Botulinum toxin in the treatment of patients with myofascial pain: a scoping review




Temporomandibular Joint Dysfunction Syndrome; Botulinum Toxins, Type A; Myofascial pain syndromes.


Temporomandibular disorders (TMD) can be classified as alterations that affect the temporomandibular joint, the masticatory muscles, and associated structures, being divided into two large groups: TMD of muscular origin and joint origin, being those of muscular origin more frequent. Despite existing studies, the etiology and treatment of these alterations have not yet been fully clarified, and among the treatment modalities, the use of botulinum toxin type A (TXA) in myofascial pain, a TMD of muscular origin, has been discussed. This study aims to review the literature on the effectiveness of using TXA for the treatment of myofascial pain. A search was carried out in the PubMed and SciELO databases using the descriptors “Botulinum Toxin”, “Temporomandibular” and “Myofascial Pain”, from 2012 to 2022. One hundred sixty-seven articles were found, but only 11 met the established inclusion criteria. It was observed that the use of TXA for the treatment of myofascial pain proved to be, in most studies, equally effective when compared to other less invasive treatment methods, but there are still few studies on the subject, especially randomized controlled clinical trials. Therefore, more randomized controlled trials with high methodological rigor and long-term follow-up are needed to support the indication of TXA in the treatment of TMD-related myofascial pain.


Al-Moraissi, E. A., Farea, R., Qasem, K. A., Al-Wadeai, M. S., Al-Sabahi, M. E., & Al-Iryani, G. M. (2020). Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials. International Journal of Oral and Maxillofacial Surgery, 49(8), 1042–1056.

Armijo-Olivo, S., Pitance, L., Singh, V., Neto, F., Thie, N., & Michelotti, A. (2016). Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Physical Therapy, 96(1), 9–25.

Chaurand, J., Pacheco-Ruíz, L., Orozco-Saldívar, H., & López-Valdés, J. (2017). Efficacy of botulinum toxin therapy in treatment of myofascial pain. Journal of Oral Science, 59(3), 351–356.

Costa, Y. M., Conti, P. C. R., de Faria, F. A. C., & Bonjardim, L. R. (2017). Temporomandibular disorders and painful comorbidities: clinical association and underlying mechanisms. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 123(3), 288–297.

de Barros Pascoal, A. L., de Freitas, R. F. C. P., da Silva, L. F. G., Oliveira, A. G. R. C., & Dos Santos Calderon, P. (2020). Effectiveness of Counseling on Chronic Pain Management in Patients with Temporomandibular Disorders. Journal of Oral & Facial Pain and Headache, 34(1), 77–82.

De Carli, B. M. G., Magro, A. K. D., Souza-Silva, B. N., Matos, F. de S., De Carli, J. P., Paranhos, L. R., & Magro, E. D. (2016). The effect of laser and botulinum toxin in the treatment of myofascial pain and mouth opening: A randomized clinical trial. Journal of Photochemistry and Photobiology. B, Biology, 159, 120–123.

De la Torre Canales, G., Alvarez-Pinzon, N., Muñoz-Lora, V. R. M., Vieira Peroni, L., Farias Gomes, A., Sánchez-Ayala, A., Haiter-Neto, F., Manfredini, D., & Rizzatti-Barbosa, C. M. (2020). Efficacy and Safety of Botulinum Toxin Type A on Persistent Myofascial Pain: A Randomized Clinical Trial. Toxins, 12(6), 395.

De La Torre Canales, G., Câmara-Souza, M. B., Muñoz Lora, V. R. M., Guarda-Nardini, L., Conti, P. C. R., Rodrigues Garcia, R. M., Del Bel Cury, A. A., & Manfredini, D. (2018). Prevalence of psychosocial impairment in temporomandibular disorder patients: A systematic review. Journal of Oral Rehabilitation, 45(11), 881–889.

De La Torre Canales, G., Câmara-Souza, M. B., Poluha, R. L., Grillo, C. M., Conti, P. C. R., Sousa, M. da L. R. de, Rodrigues Garcia, R. C. M., & Rizzatti-Barbosa, C. M. (2021). Botulinum toxin type A and acupuncture for masticatory myofascial pain: a randomized clinical trial. Journal of Applied Oral Science : Revista FOB, 29, e20201035.

