A clinical algorithm for painful TMD associated with sleep bruxism: the role of botulinum toxins

Temporomandibular disorders (TMD) and sleep bruxism (SB) are commonly seen in both general and specialty dental practices. The relationship between them is still elusive. Some studies have found an association between TMD and SB, while others failed to confirm this relationship. The complexity extends to management strategies, particularly when patients present with symptoms of painful TMD as well as SB. Several treatments have been proposed for this presentation, including botulinum toxin injections. Despite the presence of evidence, clear guidance on management is lacking.

To review (1) the relationship between painful TMD and SB according to the current literature; (2) the proposed mechanisms of action of botulinum toxins as they relate to TMD and SB; (3) the management strategies of painful TMD associated with SB, highlighting the role of botulinum toxin injections.

The relationship between painful TMD and SB is still poorly understood. Psychological factors may play a role in this relationship. Several treatment modalities can be beneficial for painful TMD associated with SB, including oral appliances, physical therapy, behavioral therapy, and muscle relaxers. Botulinum toxin injections can be used as a last resort for complex and persistent cases.