Evidence map›Paper›PMID 41636950›Full record

ReviewCurrent pain and headache reports2026

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

Paul G Mathew, Marcela Romero-Reyes, Amrittej S Virk, Salvador L Manrriquez, Robert A Duarte, Antonia Teruel, Robert L Merrill, Carrie E Robertson, Donald Tanenbaum, Rich Cohen

Abstract readReview
PubMed Publisher
In one paragraph

Review in Current pain and headache reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Paul G MathewHarvard Medical School, Boston, MA, USA. PMathew@BWH.Harvard.edu.
Marcela Romero-ReyesSchool of Dentistry, Department of Neural and Pain Sciences, Brotman Facial Pain Clinic, University of Maryland, Baltimore, MD, USA.
Amrittej S VirkTexas TMJ Sleep & Facial Pain, Southlake, TX, USA.
Salvador L ManrriquezHerman Ostrow School of Dentistry, Orofacial Pain and Oral Medicine Clinic, University of Southern California, Los Angeles, CA, USA.
Robert A DuarteHofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
Antonia TeruelHead Pain Institute, Scottsdale, AZ, USA.
Robert L MerrillDepartment of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.
Carrie E RobertsonDepartment of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Donald TanenbaumDepartment of Oral & Maxillofacial Surgery, School of Dental Medicine, Stony Brook University, Stony Brook, NY, USA.
Rich CohenDepartment of Diagnostic Sciences, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purpose of reviewTo describe the use of botulinum toxin (BTX) injections for the management of myogenous temporomandibular disorders (TMD) based on current evidence and clinical practice. RECENT

findingsOnabotulinum 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.

conclusionsBTX 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.

Indexed as

Botulinum Toxins, Type ANeuromuscular AgentsTemporomandibular Joint DisordersHumansBotulinum Toxins, Type ANeuromuscular Agentsonabotulinum toxin ABotulinum toxinBruxismMyofascial painOrofacial painTemporomandibular disorder

Identifiers

PMID41636950

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.