De la Torre Canales, G., Poluha, R. L., Lora, V. M., Araújo Oliveira Ferreira, D. M., Stuginski-Barbosa, J., Bonjardim, L. R., Cury, A. A. D. B., & Conti, P. C. R. (2019). Botulinum toxin type A applications for masticatory myofascial pain and trigeminal neuralgia: what is the evidence regarding adverse effects? Clinical Oral Investigations, 23(9), 3411–3421.

Denglehem, C., Maes, J.-M., Raoul, G., & Ferri, J. (2012). [Botulinum toxin A: analgesic treatment for temporomandibular joint disorders]. Revue de Stomatologie et de Chirurgie Maxillo-Faciale, 113(1), 27–31.

Fernandes, A., Moura, D., Da Silva, L., De Almeida, E., & Barbosa, G. (2017). Acupuncture in Temporomandibular Disorder Myofascial Pain Treatment: A Systematic Review. Journal of Oral & Facial Pain and Headache, 31(3), 225–232.

Freitas Júnior, W. J. L. de, Marcos, Â. M. da S., Maranhão, A. R. M., Lira, M. L. G. de O., Mendonça, G. L. de, Travassos, R. M. C., Cardoso, M. S. O., & Milhomens Filho, J. A. (2022). Toxina botulínica e Odontologia: revisão integrativa. Research, Society and Development, 11(11), e561111134081.

Góes, K. R. B., Grangeiro, M. T. V., & De Figueiredo, V. M. G. (2018). Epidemiologia da disfunção temporomandibular: uma revisão de literatura. Journal of Dentistry & Public Health, 9(2), 115–120.

Greene, C. S., Klasser, G. D., & Epstein, J. B. (2010). Revision of the American Association of Dental Research’s Science Information Statement about Temporomandibular Disorders. Journal (Canadian Dental Association), 76, a115.

Guarda-Nardini, L., Stecco, A., Stecco, C., Masiero, S., & Manfredini, D. (2012). Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. Cranio : The Journal of Craniomandibular Practice, 30(2), 95–102.

Han, Z. A., Song, D. H., Oh, H. M., & Chung, M. E. (2016). Botulinum toxin type A for neuropathic pain in patients with spinal cord injury. Annals of Neurology, 79(4), 569–578.

Hong, S. W., & Kang, J. H. (2020). Decreased mandibular cortical bone quality after botulinum toxin injections in masticatory muscles in female adults. Scientific Reports, 10(1), 1–12.

Kaya, D. I., & Ataoglu, H. (2021). Botulinum toxin treatment of temporomandibular joint pain in patients with bruxism: A prospective and randomized clinical study. Nigerian Journal of Clinical Practice, 24(3), 412–417.

Kim, H.-S., Yun, P.-Y., & Kim, Y.-K. (2016). A clinical evaluation of botulinum toxin-A injections in the temporomandibular disorder treatment. Maxillofacial Plastic and Reconstructive Surgery, 38(1), 5.

Kim, K. S., Byun, Y. S., Kim, Y. J., & Kim, S. T. (2009). Muscle Weakness After Repeated Injection of Botulinum Toxin Type A Evaluated According to Bite Force Measurement of Human Masseter Muscle. Dermatologic Surgery, 35(12), 1902–1907.

Lee, H. J., Kim, S. J., Lee, K. J., Yu, H. S., & Baik, H. S. (2017). Repeated injections of botulinum toxin into the masseter muscle induce bony changes in human adults: A longitudinal study. Korean Journal of Orthodontics, 47(4), 222–228.

Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: advancing the methodology. Implementation Science : IS, 5, 69.

Lopes, T. S., Oliveira, E. M. de, Paiva, C. L. de O. C., Santos, T. J. S. dos, Araújo, I. dos S., Cavalcante, V. F., Nascimento, A. C. C. do, Lima, A. P. de, Fiamengui, L. M. S. P., & Chaves, H. V. (2022). Associação entre distúrbios gastrointestinais e disfunção temporomandibular: uma revisão integrativa. Research, Society and Development, 11(15), e30111536910.

