Botulinum toxin injection
Botulinum toxin is an exotoxin produced by the anaerobic bacterium Clostridium botulinum. Some studies have demonstrated promising activity of botulinum toxin in TMD pain management, while others have not shown any benefit over placebo or other treatments.[75]Delcanho R, Val M, Guarda Nardini L, et al. Botulinum toxin for treating temporomandibular disorders: what is the evidence? J Oral Facial Pain Headache. 2022 Winter;36(1):6-20.
https://www.jofph.com/articles/10.11607/ofph.3023
http://www.ncbi.nlm.nih.gov/pubmed/35298571?tool=bestpractice.com
[76]Saini RS, Ali Abdullah Almoyad M, Binduhayyim RIH, et al. The effectiveness of botulinum toxin for temporomandibular disorders: a systematic review and meta-analysis. PLoS One. 2024;19(3):e0300157.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0300157
http://www.ncbi.nlm.nih.gov/pubmed/38483856?tool=bestpractice.com
[77]Thambar S, Kulkarni S, Armstrong S, et al. Botulinum toxin in the management of temporomandibular disorders: a systematic review. Br J Oral Maxillofac Surg. 2020 Jun;58(5):508-19.
http://www.ncbi.nlm.nih.gov/pubmed/32143934?tool=bestpractice.com
[78]Machado D, Martimbianco ALC, Bussadori SK, et al. Botulinum toxin type A for painful temporomandibular disorders: systematic review and meta-analysis. J Pain. 2020 Mar-Apr;21(3-4):281-93.
https://www.jpain.org/article/S1526-5900(19)30793-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/31513934?tool=bestpractice.com
One systematic review and meta-analysis reported slightly better pain management by botulinum toxin compared with placebo at 1 month; no significant difference was seen at 3 or 6 months.[78]Machado D, Martimbianco ALC, Bussadori SK, et al. Botulinum toxin type A for painful temporomandibular disorders: systematic review and meta-analysis. J Pain. 2020 Mar-Apr;21(3-4):281-93.
https://www.jpain.org/article/S1526-5900(19)30793-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/31513934?tool=bestpractice.com
Another systematic review and meta-analysis reported no difference between botulinum toxin and placebo and other treatments with respect to maximum mouth opening, bruxism events, and maximum occlusal force.[76]Saini RS, Ali Abdullah Almoyad M, Binduhayyim RIH, et al. The effectiveness of botulinum toxin for temporomandibular disorders: a systematic review and meta-analysis. PLoS One. 2024;19(3):e0300157.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0300157
http://www.ncbi.nlm.nih.gov/pubmed/38483856?tool=bestpractice.com
More trials are warranted.
Acupuncture
Acupuncture has been found to relieve pain associated with TMD.[79]Fink M, Rosted P, Bernateck M, et al. Acupuncture in the treatment of painful dysfunction of the temporomandibular joint - a review of the literature. Forsch Komplementarmed. 2006;13:109-15.
http://www.ncbi.nlm.nih.gov/pubmed/16645291?tool=bestpractice.com
[80]Cho SH, Whang WW. Acupuncture for temporomandibular disorders: a systematic review. J Orofac Pain. 2010;24:152-62.
http://www.ncbi.nlm.nih.gov/pubmed/20401353?tool=bestpractice.com
[81]Fernandes AC, Duarte Moura DM, Da Silva LGD, et al. Acupuncture in temporomandibular disorder myofascial pain treatment: a systematic review. J Oral Facial Pain Headache. 2017 Summer;31(3):225-32.
https://www.jofph.com/articles/10.11607/ofph.1719
http://www.ncbi.nlm.nih.gov/pubmed/28738107?tool=bestpractice.com
[82]Peixoto KO, da Silva Bezerra A, Melo RA, et al. Short-term effect of scalp acupuncture on pain, sleep disorders, and quality of life in patients with temporomandibular disorders: a randomized clinical trial. Pain Med. 2021 Apr 20;22(4):905-14.
https://academic.oup.com/painmedicine/article/22/4/905/6131794
http://www.ncbi.nlm.nih.gov/pubmed/33561277?tool=bestpractice.com
[83]Şen S, Orhan G, Sertel S, et al. Comparison of acupuncture on specific and non-specific points for the treatment of painful temporomandibular disorders: a randomised controlled trial. J Oral Rehabil. 2020 Jul;47(7):783-95.
https://onlinelibrary.wiley.com/doi/10.1111/joor.12952
http://www.ncbi.nlm.nih.gov/pubmed/32077514?tool=bestpractice.com
[84]Grillo CM, Canales Gde L, Wada RS, et al. Could acupuncture be useful in the treatment of temporomandibular dysfunction? J Acupunct Meridian Stud. 2015 Aug;8(4):192-9.
