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

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Abstract

Objectives

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.

Results

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.

Conclusions

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.

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Funding source

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

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Authors and Affiliations

  1. Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil

    Giancarlo De la Torre Canales, Rodrigo Lorenzi Poluha, Dyna Mara Araújo Oliveira Ferreira, Juliana Stuginski-Barbosa, Leonardo Rigoldi Bonjardim & Paulo César Rodrigues Conti

  2. Department of Prosthodontics, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil

    Victor Muñoz Lora & Altair Antoninha Del Bel Cury

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  1. Giancarlo De la Torre Canales
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Correspondence to Giancarlo De la Torre Canales.

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Appendix. CASP, Critical Appraisal Skills Programme

Appendix. CASP, Critical Appraisal Skills Programme

To access all 12 items of CASP quality assessment for cohort studies, click the following link:

https://casp-uk.net/wp-content/uploads/2018/03/CASP-Cohort-Study-Checklist-2018_fillable_form.pdf

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De la Torre Canales, G., Poluha, R.L., Lora, V.M. et al. Botulinum toxin type A applications for masticatory myofascial pain and trigeminal neuralgia: what is the evidence regarding adverse effects?. Clin Oral Invest 23, 3411–3421 (2019). https://doi.org/10.1007/s00784-019-03026-4

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