Machado, E., Santos, L. Z. dos, Custódio, L. G., & Cunali, P. A. (2012). Botulinum toxin for treating muscular temporomandibular disorders: a systematic review. Dental Press Journal of Orthodontics, 17(6), 167–171.

Montes-Carmona, J.-F., Gonzalez-Perez, L.-M., & Infante-Cossio, P. (2020). Treatment of Localized and Referred Masticatory Myofascial Pain with Botulinum Toxin Injection. Toxins, 13(1), 6.

Munguia, F., Jang, J., Salem, M., Clark, G., & Enciso, R. (2018). Efficacy of Low-Level Laser Therapy in the Treatment of Temporomandibular Myofascial Pain: A Systematic Review and Meta-Analysis. Journal of Oral & Facial Pain and Headache, 32(3), 287–297.

Padula, J. H., Cunali, P. A., Zwir, L. F., & Teixeira, R. E. (2016). Declaração Oficial da Sociedade Brasileira de Disfunção Temporomandibular e Dor Orofacial – SBDOF sobre a utilização da toxina botulínica na especialidade de DTM e Dor Orofacial. SBDOF.

Park, H. U., Kim, B. I., Kang, S. M., Kim, S. T., Choi, J. H., & Ahn, H. J. (2013). Changes in masticatory function after injection of botulinum toxin type A to masticatory muscles. Journal of Oral Rehabilitation, 40(12), 916–922.

Patel, J., Cardoso, J. A., & Mehta, S. (2019). A systematic review of botulinum toxin in the management of patients with temporomandibular disorders and bruxism. British Dental Journal, 226(9), 667–672.

Raphael, K. G., Tadinada, A., Bradshaw, J. M., Janal, M. N., Sirois, D. A., Chan, K. C., & Lurie, A. G. (2014). Osteopenic consequences of botulinum toxin injections in the masticatory muscles: A pilot study. Journal of Oral Rehabilitation, 41(8), 555–563.

Sales, J. M., Lavôr, T. F. A. de, Marinho, S. A., Vasconcelos, R. G., & Vasconcelos, M. G. (2020). Toxina botulínica como opçãoo no tratamento da disfunção temporomandibular. Rev. Salusvita (Online), 39(1), 229–254.

Schiffman, E., Ohrbach, R., Truelove, E., Look, J., Anderson, G., Goulet, J.-P., List, T., Svensson, P., Gonzalez, Y., Lobbezoo, F., Michelotti, A., Brooks, S. L., Ceusters, W., Drangsholt, M., Ettlin, D., Gaul, C., Goldberg, L. J., Haythornthwaite, J. A., Hollender, L., … Orofacial Pain Special Interest Group, I. A. for the S. of P. (2014). 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 Group†. Journal of Oral & Facial Pain and Headache, 28(1), 6–27.

Shah, J. P., Thaker, N., Heimur, J., Aredo, J. V, Sikdar, S., & Gerber, L. (2015). Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. PM & R : The Journal of Injury, Function, and Rehabilitation, 7(7), 746–761.

Vier, C., Almeida, M. B. de, Neves, M. L., Santos, A. R. S. Dos, & Bracht, M. A. (2019). The effectiveness of dry needling for patients with orofacial pain associated with temporomandibular dysfunction: a systematic review and meta-analysis. Brazilian Journal of Physical Therapy, 23(1), 3–11.

Zhang, L.-D., Liu, Q., Zou, D.-R., & Yu, L.-F. (2016). Occlusal force characteristics of masseteric muscles after intramuscular injection of botulinum toxin A(BTX - A)for treatment of temporomandibular disorder. The British Journal of Oral & Maxillofacial Surgery, 54(7), 736–740.



How to Cite

FREITAS, R. D. de .; ABREU, B. A. de .; SILVEIRA, F. D. .; FIAMENGUI, L. M. S. P. .; BEZERRA, M. M.; CHAVES, H. V. Botulinum toxin in the treatment of patients with myofascial pain: a scoping review. Research, Society and Development, [S. l.], v. 12, n. 4, p. e10312440996, 2023. DOI: 10.33448/rsd-v12i4.40996. Disponível em: Acesso em: 29 may. 2024.



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