The Management of Myogenous Temporomandibular Disorders with Botulinum Toxin: A Narrative Review and Management Recommendations

Authors

• Paul G. Mathew, Harvard Medical School
• Marcela Romero-Reyes, University of Maryland School of Dentistry
• Amrittej S. Virk, Texas TMJ Sleep & Facial Pain
• Salvador L. Manrriquez, Herman Ostrow School of Dentistry of USC
• Robert A. Duarte, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
• Antonia Teruel, Head Pain Institute
• Robert L. Merrill, Herman Ostrow School of Dentistry of USC
• Carrie E. Robertson, Mayo Clinic College of Medicine and Science
• Donald Tanenbaum, Stony Brook University
• Rich Cohen, Herman Ostrow School of Dentistry of USC

Document Type

Article

Publication Title

Current Pain and Headache Reports

Abstract

Purpose of Review: To describe the use of botulinum toxin (BTX) injections for the management of myogenous temporomandibular disorders (TMD) based on current evidence and clinical practice. Recent Findings: Onabotulinum Toxin Type A (OBTX) is approved by the Food and Drug Administration (FDA) for the treatment of chronic migraine using an evidence-based standardized injection paradigm. OBTX is widely used by dental and medical clinicians for the management of Temporomandibular Disorders (TMD) despite not being FDA approved for this indication. There are currently no clear guidelines for indications of use and no standardized injection protocols. A literature review using Pubmed was conducted regarding the use of BTX for the management of TMD. The review included retrospective studies, systematic reviews, meta-analysis, clinical trials, and basic science studies that were published after 1990. Based on the available literature, BTX can be effective for TMD management in cases of myogenous TMD and significant bruxism that have been refractory to conventional therapy as well as in cases of TMD in the setting of comorbid headache disorders when conventional treatment has not been effective in managing the TMD component. Special procedural considerations, including the use of EMG guidance, may be necessary for certain masticatory muscle injections, such as the medial and lateral pterygoid muscles. There are currently no standardized injection protocols. BTX injections can involve potential long-term risks including loss of bone density and changes in muscle structure, but there are no prospective studies that evaluate its long-term consequences. Conclusions: BTX is not a first-line treatment nor standard of care for the management of TMD. Further research, including prospective studies and randomized clinical trials are needed to delineate clear indications, injection paradigms, as well as the potential risks with the long-term use of BTX in TMD management. In refractory cases, evaluation by an orofacial pain specialist or clinician familiar with TMD to establish a proper diagnosis is critical for appropriate patient selection and optimization of the use of BTX.

DOI

10.1007/s11916-025-01463-3

Publication Date

12-1-2026

Recommended Citation

Mathew, Paul G.; Romero-Reyes, Marcela; Virk, Amrittej S.; Manrriquez, Salvador L.; Duarte, Robert A.; Teruel, Antonia; Merrill, Robert L.; Robertson, Carrie E.; Tanenbaum, Donald; and Cohen, Rich, "The Management of Myogenous Temporomandibular Disorders with Botulinum Toxin: A Narrative Review and Management Recommendations" (2026). ASDOH Faculty Publications. 534.
https://scholarworks.atsu.edu/asdoh-faculty/534