Abstract
Background: Botulinum Neurotoxin Type A (BoNT-A) has evolved from a niche neurotoxin used in focal dystonias to a multifaceted therapeutic agent across neurology, urology, dermatology, and maxillofacial surgery. Within oral medicine and dentistry, BoNT-A offers significant therapeutic potential for managing temporomandibular disorders (TMDs), severe nocturnal and diurnal bruxism, masseteric hypertrophy, and myofascial pain syndromes. However, the translation of clinical evidence into routine practice remains heterogeneous across geographical regions, influenced by practitioner specialty, educational exposure, regulatory frameworks, and personal therapeutic beliefs.
Objectives: This nationwide observational study investigates the levels of awareness, underlying clinical beliefs, and practical implementation rates of BoNT-A therapies among healthcare and oral medicine specialists across Türkiye. It aims to identify the demographic, institutional, and educational determinants that dictate clinical adoption while characterizing prevailing diagnostic and therapeutic patterns.
Methods: A multi-center, cross-sectional observational survey was conducted across university dental faculties, state research hospitals, and private specialty practices in Türkiye. A total of 612 qualified practitioners—comprising oral and maxillofacial surgeons, oral medicine specialists, prosthodontists, general dental practitioners, neurologists, and dermatologists—completed a validated 42-item questionnaire. The survey evaluated objective knowledge regarding BoNT-A mechanisms and protocols, subjective clinical attitudes, patterns of clinical utilization, self-reported post-graduate training, and perceived institutional or regulatory barriers. Bivariate chi-square tests and multivariate logistic regression models were executed to identify independent predictors of BoNT-A administration and diagnostic accuracy.
Results: Objective knowledge scores regarding BoNT-A pharmacology and localized anatomical injection protocols varied significantly by specialty ($p < 0.001$). Oral and maxillofacial surgeons and neurologists demonstrated the highest overall domain competence (mean score $84.2\%$ and $82.6\%$, respectively), whereas general dental practitioners exhibited sub-optimal knowledge levels ($48.1\%$). Although $78.4\%$ of respondents acknowledged the therapeutic efficacy of BoNT-A in managing refractory TMDs and severe bruxism, only $31.2\%$ routinely administered BoNT-A in their clinical practice. Multivariate logistic regression revealed that completion of hands-on post-graduate training (OR = 6.42, 95% CI: 4.12–10.01, $p < 0.001$) and affiliation with an academic institution (OR = 2.18, 95% CI: 1.45–3.28, $p = 0.002$) were the strongest positive predictors of clinical implementation. Concerns regarding localized adverse events, off-label legal liability, high cost, and lack of standardized clinical guidelines were identified as primary barriers to clinical adoption.
Conclusions: While theoretical awareness and positive beliefs regarding BoNT-A efficacy are widespread among medical and dental professionals in Türkiye, routine clinical implementation remains restricted. Strategic educational initiatives, standardized national guidelines, and structured hands-on clinical workshops are required to bridge the gap between evidence-based recommendations and daily clinical practice.
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