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Related Experiment Video

Updated: Jan 29, 2026

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A Clinical Decision-Making Algorithm for Botulinum Toxin Use in Temporomandibular Disorders and Bruxism.

Anna N Scheiwiler1, Muhammed Ilhan2, Oliver V Waldvogel1,3

  • 1Department of Oral and Cranio-Maxillofacial Surgery, University Hospital Basel, 4031 Basel, Switzerland.

Journal of Clinical Medicine
|January 28, 2026
PubMed
Summary

A new clinical decision-making algorithm improved botulinum toxin (BTX) use for temporomandibular disorders (TMD) and bruxism. Dentists showed increased accuracy and confidence, supporting evidence-based treatment in dental practice.

Keywords:
botulinum toxin (BTX)bruxismclinical decision algorithmdental decision supportmasseter Hypertrophyorofacial paintemporomandibular disorders (TMD)

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Area of Science:

  • Dentistry
  • Neurology
  • Pharmacology

Background:

  • Temporomandibular disorders (TMD) and bruxism are common dental conditions with inconsistent treatment approaches, particularly regarding botulinum toxin (BTX).
  • Lack of standardized protocols for BTX in TMD and bruxism management leads to variability in clinical decision-making among dentists.

Purpose of the Study:

  • To develop and evaluate a structured clinical decision-making algorithm for the application of botulinum toxin (BTX) in patients diagnosed with TMD and bruxism.
  • To assess the algorithm's impact on diagnostic accuracy, treatment consistency, and clinician confidence in managing these conditions.

Main Methods:

  • A treatment algorithm was created based on literature review and German S3 guidelines.
  • 227 dentists evaluated three clinical case vignettes before and after using the algorithm via an online survey.
  • Data analysis compared decision accuracy, confidence levels, and treatment choices based on clinical experience and gender.

Main Results:

  • The algorithm significantly improved BTX decision accuracy in two of three cases (62.5% to 87.5% and 14.3% to 87.5%).
  • Dentist confidence increased, and uncertainty decreased, especially among those with less clinical experience (≤5 years).
  • The algorithm promoted guideline-based treatment choices and was deemed useful by 78.6% of respondents.

Conclusions:

  • The developed algorithm enhances diagnostic accuracy and treatment consistency for botulinum toxin (BTX) in managing TMD and bruxism.
  • It supports evidence-based, experience-independent decision-making, offering a valuable clinical tool for dental practitioners.
  • The algorithm contributes to more standardized and effective patient care for these prevalent oral conditions.