Clinical Oral Investigations

, Volume 23, Issue 9, pp 3411–3421 | Cite as

Botulinum toxin type A applications for masticatory myofascial pain and trigeminal neuralgia: what is the evidence regarding adverse effects?

  • Giancarlo De la Torre CanalesEmail author
  • Rodrigo Lorenzi Poluha
  • Victor Muñoz Lora
  • Dyna Mara Araújo Oliveira Ferreira
  • Juliana Stuginski-Barbosa
  • Leonardo Rigoldi Bonjardim
  • Altair Antoninha Del Bel Cury
  • Paulo César Rodrigues Conti



The objective of the study was to conduct a systematic review of literature assessing botulinum toxin type A (BoNT-A) safety and adverse effects in the treatment of myofascial pain (MFP) and trigeminal neuralgia (TN).

Materials and methods

The search for articles by two specific researchers involved the PubMed, EMBASE, Web of Science, and Scopus databases. Specific terms were used, and no publication time and language restrictions were applied. Clinical trials that investigated the effects of BoNT-A among participants with myofascial pain in masticatory muscles or trigeminal neuralgia were considered eligible for this systematic review. Data for each study were extracted and analyzed according to a PICO-like structured reading.


The search strategy provided 436 citations. After analysis, 16 citations were included, seven for MFP and nine for TN. In all studies, BoNT-A was well tolerated and improved pain. The most common adverse effects were temporary regional weakness, tenderness over the injection sites, and minor discomfort during chewing. Most studies reported a spontaneous resolution of adverse effect.


It can be concluded that BoNT-A treatment is well tolerated, since minor adverse effects were the most frequently reported; however, it is recommended that future studies aim to assess the safety and possible adverse effects of multiples applications or high doses of this treatment.

Clinical relevance

BoNT-A has been increasingly diffused in dentistry, being used for the management of masticatory myofascial pain and trigeminal neuralgia. Nonetheless, there is no consensus about its efficacy and adverse effects that could occur when this treatment is applied.


Botulinum toxins Adverse effects Muscle weakness Muscle atrophy Bone loss Muscle paralysis 


Funding source

Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP (number 2017/21674-0).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Giancarlo De la Torre Canales
    • 1
    Email author
  • Rodrigo Lorenzi Poluha
    • 1
  • Victor Muñoz Lora
    • 2
  • Dyna Mara Araújo Oliveira Ferreira
    • 1
  • Juliana Stuginski-Barbosa
    • 1
  • Leonardo Rigoldi Bonjardim
    • 1
  • Altair Antoninha Del Bel Cury
    • 2
  • Paulo César Rodrigues Conti
    • 1
  1. 1.Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of DentistryUniversity of Sao PauloBauruBrazil
  2. 2.Department of Prosthodontics, Piracicaba Dental SchoolUniversity of CampinasPiracicabaBrazil

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