BACKGROUND: BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear. OBJECTIVE: this study aimed to compare the immediate effects of Botulinum Toxin Type A (BoNT-A) injections and acupuncture in myofascial temporomandibular disorders (TMD) patients. METHODOLOGY: 54 women were divided into three groups (n = 18). AC patients received four sessions of traditional acupuncture, being one session/week during 20-min. BoNT-A patients were bilaterally injected with 30 U and 10 U in masseter and anterior temporal muscles, respectively. Moreover, a control group received saline solution (SS) in the same muscles. Self-perceived pain was assessed by visual analog scale, while pressure pain threshold (PPT) was verified by a digital algometer. Electromyographic evaluations (EMG) of anterior temporal and masseter muscles were also measured. All variables were assessed before and 1-month after therapies. The mixed-design two-way repeated measures ANOVA and Tukey's post-hoc tests were used for analysis, considering alpha = 0.05. RESULTS: Self-perceived pain decreased in all groups after one month of therapy (p < 0.001). BoNT-A was not better than AC in pain reduction (p = 0.05), but both therapies were more effective in reducing pain than SS (p < 0.05). BoNT-A was the only treatment able to improve PPT values (p < 0.05); however, a severe decrease of EMG activity was also found in this group, which is considered an adverse effect. CONCLUSION: after one month of follow-up, all therapies reduced the self-perceived pain in myofascial TMD patients, but only BoNT-A enhanced PPT yet decreased EMG.

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