Objective: To demonstrate the advantages of OE, when facing challenges with identifying patterns of OMD for employment of EMG for guided BoNT/A precision management.
Background: OMD causes involuntary muscle contractions in the jaws and oral area, leading to functional impairment, dental attrition, pain, and decreased quality of life. The diverse and complex clinical manifestations challenge both diagnosis and treatment. EMG and OE are valuable tools for diagnosis and precise intervention.
Method: Patients with OMD were assessed in five domains before BoNT/A treatment:
– Clinical examination (temporomandibular joint, masticatory muscles, and dentition)
– Orofacial function (NOT-S, Jaw Disability Scale, Chewing index/efficiency, and Sialometry)
– Muscle Strength (bite force, jaw opening force, hand grip strength)
– Sensibility (oral stereognosis and two-point discrimination)
– Dystonia severity (BFMDRS, EMG, clinical description, Pain Numeric Rating Scale, NRS)
Treatment with needle-EMG-guided BoNT/A was based on the outcome of the five domains. The patients were treated regularly every 3-4 months.
Results: Our cohort from 2015- 2022 included 236 patients, (149 (63.1%) were females), mean age 52.2yr (17.5 SD), range 14-90, see Table 1. Based on the assessments in the five domains, patients were categorized according to the pattern of OMD [n (%)]: Jaw opening 28 (11.9); Jaw closing 54 (22.9); Jaw deviation 7 (3.0); Lingual 6 (2.5); Mixed 114 (48.3); Unknown or uncategorizable, 27 (11.4), see Fig 1. Thus, the majority were categorized as mixed OMD.
Conclusion: The mixed OMD were the most common type of dystonia in the cohort. Whereas opening and closing OMD are relatively easily diagnosed clinically, the diagnosis of mixed OMD is difficult. A multidisciplinary evaluation and EMG-guided interventions allow for a more targeted therapy and precise, individualized evaluation, supporting optimal treatment even in difficult cases.
Table 1
Figure 1 Type of oromandibular dystonia
To cite this abstract in AMA style:
A. Stark, H. Biernat, K. Benedek, P. Mcgettigan, M. Bakke, A. Lokkegaard. Precision Management of Oromandibular Dystonia (OMD): The Role of Neurological examination, Electromyographic (EMG) Guidance, and Odontological evaluation (OE) – A descriptive study with a Multidisciplinary Approach for Botulinum Toxin A (BoNT/A) Treatment [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/precision-management-of-oromandibular-dystonia-omd-the-role-of-neurological-examination-electromyographic-emg-guidance-and-odontological-evaluation-oe-a-descriptive-study-with-a-mul/. Accessed October 5, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/precision-management-of-oromandibular-dystonia-omd-the-role-of-neurological-examination-electromyographic-emg-guidance-and-odontological-evaluation-oe-a-descriptive-study-with-a-mul/