TEMPOROMANDIBULAR DISORDERS AND PRINCIPLES OF REHABILITATION

tmjkapak

USAGE OF BOTULINUM TOXIN A IN BRUXISM AND TEMPOROMANDIBULAR DISORDERS

Selen Onat Kayıkcı1
Seçil Çubuk2

1Başkent University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Türkiye
2Başkent University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Türkiye

Onat Kayıkcı S, Çubuk S. Usage of Botulinum Toxin a in Bruxism and Temporomandibular Disorders. In: Coşar SN, Afşar Sİ editors. Temporomandibular Disorders and Principles of Rehabilitation. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.103-113.

ABSTRACT

Bruxism is a common parafunctional behavior that involves teeth clenching and grinding, often resulting in various complications such as temporomandibular joint (TMJ) disorders, headaches, and dental damage. Despite various suggested etiological factors, bruxism remains a multifactorial condition with significant involvement of psychological and neurological factors. The pathophysiology of bruxism is not entirely understood, but it is believed to be influenced by central nervous system activity, autonomic nervous system function, emotional stress, and external triggers. This complexity makes its diagnosis and management challenging. Treatment options for bruxism include psychological therapies, sleep hygiene improvements, occlusal splints, pharmacological interventions, and botulinum toxin (BTX) injections. BTX, particularly Type A, has been widely studied for its effectiveness in reducing excessive muscle activity associated with bruxism, alleviating pain, and improving muscle function. BTX injections target hyperactive masticatory muscles, including the masseter, temporalis, and pterygoid muscles, significantly reducing excessive muscle contraction and providing relief in both sleep and awake bruxism. Clinical studies suggest that BTX reduces biting forces, pain intensity, and muscle activity, with peak effects observed between 5-8 weeks post-treatment. The injection technique and dosage vary based on the severity of the condition, with recommended doses typically ranging between 10-50 units per site. Additionally, BTX’s ability to modulate neurotransmitter release and its analgesic properties make it a suitable alternative for patients who do not respond well to conventional treatments such as occlusal splints. Beyond bruxism, BTX has also demonstrated efficacy in treating other orofacial pain conditions, including myofascial pain syndrome (MPS), temporomandibular joint hypermobility, and associated disorders. Research highlights its role in improving functional outcomes and pain management, offering a minimally invasive solution for patients experiencing chronic symptoms. In addition to pain reduction, BTX has been found to contribute to improved jaw mobility and decreased muscle hypertrophy, which may be beneficial for patients with masseteric hypertrophy. While BTX injections are generally well-tolerated, optimal patient selection and proper technique are essential to maximize therapeutic benefits and minimize potential adverse effects, such as transient muscle weakness, asymmetry, and unintended diffusion to adjacent muscles. Although the short-term benefits of BTX are well documented, further longitudinal studies are necessary to assess long-term effects, treatment durability, and patient-specific responses to BTX therapy across diverse populations. Understanding the ideal patient profile, dosage optimization, and the most effective injection sites will enhance treatment outcomes and ensure safety in clinical applications.

Keywords: Bruxism; Botulinum toxin; Temporomandibular disorders; Myofascial pain syndrome

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