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

Background: Temporomandibular disorders (TMD) and bruxism are prevalent conditions managed by dentists. However, treatment choices-especially concerning botulinum toxin (BTX)-often lack consistency. This study aimed to develop and assess a structured clinical decision-making algorithm for BTX use in patients with TMD and bruxism. Methods: A treatment algorithm was designed through a qualitative analysis of the literature and aligned with German S3 guidelines. A total of 227 dentists assessed three clinical case vignettes reflecting routine clinical practice. Each vignette was evaluated first without and subsequently with the algorithm, focusing on typical indications for botulinum toxin treatment. Data were collected via online survey (SurveyMonkey) and analyzed using Microsoft Excel. Participants were stratified by gender and clinical experience (≤5 years vs. >5 years). Results: Of the 227 dentists contacted, 103 responded, and 56 completed the survey (57.1% male; mean age: 34.5 ± 10.6 years). BTX decision accuracy significantly improved for Case 1 (62.5% → 87.5%, p = 0.0013) and Case 2 (14.3% → 87.5%, p < 0.0001), but not for Case 3 (44.6% → 46.4%, p = 1.000). Confidence increased, and uncertainty decreased, particularly among less experienced dentists. The algorithm also significantly influenced both first- and second-line treatment choices, aligning them more closely with guideline-based therapy. Usefulness was confirmed by 78.6% of respondents, with no significant differences based on gender or experience. Conclusions: The proposed algorithm significantly improved diagnostic accuracy, treatment consistency, and confidence in the use of BTX for TMD and bruxism. It facilitates evidence-based, experience-independent decision-making and potentially represents a useful clinical tool in dental practice.