Title Botulinum Toxin-A Provides Short-Term Relief to a Wide Variety of Patients with Temporomandibular Disorders
Clinical Question Would a patient with a temporomandibular disorder (TMD) obtain significant improvement from Botulinum Toxin-A injections compared to no treatment?
Clinical Bottom Line Botulinum Toxin-A provides clinically significant short-term relief to a wide variety of patients with temporomandibular disorders in comparison with no treatment. This clinical trial was performed with 21 patients who completed the trial and who also fell into almost all TMD subgroups. Clinically significant positive results were obtained for 7 out of 8 different categories scored. The importance of this trial is that it provides an alternative method for TMD treatment for those who have not found significant or acceptable TMD relief from other treatments. It’s important to note that all subtypes found improvement and that no one class of TMD was unable to benefit from this treatment. This is, however, an expensive short-term treatment that may last 3 to 6 months. The problem with this study is the lack of control patients. There were no patients who were injected with a placebo instead of the botox makes it harder to validate the pain grades.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
26855937Kim/201621 Adult Temporomandibular Disorder PatientsClinical Study
Key resultsThere was a significant difference in the pre- and post-injection scores for graded pain score, characteristic pain intensity, disability points for temporomandibular usage, chronic pain grade, and nonspecific pain (p<.05). The relaxation of the bilateral masseter and temporalis muscles showed improvement on all fronts using the multiple injection technique. No control group was used, only pre-post pain scores.
Evidence Search ("temporomandibular joint disorders"[MeSH Terms] OR ("temporomandibular"[All Fields] AND "joint"[All Fields] AND "disorders"[All Fields]) OR "temporomandibular joint disorders"[All Fields] OR ("temporomandibular"[All Fields] AND "disorder"[All Fields]) OR "temporomandibular disorder"[All Fields]) AND ("botulinum toxins"[MeSH Terms] OR ("botulinum"[All Fields] AND "toxins"[All Fields]) OR "botulinum toxins"[All Fields] OR ("botulinum"[All Fields] AND "toxin"[All Fields]) OR "botulinum toxin"[All Fields])
Comments on
The Evidence
Validity: All patients in the study group were adults and the completion rate was 100% for all subjects. Patients were followed by a specialist. An adequate spectrum of patients were seen, falling into all 5 of the Japanese Society for the Temporomandibular Joint categories. This study had a small sample size that was addressed in the study’s conclusion; more studies with larger sample sizes need to be done with longer follow-up periods to add more evidence to this specific subject. Also, there were no control groups (either placebo injection or no injection). Perspective: The patients were evaluated on multiple specific levels of TMD pain and were also followed up with a TMD specialist in the field of dentistry. This article provides solid evidence because it was a clinical trial.
Applicability Botulinum Toxin-A injections have been shown to help those with temporomandibular joint disorders including: masticatory muscle disorder, capsule-ligament disorder, disc disorder, degenerative joint diseases, osteoarthritis, and osteoarthrosis. It may also aid those with parafunctional oral habits such as bruxism, clenching, and unilateral mastication. Botulinum Toxin-A injections are recommended for those who have already tried to resolve pain through other methods due to the injection's high cost and that fact that the treatment might have to be repeated every 3-6 months. It should also be noted that application of Botox requires additional training, which can be problematic economically for the dentist as these courses can range from $700-$1500.
Specialty (General Dentistry) (Oral Surgery)
Keywords Temporomandibular, Disorder, TMD, Botulinum, Toxin, Toxin-A, injections
ID# 3015
Date of submission 05/10/2016
E-mail lakemper@livemail.uthscsa.edu
Author Damian La Kemper
Co-author(s) e-mail
Faculty mentor Edward F. Wright, DDS, MS
Faculty mentor e-mail Wrighte2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available