There is a growing body of evidence that supports the use of BTX A as a treatment modality for various TMD. Several subcategories of TMD including bruxism, clenching, masseteric hypertrophy, recurrent dislocation of the TMJ, oromandibular dystonias, and chronic myogenous orofacial pain have been effectively treated with BTX. However, without FDA approval, using BTX for treatment of TMD (with the exception of oromandibular dystonia) is an off-label application.
BTX has become a treatment modality in many healthcare disciplines. Its effects are reversible, and administration is minimally invasive. Adverse side effects such as dysarthria and dysphagia are observed when overdosing occurs or the injection misses the target muscle and the medication diffuses into adjacent structures. In addition, this treatment can be expensive ($474 for a 100-unit vial; adding a professional fee can bring the cost to more than $1,100 for a therapy that lasts up to 4 months). For off-label application, insurance does not cover BTX injections. Injection of BTX A should be performed by a clinician with knowledge of its pharmacology and the relevant anatomy of the sites receiving the injection. Finally, Allergan offers a comprehensive manufacturer’s package insert, which includes FDA-approved use of the medication as well as contraindications for its use, such as hypersensitivity, pre-existing neuromuscular disorders (eg, muscular dystrophy), and dysphagia. Although there has been no fatal hypersensitivity/allergic reaction to BTX, severe dysphagia, which resulted in aspiration pneumonia and death, has been reported
