title: Clinical outcomes of Botox injections for chronic temporomandibular disorders: do we understand how Botox works on muscle, pain, and the brain?
abstract: The main objective of this retrospective review was to analyze the clinical outcomes following the use of botulinum toxin (onabotulinumtoxinA, Botox) injections to relieve the symptoms of chronic temporomandibular disorders (TMD). Seventy-one patients with a diagnosis of TMD (according to the RDC/TMD international consortium) associated with or without bruxism and refractory to conventional treatment (e.g. oral appliances, physiotherapy, etc.) received Botox injections into the temporalis and masseter muscles. Subjective responses to Botox were categorized as 'beneficial' or 'not beneficial', as patient-reported outcomes based on the subjective reduction in pain and/or improvement in function. Fifty-five of the 71 subjects (77%) reported beneficial effects with Botox. Subjects with a concomitant bruxism diagnosis reported significant improvement over subjects without bruxism (87% vs. 67%; P=0.042). Subjects with stress-related psychiatric comorbidities and bruxism had a significantly higher benefit than those with stress-related psychiatric comorbidities alone (P=0.027). Patients reported less improvement if the time between the initial Botox injection and follow-up was less than an average of 5 weeks, compared to an average follow-up of 5-10 weeks (P=0.009). The subgroup TMD diagnosis and time interval post-injection are important predictors of patient-reported beneficial outcomes.
authors.affiliation: San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA. Electronic address: stephen.connelly2@va.gov.
authors.forename: S T
authors.initials: ST
authors.lastname: Connelly
authors.affiliation: San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Myung
authors.affiliation: San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Universita degli Studi di Milano, Milano, Italy; Private Practice, SST Dental Clinic, Segrate, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Tartaglia
authors.affiliation: Department of Biomedical Sciences for Health, Functional Anatomy Research Center (FARC), Universita degli Studi di Milano, Milano, Italy; Private Practice, SST Dental Clinic, Segrate, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gizdulich
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of California San Francisco Medical Center, San Francisco, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Yang
authors.affiliation: San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Silva
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D015897:Comorbidity; D005152:Facial Muscles / Q000187:drug effects*; D005157:Facial Pain / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D013705:Temporomandibular Joint Disorders / Q000188:drug therapy*; D016896:Treatment Outcome; D014481:United States; D014728:Veterans
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
keywords: Botox; anxiety; bruxism; chronic pain; post-traumatic stress disorder; temporomandibular joint