, Barbosa CM. Botulinum toxin type A reduces inflammatory hypernociception induced by arthritis in the temporomadibular joint of rats. Toxicon. 2017 Apr;129:52-57. doi: 10.1016/j.toxicon.2017.02.010. Epub 2017 Feb 14.
• Background Drinovac Vlah V, Filipovic B, Bach-Rojecky L, Lackovic Z. Role of central versus peripheral opioid system in antinociceptive and anti-inflammatory effect of botulinum toxin type A in trigeminal region. Eur J Pain. 2018 Mar;22(3):583-591. doi: 10.1002/ejp.1146. Epub 2017 Nov 13.
• Background Sipahi Calis A, Colakoglu Z, Gunbay S. The use of botulinum toxin-a in the treatment of muscular temporomandibular joint disorders. J Stomatol Oral Maxillofac Surg. 2019 Sep;120(4):322-325. doi: 10.1016/j.jormas.2019.02.015. Epub 2019 Feb 23.
• Macedo de Sousa B, Lopez-Valverde N, Ferreira C, de Almeida AM, Lopez-Valverde A, Blanco Rueda JA. Efficacy of botulinum toxin type A in myogenic temporomandibulardisorders: a single arm, prospective, pilot study. Front Rehabil Sci. 2025 Dec 19;6:1737706. doi: 10.3389/fresc.2025.1737706. eCollection 2025.

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