Botulinum Toxin for Temporomandibular Disorders: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Key Message

None of the included systematic reviews expressed confidence in the clinical effectiveness of Botox for treating temporomandibular disorder (TMD). While there were some primary studies indicating improvements in pain scores for botulinum toxin relative to saline injections, this finding was not consistently reported across all studies and the clinical significance of the improvements was uncertain. The evidence suggests that botulinum toxin is not superior to occlusive devices, dry needling or fascial manipulation.

In the primary studies, there was heterogeneity in TMD clinical presentation, botulinum toxin administration techniques and comparator treatment approaches and this creates significant uncertainty about the clinical utility for Botox in TMD. Assessing generalizability of the results to the Canadian context is difficult given these issues.

While there have been no consistent signals of increased risk of harm for botulinum toxin relative to control groups in the data reviewed, none of the primary studies were rigorously designed to study harms. This is an important issue to be addressed in future research since botulinum toxin treatment for TMD is an invasive procedure with some risks inherent in its administration.

There was no evidence to inform the cost effectiveness of botulinum toxin in TMD and no clinical practice guidelines were identified.