Date of Graduation

Spring 5-1-2011

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Annjanette Sommers MS, PAC

Second Advisor

Torry Cobb, DHSc, MPH, PA-C

Abstract

Background: Temporomandibular joint disorder (TMJD) affects nearly 10 million people in the United States accounting for 17 million lost working days in 2001. Traditional conservative treatment for TMJD has limited benefit, which is why recent trials have studied the effects of botulinum toxin A on TMJD. Using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) the available evidence regarding the efficacy of botulinum toxin A for treating TMJD was evaluated.

Method: An exhaustive search of available medical literature was conducted using Medline, CINAHL, Evidence-Based Medicine Review Multifile and PubMed resulting in five randomized controlled trials limited to the English language, randomized controlled trials, and articles published since 2000 involving human subjects.

Results: This paper reviewed five studies and evaluated the three outcomes of pain resolution, jaw manipulation, and electromyography conduction using GRADE criteria. Three randomized controlled trials demonstrated reduction in electromyographic activity with the use of botulinum toxin A. Two randomized controlled trials concluded that botulinum toxin A can increase jaw manipulation without pain. Four out of five trails demonstrated improvement in TMJD pain with the use of botulinum toxin A.

Conclusion: The final GRADE for this systematic review was determined to be moderate. Although high grade studies need to be conducted, botulinum toxin A appears to be an effective alternative treatment for TMJD.

Keywords: botulinum, botulinum toxin A, joints, pain, facial pain, electromyography, masseter muscle, bruxism, masticatory muscles and orofacial pain.

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