Emerging treatments

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][76]​​​​[77][78]​ 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]​ 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]​ More trials are warranted.

Acupuncture

Acupuncture has been found to relieve pain associated with TMD.​[79][80]​​​​[81][82][83]​​​​[84]​ This pain relief is usually short term.​[82]​​​​[84][85][86]​​​​​​ One randomised controlled trial reported reduction in TMD-associated pain upon treatment to both specific and non-specific acupoints.[83]​ Acupuncture helps relieve pain by releasing endogenous opioids along with serotonin and noradrenaline in the dorsal horn of the spinal cord.[87] 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]

Low-level laser therapy

Low-level laser therapy has been used to treat temporomandibular disorders.[89][90][91]​​​​​​ One systematic review concluded that low-level laser therapy effectively reduced pain and is a promising therapy for the management of TMDs.[90]​ Another systematic review and network meta-analysis recommended treating TMDs using low-level laser therapy with wavelength ranging from 910 to 1100 nm.[91]

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