Effect of botulinum toxin type A on muscular temporomandibular disorder: A systematic review and meta‐analysis of randomized controlled trials

BACKGROUND: Botulinum toxin type A (BTX-A) is increasingly used to manage painful temporomandibular disorders (TMD). However, the effect of BTX-A on muscular TMD remains unclear. OBJECTIVE: To assess the efficacy, safety and optimal dose of BTX-A for treating TMD. METHODS: We conducted systematic literature searches in MEDLINE, Embase, Web of Science, ClinicalTrials.gov and Cochrane Library until March 2023. We extracted data from randomized controlled trials (RCTs) that evaluated the efficacy and safety of BTX-A in treating muscular TMD. We performed a meta-analysis using a random-effects model. RESULTS: Fifteen RCTs involving 504 participants met the inclusion criteria. BTX-A was significantly more effective than placebo in reducing pain intensity, as measured on a 0-10 scale, at 1 month (MD 95% CI = -1.92 -2.87, -0.98, p < .0001) and 6 months (MD 95% CI -2.08, -3.19 to -0.98; p = .0002). A higher dosage of BTX-A (60-100 U bilaterally) was associated with a greater reduction in pain at 6 months (MD 95% CI = -2.98 -3.52, -2.44; p < .001). BTX-A also resulted in decreased masseter muscle intensity (μV) (MD 95% CI = -44.43 -71.33, -17.53; p = .001) at 1 month and occlusal force (kg) at 3 months (MD 95% CI = -30.29 -48.22 to -12.37; p = .0009). There was no significant difference in adverse events between BTX-A and placebo. CONCLUSIONS: BTX-A is a safe and effective treatment for reducing pain and improving temporomandibular muscle and joint function in muscular TMD patients. A bilateral dose of 60-100 U might be an optimal choice for treating muscular TMD pain.