Botulinum toxin in orofacial pain management: INfORM/IADR recommendations

Abstract

Objective To present a list of key points to summarize the standard of care based on the available evidence for the appropriate use of botulinum toxin (BTX) in the management of orofacial pain conditions, including temporomandibular disorders (TMDs), on behalf of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) of the International Association for Dental, Oral and Craniofacial Research (IADR).Methods An open working group discussion was held at the IADR/AADOCR General Session in San Diego (March 2026), where members of the INfORM group debated and finalized a list of key points on the use of BTX in orofacial pain and TMD management during a dedicated Satellite Symposium.Results The key points cover the diagnostic prerequisites, therapeutic rationale, indications and limitations, patient selection, procedural and training requirements, and safety considerations relevant to BTX use. They represent a summary of the current standard of care and emphasize that BTX is an adjunctive, off-label, second-line option that does not replace conservative and supported self-management approaches. While there is a need for further research across most indications, these points serve to assist dental practitioners and orofacial pain clinicians in both understanding the interpreted accepted uses and avoiding inappropriate treatment.Conclusions The key points can be viewed as a guiding template for other national and international associations to prepare guidelines and recommendations on the use of BTX in orofacial pain and TMDs, adapted to the different cultural, social, educational, regulatory, and healthcare requirements around the world.