https://www.sciencedirect.com/science/article/pii/S2005290114002301
http://www.ncbi.nlm.nih.gov/pubmed/26276455?tool=bestpractice.com
This pain relief is usually short term.[82]Peixoto KO, da Silva Bezerra A, Melo RA, et al. Short-term effect of scalp acupuncture on pain, sleep disorders, and quality of life in patients with temporomandibular disorders: a randomized clinical trial. Pain Med. 2021 Apr 20;22(4):905-14.
https://academic.oup.com/painmedicine/article/22/4/905/6131794
http://www.ncbi.nlm.nih.gov/pubmed/33561277?tool=bestpractice.com
[84]Grillo CM, Canales Gde L, Wada RS, et al. Could acupuncture be useful in the treatment of temporomandibular dysfunction? J Acupunct Meridian Stud. 2015 Aug;8(4):192-9.
https://www.sciencedirect.com/science/article/pii/S2005290114002301
http://www.ncbi.nlm.nih.gov/pubmed/26276455?tool=bestpractice.com
[85]La Touche R, Angulo-Diaz-Parreno S, de-la-Hoz JL, et al. Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade. J Altern Complement Med. 2010;16:107-12.
http://www.ncbi.nlm.nih.gov/pubmed/20038262?tool=bestpractice.com
[86]La Touche R, Goddard G, De-la-Hoz JL, et al. Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. Clin J Pain. 2010;26:541-50.
http://www.ncbi.nlm.nih.gov/pubmed/20551730?tool=bestpractice.com
One randomised controlled trial reported reduction in TMD-associated pain upon treatment to both specific and non-specific acupoints.[83]Şen S, Orhan G, Sertel S, et al. Comparison of acupuncture on specific and non-specific points for the treatment of painful temporomandibular disorders: a randomised controlled trial. J Oral Rehabil. 2020 Jul;47(7):783-95.
https://onlinelibrary.wiley.com/doi/10.1111/joor.12952
http://www.ncbi.nlm.nih.gov/pubmed/32077514?tool=bestpractice.com
Acupuncture helps relieve pain by releasing endogenous opioids along with serotonin and noradrenaline in the dorsal horn of the spinal cord.[87]Ernst E, White AR. Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials. Arch Otolaryngol Head Neck Surg. 1999;125:269-72.
http://www.ncbi.nlm.nih.gov/pubmed/10190797?tool=bestpractice.com
Acupuncture treatment can be given weekly for a total of 6 treatments and can be used as an adjunct to more traditional TMD treatment under the guidance of an appropriately trained specialist physiotherapist.[88]Rosted P. Practical recommendations for the use of acupuncture in the treatment of temporomandibular disorders based on the outcome of published controlled studies. Oral Dis. 2001;7:109-15.
http://www.ncbi.nlm.nih.gov/pubmed/11355435?tool=bestpractice.com
Low-level laser therapy
Low-level laser therapy has been used to treat temporomandibular disorders.[89]Melis M, Di Giosia M, Zawawi KH. Low level laser therapy for the treatment of temporomandibular disorders: A systematic review of the literature. Cranio. 2012;30:304-12.
http://www.ncbi.nlm.nih.gov/pubmed/23156972?tool=bestpractice.com
[90]Ahmad SA, Hasan S, Saeed S, et al. Low-level laser therapy in temporomandibular joint disorders: a systematic review. J Med Life. 2021 Mar-Apr;14(2):148-64.
https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/34104237
http://www.ncbi.nlm.nih.gov/pubmed/34104237?tool=bestpractice.com
[91]Ren H, Liu J, Liu Y, et al. Comparative effectiveness of low-level laser therapy with different wavelengths and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular disorders: a systematic review and network meta-analysis. J Oral Rehabil. 2022 Feb;49(2):138-49.
http://www.ncbi.nlm.nih.gov/pubmed/34289157?tool=bestpractice.com
One systematic review concluded that low-level laser therapy effectively reduced pain and is a promising therapy for the management of TMDs.[90]Ahmad SA, Hasan S, Saeed S, et al. Low-level laser therapy in temporomandibular joint disorders: a systematic review. J Med Life. 2021 Mar-Apr;14(2):148-64.
https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/34104237
http://www.ncbi.nlm.nih.gov/pubmed/34104237?tool=bestpractice.com
Another systematic review and network meta-analysis recommended treating TMDs using low-level laser therapy with wavelength ranging from 910 to 1100 nm.[91]Ren H, Liu J, Liu Y, et al. Comparative effectiveness of low-level laser therapy with different wavelengths and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular disorders: a systematic review and network meta-analysis. J Oral Rehabil. 2022 Feb;49(2):138-49.
http://www.ncbi.nlm.nih.gov/pubmed/34289157?tool=bestpractice.com